Alpha 2.0
Login Register
» Articles » PMID: 18697903

Restoration of Hypoglycemia Awareness After Islet Transplantation

Overview
Journal Diabetes Care
Specialty Endocrinology
Date 2008 Aug 14
PMID 18697903
Citations 28
Authors
Cristiane B Leitao
Thipaporn Tharavanij
Pablo Cure
Antonello Pileggi
David A Baidal
Camillo Ricordi
Rodolfo Alejandro
Affiliations
Soon will be listed here.
Abstract

Objective: To determine the impact of islet transplantation (ITx) on hypoglycemia awareness in patients with unstable type 1 diabetes and its relation to islet function.

Research Design And Methods: A total of 31 ITx recipients were studied. Hypoglycemia unawareness was assessed using the Clarke hypoglycemic score (0 = no hypoglycemia; >or=4 = hypoglycemia unawareness). Subjects were grouped based on graft function: off-insulin (n = 8), graft dysfunction (on-insulin and stimulated C-peptide >or=0.3 ng/ml, n = 13), and graft failure (stimulated C-peptide <0.3 ng/ml, n = 10, evaluated 11.5 +/- 14.5 months after graft failure).

Results: The hypoglycemia score improved after ITx when compared with baseline values (before vs. after: 5.29 +/- 1.51 vs. 1.35 +/- 1.92, P < 0.001). This result was sustained even after patient stratification based on islet function (pre vs. post off-insulin: 5.63 +/- 2.00 vs. no hypoglycemia reported; graft dysfunction: 5.31 +/- 1.49 vs. 1.15 +/- 1.63, P < 0.001; and graft failure: 5.00 +/- 1.16 vs. 2.70 +/- 2.26, P = 0.014).

Conclusions: The improved metabolic control achieved with ITx can restore hypoglycemia awareness in patients with type 1 diabetes, persisting even after islet graft failure.

Citing Articles

Global scientific trends on the islet transplantation in the 21st century: A bibliometric and visualized analysis.

Chen S, Wu P, Zhang T, Zhang J, Gao H Medicine (Baltimore). 2024; 103(17):e37945.

PMID: 38669398 PMC: 11049693. DOI: 10.1097/MD.0000000000037945.

Allo Beta Cell transplantation: specific features, unanswered questions, and immunological challenge.

Caldara R, Tomajer V, Monti P, Sordi V, Citro A, Chimienti R Front Immunol. 2023; 14:1323439.

PMID: 38077372 PMC: 10701551. DOI: 10.3389/fimmu.2023.1323439.

Felix dies natalis, insulin… ceterum autem censeo "beta is better".

Piemonti L Acta Diabetol. 2021; 58(10):1287-1306.

PMID: 34027619 DOI: 10.1007/s00592-021-01737-3.

Isolated pancreatic islet yield and quality is inversely related to organ donor age in rats.

Gonzalez N, Salgado M, Medrano L, Mullen Y, Komatsu H Exp Gerontol. 2019; 128:110739.

PMID: 31634542 PMC: 9347290. DOI: 10.1016/j.exger.2019.110739.

Kidney Donors With Diabetes: Renal Biopsy Findings at Time of Transplantation and Their Significance.

Truong L, Suki W, Gaber L, Gaber O, Khan F Transplant Direct. 2019; 5(7):e465.

PMID: 31334339 PMC: 6616142. DOI: 10.1097/TXD.0000000000000903.

References
1.
Kendall D, Rooney D, Smets Y, Salazar Bolding L, Robertson R . Pancreas transplantation restores epinephrine response and symptom recognition during hypoglycemia in patients with long-standing type I diabetes and autonomic neuropathy. Diabetes. 1997; 46(2):249-57. DOI: 10.2337/diab.46.2.249. View
2.
Clarke W, Cox D, Gonder-Frederick L, Julian D, Schlundt D, Polonsky W . Reduced awareness of hypoglycemia in adults with IDDM. A prospective study of hypoglycemic frequency and associated symptoms. Diabetes Care. 1995; 18(4):517-22. DOI: 10.2337/diacare.18.4.517. View
3.
Rickels M, Schutta M, Mueller R, Kapoor S, Markmann J, Naji A . Glycemic thresholds for activation of counterregulatory hormone and symptom responses in islet transplant recipients. J Clin Endocrinol Metab. 2006; 92(3):873-9. DOI: 10.1210/jc.2006-2426. View
4.
Froud T, Ricordi C, Baidal D, Hafiz M, Ponte G, Cure P . Islet transplantation in type 1 diabetes mellitus using cultured islets and steroid-free immunosuppression: Miami experience. Am J Transplant. 2005; 5(8):2037-46. DOI: 10.1111/j.1600-6143.2005.00957.x. View
5.
Paty B, Ryan E, Shapiro A, Lakey J, Robertson R . Intrahepatic islet transplantation in type 1 diabetic patients does not restore hypoglycemic hormonal counterregulation or symptom recognition after insulin independence. Diabetes. 2002; 51(12):3428-34. DOI: 10.2337/diabetes.51.12.3428. View