Endothelial Dysfunction Clinical Trial
Official title:
Assessment of Cardiovascular Risk Factors, Including Endothelial Function, After Restoration of Normoglycemia Following Single Pancreas Transplantation
Patients accepted for the waiting list for single pancreas transplantation suffer from
severe glucose instability with hyperglycemia due to diabetes type 1, but do not have
significant diabetes-related complications. Pancreas transplantation restores normoglycemia
in diabetes type 1 patients with unstable control of glycemia. Both hypo- and hyperglycemic
events are abolished, and 70-80 % of the patients obtain satisfactory HbA1c levels (HbA1c
5.0-6.0 %) without the need of exogenous insulin. Endothelial dysfunction is considered as
an early and potentially reversible stage in the atherosclerotic process. The endothelium is
involved in homeostasis, leucocyte adhesion and vasomotor activity. Reduced
endothelium-dependent vasodilation is associated with increments in cardiovascular risk
factors, and endothelial dysfunction is a predictor for future cardiovascular disease. It
has also been hypothesized that endothelial dysfunction may be involved in the impaired
glycemic control by reducing the availability of glucose in peripheral muscles.Establishing
normoglycemia by pancreas transplantation alone in previously diabetic type 1 patients has
recently been shown to improve left ventricular ejection fraction, assessed by Doppler
echocardiographic examination. In diabetic patients receiving a new pancreas it is possible
to assess the effect of changing blood glucose excursions on cardiovascular risk factors,
including endothelial function, without the use of antidiabetic drugs (exclude pleiotropic
effects).
The primary objective of the present study is to assess if endothelial function (assessed by
flow-mediated dilatation of arteria brachialis) is improved when hyperglycemia is reversed
by single pancreas transplantation in patients with type 1 diabetes.
Secondary objectives are to investigate the changes in the following parameters by reversal
of hyperglycemia by pancreas transplantation; Peripheral arterial tonometry, serum/plasma
concentrations of endothelial dysfunction markers, blood pressure, lipid and lipoprotein
concentrations.
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