Treatment Algorithm helps Successfully Manage Diabetes after Transplant Surgery

Friday, May 15, 2009 8:08 am EDT

Dateline:

HOUSTON
"Prevention strategies must be considered in environments where they are commonly used."

New research highlighting the relationship between steroids and insulin requirements suggests a possible treatment algorithm in post-liver transplant patients. This research was presented today at the American Association of Clinical Endocrinologists (AACE) 18th Annual Meeting & Clinical Congress.

The tentative algorithm was developed as doctors tried to understand the elevation in blood sugar levels in patients that received post-operative steroids due to a liver transplant. The blood sugar rise was attributed to the toxic effects of steroid medications on beta cell function.

Additionally, the relationship between prolonged exposure to steroids, generally six months, revealed a strong relationship with persistent diabetes at a one-year follow-up after transplantation.

“It appears that these steroids can lead to a permanent diabetic state,” Umadevi Muthyala, MD, said. “Prevention strategies must be considered in environments where they are commonly used.”

The research indicated that nearly 33 percent of patients in the study without diabetes at transplant developed diabetes one year after their procedure. The possibility of protecting this group from the toxic effects of the immunosuppressive regimen on the beta cell is an exciting future area of research: “Agents that have shown promise for this are the GLP-1 agonists and DPP4 inhibitors,” Dr. Muthyala said.

Muthyala’s team developed a tentative dosing algorithm to account for the increased insulin need in relation to steroid dosage: Their results showed that below 80 milligrams (mgs) the effect of steroids on insulin requirements was moderate, but above 80-120 mgs the effect showed a substantial increase. For doses above 80 the effect on insulin needs were increased 2 to 5 times.

“Although the data is not definitive, it gives us a handle on proper dosing and can be used to prospectively study other populations,” she said.

For more information about diabetes, download the American College of Endocrinology’s (ACE) “Power of Prevention®” Magazine here. The magazine features medical information on prediabetes, type 1 and type 2 diabetes, diabetes complications, and tips on how diabetes patients can best prepare for disaster.

About AACE

AACE is a professional medical organization with more than 6,200 members in the United States and 92 other countries. Founded in 1991, AACE is dedicated to the optimal care of patients with endocrine problems. AACE initiatives inform the public about endocrine disorders. AACE also conducts continuing education programs for clinical endocrinologists, physicians whose advanced, specialized training enables them to be experts in the care of endocrine disease such as diabetes, thyroid disorders, growth hormone deficiency, osteoporosis, cholesterol disorders, hypertension and obesity.

Contact:

American Association of Clinical Endocrinologists
Greg Willis, 904-353-7878 ext. 147