Spontaneous hypoglycaemia after pancreas transplantation in type 1 diabetes mellitus

Hypoglycaemia is an important complication of insulin treatment in Type 1 d iabetes mellitus (DM). Pancreas transplantation couples glucose sensing and insulin secretion, attaining a distinctive advantage over insulin treatmen t. We tested whether successful transplantation can avoid hypoglycaemia in Type 1 DM. Combined kidney and pancreas transplanted Type 1 DM who complied with good function criteria (KP-Tx, n = 55), and isolated kidney or liver transplanted non-diabetic subjects on the same immunosuppressive regimen (C ON-Tx, n = 14), underwent 1-day metabolic profiles in the first 3 years aft er transplantation, sampling plasma glucose (PC) and pancreatic hormones ev ery 2 hours. KP-Tx had lower PG than CON-Tx in the night and in the morning and higher insulin concentrations throughout the day. KP-Tx had lower PC n adirs than CON-Tx (4.40 +/- 0.05 vs 4.96 +/- 0.16 mmol l(-1), ANOVA p = 0.0 01). Nine per cent of KP-Tx had hypoglycaemic values (PG less than or equal to 3.0 mmol l(-1)) in the profiles, both postprandial and postabsorptive, whereas none of CON-Tx did (p < 0.02). In conclusion, after pancreas transp lantation, mild hypoglycaemia is frequent, although its clinical impact is limited. Compared to insulin treatment in Type 1 DM, pancreas transplantati on improves but cannot eliminate hypoglycaemia. (C) 1998 John Wiley & Sons, Ltd.