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Deterioration of glycemic control after corticosteroid administration in islet autotransplant recipients: a cautionary tale.

Abstract：

:Islet autotransplantation (IAT) is performed at the time of total pancreatectomy (TP) to prevent or minimize post-surgical diabetes. Corticosteroids induce insulin resistance and present a risk to islet autografts, through glucotoxicity and increased metabolic demand on a marginal islet mass. We present four IAT recipients treated with oral or injected corticosteroids after transplant for medical conditions unrelated to chronic pancreatitis or TPIAT. Hyperglycemia or insulin resistance was evident in all four patients, including reversion to long-term insulin therapy in two patients. One patient receiving corticosteroid injections had a transient increase in hemoglobin A1c (+0.6% above baseline), and one patient given a one time dose of oral dexamethasone exhibited hyperglycemia despite high insulin (>200 mU/L) and C-peptide (15.3 ng/mL) production on an oral glucose tolerance test. IAT recipients have insufficient islet mass to compensate for the insulin resistance induced by corticosteroids. Caution should be given to using these agents in IAT recipients. When corticosteroids are medically necessary, insulin therapy should be administered temporarily to compensate for the increased metabolic demand and minimize long-term risks on the islet graft.

journal_name

Acta Diabetol

journal_title

Acta diabetologica

authors

Ngo A,Sutherland DE,Beilman GJ,Bellin MD

doi

10.1007/s00592-011-0315-8

subject

Has Abstract

pub_date

2014-02-01 00:00:00

pages

141-5

issue

1

eissn

0940-5429

issn

1432-5233

journal_volume

51

pub_type

杂志文章

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