Pancreas Transplantation Improves Vascular Disease in Patients With Type 1 Diabetes
Pancreas Transplantation Improves Vascular Disease in Patients With Type 1 Diabetes Jennifer L. Larsen , MD 1 , Christopher W. Colling , BS 1 , Tanaporn Ratanasuwan , MD 2 , Tab W. Burkman , BS 1 , Thomas G. Lynch , MD 3 , Judi M. Erickson , RN, CDE 1 , Elizabeth R. Lyden , MS 4 , James T. Lane , MD...
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| Published in: | Diabetes care Vol. 27; no. 7; pp. 1706 - 1711 |
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| Main Authors: | , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
Alexandria, VA
American Diabetes Association
01-07-2004
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| Subjects: | |
| Online Access: | Get full text |
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| Summary: | Pancreas Transplantation Improves Vascular Disease in Patients With Type 1 Diabetes
Jennifer L. Larsen , MD 1 ,
Christopher W. Colling , BS 1 ,
Tanaporn Ratanasuwan , MD 2 ,
Tab W. Burkman , BS 1 ,
Thomas G. Lynch , MD 3 ,
Judi M. Erickson , RN, CDE 1 ,
Elizabeth R. Lyden , MS 4 ,
James T. Lane , MD 1 and
Lynn R. Mack-Shipman , MD 1
1 Department of Internal Medicine, University of Nebraska Medical Center and Nebraska Health System, Omaha, Nebraska
2 Lerdsin Hospital, Ministry of Public Health, Bangkok, Thailand
3 Department of Surgery, University of Nebraska Medical Center and Nebraska Health System, Omaha, Nebraska
4 Department of Preventive and Societal Medicine, University of Nebraska Medical Center and Nebraska Health System, Omaha, Nebraska
Address correspondence and reprint requests to Jennifer Larsen, MD, Department of Internal Medicine, 983020 Nebraska Medical
Center, Omaha, NE 68198-3020. E-mail: jlarsen{at}unmc.edu
Abstract
OBJECTIVE —Pancreas transplantation (PTX) normalizes glucose and improves microvascular complications, but its impact on macrovascular
disease is still debated.
RESEARCH DESIGN AND METHODS —Carotid intima-media thickness (IMT), shown to correlate with cardiovascular disease (CVD) risk and events, was determined
prospectively by ultrasonography in successful pancreas transplant recipients to evaluate the effect of PTX on CVD risk. Carotid
IMT and CVD risk factors of pancreas transplant recipients ( n = 25) were compared with three groups: individuals with type 1 diabetes without significant nephropathy ( n = 20), nondiabetic kidney transplant recipients ( n = 16), and normal control subjects ( n = 32). Mean age of pancreas transplant recipients at the time of transplantation was 42.4 ± 1.2 years (mean ± SE) and duration
of diabetes was 25.9 ± 1.4 years.
RESULTS —After PTX, HbA 1c level ( P < 0.0001) decreased to normal and, whereas creatinine level ( P = 0.0002) decreased, it remained elevated compared with normal control subjects ( P < 0.05). Blood pressure, BMI, fasting lipid levels, smoking frequency, and use of hypolipidemic agents were unchanged. Mean
carotid IMT was increased in pancreas transplant candidates but decreased by 1.8 ± 0.1 year after PTX ( P = 0.0068), no longer different from that in normal control subjects or patients with type 1 diabetes.
CONCLUSIONS —Carotid IMT improves after successful PTX within 2 years of the procedure, with normalization of HbA 1c and improved renal function, independent of changes in lipid levels, BMI, blood pressure, smoking, or use of hypolipidemic
agents. This study suggests that CVD risk, future events, and mortality should improve after PTX in the absence of other significant,
untreated CVD risk factors.
CVD, cardiovascular disease
IMT, intima-media thickness
PTX, pancreas transplantation
Footnotes
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
Accepted April 1, 2004.
Received August 7, 2003.
DIABETES CARE |
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| Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
| ISSN: | 0149-5992 1935-5548 |
| DOI: | 10.2337/diacare.27.7.1706 |