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INTRODUCTION: Post-transplant diabetes mellitus and impaired glucose tolerance are confirmed complications after solid organ transplantation associated with the use of glucocorticoids and calcinuerin inhibitors in maintenance immunosuppression. Insulin resistance (IR) is also an independent factor for cardiovascular morbidity and mortality among renal allograft patients. The aim of our work was to investigate the clinical importance of elevated IR in renal transplant recipients on standard triple-drug immunosuppression in correlation with immunosuppressive therapy and certain independent factors such as body mass index (BMI), time after transplantation, lipid disorders, etc. METHODS: 36 allograft pts with different periods after transplantation without previous glucose disorders were included in the study. An oral glucose tolerance test (OGTT) was made to distinguish pts with or without glucose disorders. The basal values of glucose (G) and insulin (I) were used to calculate indexes of IR and beta-cell function according to the homeostasis equations. Impaired fasting glucose (IFG), impairred glucose tolerance (IGT), impaired post prandial hyperglycemia (IPPH) and diabetes mellitus (DM) were also analysed. RESULTS: The mean value of the IR index was 2.57 +/- 1.20. It was elevated in 31 pts (86%) The IR showed a positive correlation with: I0 (p < 0.01), I2 (p < 0.05), beta cell function (p < 0.05) and CsA (p < 0.01). The fasting I, G, and BMI were shown as independent risk factors for IR (p < 0.01, p < 0.01, and p < 0.05 respectively). There were 12 pts with different glucose disorders (IFG, IGT, DM) and 24 pts without. The pts with glucose disorders showed an elevated IR index (91%) more frequently compared with (41.67%) decreased beta-cell function. CONCLUSION: IR is frequent among renal recipients with and without glucose disorders. IR is an independent risk factor for atherogenesis. Higher CsA trough levels are assotiated with higher Insulin values and indexes of IR. The defect in insulin action is more a prominent mechanism in post-transplant glucose disorders than the impaired insulin secretion.
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Inmunosupresores/uso terapéutico , Resistencia a la Insulina , Trasplante de Riñón , Adolescente , Adulto , Ciclosporina/administración & dosificación , Ciclosporina/efectos adversos , Femenino , Glucocorticoides/administración & dosificación , Glucocorticoides/efectos adversos , Humanos , Inmunosupresores/efectos adversos , Masculino , Persona de Mediana Edad , Ácido Micofenólico/administración & dosificación , Ácido Micofenólico/efectos adversos , Ácido Micofenólico/análogos & derivados , Adulto JovenRESUMEN
AIM: to evaluate the combination of insulin pump therapy and continuous glucose monitoring in outcome on metabolic control in patients with brittle type 1 diabetes. MATERIALS AND METHODS: Insulin pump therapy was initiated in eleven brittle type 1 diabetics with poor metabolic control (mean Hba1c = 9.6%). Metabolic control was evaluated with CGMS and HbA1c in the following 6 months. RESULTS: Glycated haemoglobin showed a reduction in 1.4% in the 6 months following initialisation of pump therapy. Physical activity, various foods and insulin were tested with CGMS. There were no severe hypoglycaemia and occasional postprandial hyperglycaemia, where patients and their family learned the practical issues of carbohydrate counting. During the next 6 months on pump therapy, the patients successfully managed their diabetes. CONCLUSIONS: Insulin pump therapy can be initiated and used effectively in brittle type 1 diabetics to improve metabolic control and quality-of-life. When diabetes and pump management are appropriately individualized, this kind of therapy can help type 1 diabetics to achieve and to sustain metabolic control. Lifestyle flexibility, quality-of-life improvement, and independence can be maintained throughout young adulthood.
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Glucemia/análisis , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Sistemas de Infusión de Insulina , Adolescente , Diabetes Mellitus Tipo 1/sangre , Femenino , Hemoglobina Glucada/análisis , Humanos , MasculinoRESUMEN
AIM: To evaluate hypertension in patients with Diabetes Mellitus (DM) and its correlation with age, duration of DM, Body Mass Index (BMI) and HbA1C). MATERIALS AND METHODS: A retrospective study was made on 1211 patients with DM (male 554 and female 657), hospitalized at Clinic of Endocrinology between January 2001 and December 2002. Patients were divided in two groups: Control group (CG)-subdivided into 3 groups patients with DM type 1 (CG-1), DM type 2 on oral anti-hyper-glycemic agents (CG-2)and DM type 2 on insulin therapy (CG-3) and Examined Group (EG), the same groups for diabetes, including hypertension. RESULTS: We found hypertension in 12.6% patients with DM type 1, 30.5% in DM type 2 on oral anti-hyper-glycemic agents and 33.4% in DM type 2 on insulin therapy. CONCLUSION: Hypertension is mostly presented in DM type 2 patients (33,4%), instead of 12.6% in DM type 1. There is statistical significance (p<0.05) between duration of DM in patients with and without hypertension.