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Fasting and postprandial liver glycogen content in patients with type 1 diabetes mellitus after successful pancreas–kidney transplantation with systemic venous insulin delivery

Authors

  • M. Stadler,

    1. 3rd Medical Department of Metabolic Diseases and Nephrology, Hietzing Hospital, Vienna, Austria
    2. Karl Landsteiner Institute of Metabolic Diseases and Nephrology, Vienna, Austria
    3. Department of Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK
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  • M. Krššák,

    1. Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria
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  • D. Jankovic,

    1. Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria
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  • C. Göbl,

    1. Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria
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  • Y. Winhofer,

    1. Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria
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  • G. Pacini,

    1. Metabolic Unit, Institute of Biomedical Engineering, National Research Council (ISIB-CNR), Padova, Italy
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  • M. Bischof,

    1. Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria
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  • M. Haidinger,

    1. Division of Nephrology, Department of Internal Medicine III, Medical University Vienna
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  • M. Saemann,

    1. Division of Nephrology, Department of Internal Medicine III, Medical University Vienna
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  • F. Mühlbacher,

    1. Department of Surgery, Medical University Vienna, Vienna, Austria
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  • M. Korbonits,

    1. Department of Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK
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  • S. M. Baumgartner-Parzer,

    1. Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria
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  • A. Luger,

    1. Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria
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  • R. Prager,

    1. 3rd Medical Department of Metabolic Diseases and Nephrology, Hietzing Hospital, Vienna, Austria
    2. Karl Landsteiner Institute of Metabolic Diseases and Nephrology, Vienna, Austria
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  • C.-H. Anderwald,

    Corresponding author
    1. Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria
    2. Metabolic Unit, Institute of Biomedical Engineering, National Research Council (ISIB-CNR), Padova, Italy
    3. Medical Direction, Specialized Hospital Complex Agathenhof, Micheldorf
    • Correspondence: Christian-Heinz Anderwald, Associate Professor of Internal Medicine, Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria. Tel.: +43 1 40400 7249; Fax: +43 1 40400 7790; Email: christian-heinz.anderwald@meduniwien.ac.at

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  • M. Krebs

    1. Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria
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Abstract

Background

In patients with type 1 diabetes mellitus (T1DM), insulin is usually replaced systemically (subcutaneously) and not via the physiological portal route. According to previous studies, the liver's capacity to store glycogen is reduced in T1DM patients, but it remains unclear whether this is due to hyperglycaemia, or whether the route of insulin supply could contribute to this phenomenon. T1DM patients after successful pancreas–kidney transplantation with systemic venous drainage (T1DM-PKT) represent a suitable human model to further investigate this question, because they are normoglycaemic, but their liver receives insulin from the pancreas transplant via the systemic route.

Materials and methods

In nine T1DM-PKT, nine controls without diabetes (CON) and seven patients with T1DM (T1DM), liver glycogen content was measured at fasting and after two standardized meals employing 13C-nuclear-magnetic-resonance-spectroscopy. Circulating glucose and glucoregulatory hormones were measured repeatedly throughout the study day.

Results

The mean and fasting concentrations of peripheral plasma glucose, insulin, glucagon and C-peptide were comparable between T1DM-PKT and CON, whereas T1DM were hyperglycaemic and hyperinsulinaemic (P < 0·05 vs T1DM-PKT and CON). Total liver glycogen content at fasting and after breakfast did not differ in the three groups. After lunch, T1DM-PKT and T1DM had a 14% and 21% lower total liver glycogen content than CON (P < 0·02).

Conclusion

In spite of normalized glycaemic control, postprandial liver glycogen content was reduced in T1DM-PKT with systemic venous drainage. Thus, not even optimized systemic insulin substitution is able to resolve the defect in postprandial liver glycogen storage seen in T1DM patients.

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