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Sequential Metabolic Studies of Pancreas Allograft Function in Type 1 Diabetic Recipients

We have previously shown that the loss of acute first phase insulin secretion precedes pancreas allograft rejection and development of glucose intolerance in Type 1 diabetic patients. In order to examine whether there is a progressive loss of phases of insulin secretion and beta‐cell function in technically successful pancreas transplants during the first year, we measured glucose, insulin, and C‐peptide responses to physiological (mixed meal) and pharmacological (IV glucose and IV glucagon) stimulation in 27 glucose‐tolerant, insulin‐independent allograft recipients at 3, 6, and 12 months. Mean ± SE fasting serum glucose levels were normalized throughout the study period. Postprandial serum glucose profiles tended to increase by 12 months compared to 3 and 6 months, although peak glucose levels were not statistically different. Following pancreas transplantation, basal serum insulin levels were high at 3 months (163 ± 17 pM), 6 months (165 ± 22 pM), and 12 months (248 ± 54 pM, p = NS) in the Type 1 diabetic pancreas allograft recipients when compared to normal (25 ± 3 pM). We observed slight elevations in postprandial insulin and C‐peptide profiles at 12 months compared to 3 and 6 months. Following IV glucose and glucagon stimulation, serum insulin and C‐peptide levels as well as phases of insulin release did not differ over the 12‐month study period. Similarly, the glucose decay constant (KG) was nearly identical at 3, 6, and 12 months.