| Calcineurin inhibitors acutely improve insulin sensitivity without affecting insulin secretion in healthy human volunteers. | |
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MedLine Citation:
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PMID: 21988494 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: New Onset Diabetes After Transplantation is related to treatment with immunosuppressive medica-tions. Clinical studies have shown that risk of new onset diabetes is greater with tacrolimus compared with cyclosporine. The diabetogenicity of cyclosporine and tacrolimus has been attributed to both beta cell dysfunction and impaired insulin sensitivity. WHAT THIS STUDY ADDS: This is the first trial to investigate beta cell function and insulin sensitivity using gold standard methodology in healthy human volunteers treated with clinically relevant doses of cyclosporine and tacrolimus. We document that both drugs acutely increase insulin sensitivity, while first phase and pulsatile insulin secretion remain unaffected. This study demonstrates that cyclosporine and tacrolimus have similar acute effects on glucose metabolism in healthy humans. ABSTRACT: BACKGROUND AND PURPOSE. Introducing the calcineurin inhibitors (CNIs) cyclosporine (CsA) and tacrolimus (Tac) has improved the outcome of organ transplants, but complications such as New Onset Diabetes mellitus After Transplantation (NODAT) cause impairment of survival rates. The relative contribution of each CNI to the pathogenesis and development of NODAT remains unclear. We sought to compare the impact of CsA and Tac on glucose metabolism in human subjects. EXPERIMENTAL APPROACH. Ten healthy men underwent 5-hour infusions of CsA, Tac and saline in a randomized, double-blind, cross-over study. During infusion glucose metabolism was investigated using following methods: A hyperinsulinemic-euglycemic clamp, an intravenous glucose tolerance test (IVGTT), glucose-stimulated insulin concentration time-series and indirect calorimetry. RESULTS. Clamp derived insulin sensitivity was increased by 25 % during CsA (P < 0.0001) and 13 % during Tac administration (P= 0.047), whereas first phase and pulsatile insulin secretion were unaffected. Coinciding with the CNI induced improved insulin sensitivity, glucose oxidation rates increased, while insulin clearance rates decreased, only non-significantly. Tac singularly lowered hsCRP levels, otherwise no changes were observed in circulating glucagon, FFA or adiponectin levels. Mean blood levels of CNIs were 486.9 ± 23.5 μg/l for CsA and 12.8 ± 0.5 μg/l for Tac. CONCLUSIONS. In conclusion acute effects of intravenous CsA and to a lesser degree Tac infusions in healthy volunteers include increased insulin sensitivity, without any effect on first phase or pulsatile insulin secretion. |
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Authors:
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Lara Aygen Ozbay; Niels Møller; Claus Juhl; Mette Bjerre; Jan Carstens; Jørgen Rungby; Kaj Anker Jørgensen |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-10-11 |
Journal Detail:
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Title: British journal of clinical pharmacology Volume: - ISSN: 1365-2125 ISO Abbreviation: - Publication Date: 2011 Oct |
Date Detail:
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Created Date: 2011-10-12 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7503323 Medline TA: Br J Clin Pharmacol Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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© 2011 The Authors. British Journal of Clinical Pharmacology © 2011 The British Pharmacological Society. |
Affiliation:
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Department of Nephrology, Aarhus University Hospital, Skejby, Denmark Department of Endocrinology Aarhus University Hospital, Aarhus Sygehus, Denmark Department of Medicine, Sydvestjysk Sygehus Esbjerg, Denmark. |
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