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  • Electronic Resource  (2)
  • Diabetes mellitus Epidemiology  (1)
  • Pancreas transplant  (1)
  • 1
    Electronic Resource
    Electronic Resource
    Recent experience with 89 pancreas transplants at a single institution (1984)
    Springer
    Diabetologia 27 (1984), S. 149-153 
    Details
    ISSN: 1432-0428
    Keywords: Pancreas transplant ; cyclosporin ; azathioprine ; HLA-identical siblings ; glucose metabolism
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Of 89 pancreas transplants performed in 77 diabetic patients (43 with and 34 without previous kidney transplants), 53 were from cadaver and 36 from related donors. To date, 64 patients (83%) are alive and 27 (35%) have functioning grafts (14 〉 1 year), including 0 out of 3 duct-ligated, 3 out of 15 open-duct, 17 out of 32 enteric-drained, and 7 out of 39 duct-injected. Of technically successful allografts, 8 out of 16 (50%) in the azathioprine- and 17 out of 47 (36%) in the cyclosporin-treated recipients are functioning (eight cyclosporin patients also take azathioprine). Seven of the nine (78%) non-kidney-transplant recipients of technically successful pancreas allografts from HLA-identical siblings have functioning grafts. Causes of graft failure include allograft rejection, fibrosis secondary to duct injection, or selective β-cell destruction independent of rejection. Of the 24 recipients who are currently insulin-independent, 14 have normal or near-normal glucose tolerance test results, while 10 have abnormal results, even though they are otherwise euglycaemic. The patient population to whom pancreas transplantation is applied is gradually changing, and non-uraemic, non-kidney-transplant patients currently comprise the majority of our cases (17 out of 24 in 1983; nine of the 17 currently have functioning grafts). We now prefer the enteric drainage technique. Except for recipients of related grafts from a previous kidney donor, in which case it is necessary only to continue the current immunosuppressive regimen, we now administer cyclosporin and prednisone for immunosuppression in recipients of HLA-identical sibling grafts, and cyclosporin, azathioprine and prednisone (triple therapy) for recipients of HLA-mismatched grafts. The most interesting features in this series of cases are the variable patterns of glucose metabolism post-transplant, the finding that processes other than graft rejection, may lead to loss of β-cell function, preliminary observations on changes in morphology of kidneys following restoration of normoglycaemia, and the evolution of an immunosuppressive regimen that appears to prevent allograft rejection in non-uraemic, non-kidney-transplant patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00275675
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    A reassessment of fasting plasma glucose concentrations in population screening for diabetes mellitus in a community of northern European ancestry: the Wadena City Health Study (1994)
    Springer
    Acta diabetologica 31 (1994), S. 187-192 
    Details
    ISSN: 1432-5233
    Keywords: Fasting plasma glucose ; Diabetes mellitus Epidemiology
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In current clinical and research practice, the determination of diabetic status depends largely on plasma glucose levels 2 h after the ingestion of a standard 75-g glucose load, the oral glucose tolerance test (OGTT). The OGTT, however, remains inconvenient, not highly reproducible, and costly, especially for large-scale studies and population screening tests. Fasting plasma glucose (FPG) determinations are convenient, reliable, and valid measures of glucose intolerance, but the currently prescribed cut-off point of 140 mg/dl (7.8 mM) lacks sensitivity. We evaluated the reliability and validity of fasting plasma glucose (FPG) values compared with other measures of hyperglycemia for a diagnosis of diabetes in a populationbased study of carbohydrate metabolism in Wadena, Minnesota, a community of predominantly northern European ancestry. As a part of this effort, a random sample of Wadena adults, stratified by age and gender, plus all known, previously diagnosed diabetics participated in 2 days of baseline testing and were followed prospectively and retested 5 years later. Cross-sectional analyses of baseline data are presented in this article. Diabetic status was ascertained by administering a standard OGTT according to National Diabetes Data Group (NDDG) specifications. Sensitivity and specificity levels obtained when using a FPG cut-off point of 6.4 mM were 95.2% and 97.4%, respectively. In study subjects with no known diagnosis of diabetes, the FPG cut-off point of 6.4 mM performed reasonably well with a sensitivity and specificity of 67.7% and 97.4%, respectively. A receiver operating characteristic (ROC) curve analysis showed that FPG consistently performed better than glycosylated hemoglobin in distinguishing diabetic from non-diabetic subjects. FPG concentrations accurately and reliably discriminate diabetic from non-diabetic individuals in a population-based study of Caucasians of northern European ancestry.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00571949
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    Paper (German National Licenses)
    Fulltext
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