Skip to main content
SpringerLink
Log in

A study on glucose metabolism in a small cohort of children and adolescents with kidney transplant

  • Original Articles
  • Published:
Journal of Endocrinological Investigation Aims and scope Submit manuscript

Abstract

Post-transplant diabetes mellitus (PTDM) and impaired glucose tolerance are now considered among the major adverse events following organ transplantation. The present study was aimed at investigating the regulation of glucose metabolism in pediatric recipients of a kidney transplant (KT), receiving tacrolimus or cyclosporine A-based immunosuppression. Twelve subjects, eight males and four females, aged 12.1±3.8 yr, and with a mean time from KT of 45.6 months were enrolled in the study. All patients had a basal evaluation of fasting glucose (GF), fasting insulin (IF), C-peptide and glycated hemoglobin (HbA1c) levels. They then underwent oral glucose tolerance test (OGTT), with measurement of blood glucose and insulin concentration. Two children had impaired GF, associated with supernormal HbA1c levels, one patient showed impaired glucose tolerance, none had PTDM. Peripheral insulin resistance, as measured by quantitative insulin sensitivity check index (QUICKI) and homeostasis model assessment estimate of insulin sensitivity (HOMA-IR) index, was enhanced in 3 patients. Subsequently, GF significantly increased with time from transplant (p=0.01), while fasting C-peptide and the area under the curve of insulin correlated with creatinine clearance. In conclusion, our results, although generated in a small sample size, would suggest that long-term follow-up of children receiving a KT should extend to explore the response to oral glucose load and at least the basal measure of insulin response.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Viberti G. Diabetes mellitus: a major challenge in transplantation. Transplant Proc 2001, 33 (Suppl 5): 3–7S.

    Article  Google Scholar 

  2. Vasco L, Busson M, Bedrossian J, Bitker MO, Hiesse C, Lang P. Diabetes mellitus after renal transplantation: characteristic, outcome and risk factors. Transplantation 1996, 61: 1475–8.

    Article  Google Scholar 

  3. Revanur VK, Jardine AG, Kingsmore DB, Jaques BC, Hamilton DH, Jindal RM. Influence of diabetes mellitus on patient and graft survival in recipients of kidney transplantation. Clin Transplant 2001, 15: 89–94.

    Article  PubMed  CAS  Google Scholar 

  4. Chilcott JB, Whitby SM, Moore R. Clinical Impact and health economic conseguences of posttransplant Type 2 diabetes mellitus transplantation. Proceedings 2001, 33 (Suppl 5): 32–9S.

    Google Scholar 

  5. Hjelmesæth J, Hartmann A, Kofstad J, Stenstrom J, Leivstad J, Fauchald P. Glucose intolerance after renal transplantation depends upon prednisone dose and recipient age. Transplantation 1997, 64: 979–83.

    Article  PubMed  Google Scholar 

  6. Hjelmesæth J, Hartmann A, Kofstad J, Egeland T, Stenstrom, Fauchald P. Tapering off prednisone and cyclosporin the first year after renal transplantation: the effect on glucose tolerance. Nephrol Dial Transplant 2001, 16: 829–35.

    Article  PubMed  Google Scholar 

  7. Reisaeter AV, Hartmann A. Risk factors and incidence of posttransplant diabetes mellitus. Transplantation Proceedings 2001, 33 (Suppl. 5): 8S–18S.

    Article  PubMed  CAS  Google Scholar 

  8. Davidson J, Wilkinson A, Dantal J, et al. Diabetes after transplantation: 2003 International Consensus Guidelines. Transplantation 2003, 75: SS3–24.

    Article  PubMed  Google Scholar 

  9. Montori VM, Basu A, Erwin PJ, Velosa JA, Gabriel SE, Kudva YC. Posttransplantation diabetes: a systematic review of the literature. Diabetes Care 2003, 25: 583–92.

    Article  Google Scholar 

  10. Paolillo JA, Boyle GJ, Law YM. Posttransplant diabetes mellitus in pediatric thoracic organ recipients receiving tacrolimus based immunosuppression. Transplantation 2001, 71: 252–6.

    Article  PubMed  CAS  Google Scholar 

  11. Al-Uzri A, Stablein DM, A Cohn. Posttransplant diabetes mellitus in pediatric renal transplant recipients: a report of the North American Pediatric Renal Transplant Cooperative Study. Transplantation 2001, 72: 1020–4.

    Article  PubMed  CAS  Google Scholar 

  12. Greenspan LC, Gitelman SE, Leung MA, Glidden DV, Mathias RS. Increased incidence in post-transplant diabetes mellitus in children: a case control analysis. Pediatr Nephrol 2003, 17: 1–5.

    Article  Google Scholar 

  13. Trompeter R, Filler G, Webb NJ, et al. Randomized trial of tacrolimus versus cyclosporin microemulsion in renal transplantation. Pediatr Nephrol 2003, 17: 141–9.

    Article  Google Scholar 

  14. Reaven GM, Lithell H, Landsberg L. Hypertension and associated metabolic abnormalities: the role of insulin resistance and the sympathoadrenal system. N Engl J Med 1996, 334: 374–81.

    Article  PubMed  CAS  Google Scholar 

  15. Nijpels G. Determinant for the progression from impaired glucose tolerance to non insulin-dependetn diabetes mellitus. Eur J Clin Invest 1998, 28 (Suppl 2): 8–13.

    Article  PubMed  Google Scholar 

  16. Kahn SE. The relative contributions of insulin resistance and beta-cell dysfunction to the pathophysiology of Type 2 diabetes. Diabetologia 2003, 46: 3–19.

    Article  PubMed  CAS  Google Scholar 

  17. Hanefeld M, Koehler C, Henkel E, et al. Post-challenge hyperglycaemia relates more strongly than fasting hyperglycaemia with carotid intimamedia thickness: the RIAD Study. Risk factors in impaired glucose tolerance for atherosclerosis and diabetes. Diabet Med 2000, 17: 835–40.

    Article  PubMed  CAS  Google Scholar 

  18. Larsson H, Berglund G, Lindgarde F, Ahren B. Comparison of ADA and WHO criteria for diagnosis of diabetes and glucose intolerance. Diabetologia 1998, 41: 1124–5.

    Article  PubMed  CAS  Google Scholar 

  19. de Vegt F, Dekker JM, Stehouwer CD, Nijpels G, Bouter LM, Heine RJ. The 1997 American Diabetes Association criteria versus the 1985 Wordl Health Organization criteria for the 14 diagnosis of abnormal glucose tolerance: poor agreement in the Hoorn Study. Diabetes Care 1998, 21: 1686–90.

    Article  PubMed  Google Scholar 

  20. Cacciari E, Milani S, Balsamo A, et al. Italian cross sectional growth charts for height, weight and BMI. Eur J Clin Nutr 2002, 56: 171–80.

    Article  PubMed  CAS  Google Scholar 

  21. Katz A, Nambi SS, Mather K, et al. Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans. J Clin Endocrinol Metab 2000, 85: 2402–10.

    Article  PubMed  CAS  Google Scholar 

  22. Matthews DR, Hosker JP, Rudenski AS, etal. Homeostasis model assessment: insulin resistance and β-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985, 28: 412–9.

    Article  PubMed  CAS  Google Scholar 

  23. Gungor N, Saad R, Janosky J, Arslanian S. Validation of surrogate estimates of insulin sensitivity and insulin secretion in children and adolescents. J Pediatr 2004, 144, 1: 47–55.

    Article  PubMed  CAS  Google Scholar 

  24. American Diabetes Association. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 2003, 26 (Suppl 1): S5–20.

    Google Scholar 

  25. Stumvoll M, Mitrakou A, Pimenta W, et al. Use of the oral glucose tolerance test to assess insulin release and insulin sensitivity. Diabetes Care 2000, 23: 295–301.

    Article  PubMed  CAS  Google Scholar 

  26. The Expert Committee on the diagnosis and classification of diabetes mellitus. Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care 2003, 26: 3160–7.

    Article  Google Scholar 

  27. Montori VM, Basu A, Erwin PJ, Velosa JA, Gabriel SE, Kudva YC. Posttransplantation diabetes. A systematic review of the literature. Diabetes Care 2002, 25: 583–92.

    Article  PubMed  Google Scholar 

  28. Cotellessa M, Pastorino N, Cresta L, et al. Diabetes mellitus after kidney transplantation in pediatric recipients. Pediatr Nephrol 2003, 18: 1315–6.

    Article  PubMed  Google Scholar 

  29. Carnevale Schianca GP, Rossi A, Sainaghi PP, Maduli E, Bartoli E. The significance of impaired fasting glucose versus impaired 15 glucose tolerance: importance of insulin secretion and resistance. Diabetes Care 2003, 26: 1333–7.

    Article  PubMed  Google Scholar 

  30. Weiss R, Dziura J, Burgert TS, et al. Obesity and the metabolic syndrome in children and adolescents. Obstet Gynecol Surv 2004, 59: 822–4.

    Article  Google Scholar 

  31. Reaven PD, Traustadottir T, Brennan J, Nader PR. Cardiovascular risk factors associated with insulin resistance in children persist into late adolescence. Diabetes Care 2005, 28: 148–50.

    Article  PubMed  Google Scholar 

  32. Aldamiz-Echevarria L, Sanjurjo P, Vallo A, et al. Genetic and metabolic determinants of increased plasma plasminogen activator inhibitor-1 activity in children with renal transplants. Pediatr Nephrol 2003, 18: 749–55.

    Article  PubMed  Google Scholar 

  33. Taskinen M, Saarinen-Pihkala UM, Hovi L, Lipsanen-Nyman M. Impaired glucose tolerance and dyslipidaemia as late effects after bone-marrow transplantation in childhood. Lancet 2000, 356: 993–7.

    Article  PubMed  CAS  Google Scholar 

  34. Cosio FG, Pesavento TE, Osei K, Henry ML, Ferguson RM. Posttransplant diabetes mellitus: increasing incidence in renal allograft recipients transplanted in recent years. Kidney Int 2001, 59: 732–7.

    Article  PubMed  CAS  Google Scholar 

  35. Henriksen JH, Tronier B, Bulow JB. Kinetics of circulating endogenous insulin, C-peptide, and proinsulin in fasting nondiabetic man. Metabolism 1987, 36: 463–8.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. UO Nefrologia e Dialisi Pediatrica, Ospedale Pediatrico Giovanni XXIII, Via Amendola 207, 70126, Bari, Italy

    M. Giordano MD, V. Colella, T. Depalo & D. A. Caringella

  2. Pediatric Endocrinologic and diabetologic Unit, Children’s Hospital Giovanni XXIII, Italy

    A. Dammacco & C. Torelli

  3. Division of Nephrology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy

    G. Grandaliano, A. Teutonico & S. Di Paolo

Authors
  1. M. Giordano MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. V. Colella
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Dammacco
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. Torelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. Grandaliano
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A. Teutonico
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. T. Depalo
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. D. A. Caringella
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. S. Di Paolo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Giordano MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Giordano, M., Colella, V., Dammacco, A. et al. A study on glucose metabolism in a small cohort of children and adolescents with kidney transplant. J Endocrinol Invest 29, 330–336 (2006). https://doi.org/10.1007/BF03344104

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03344104

Key Words

Search

Navigation