Impact of Islet Transplantation on Glycemic Control As Evidenced by a Continuous Glucose Monitoring System

Overview

Journal J Diabetes Sci Technol

Specialty Endocrinology

Date 2009 Nov 4

PMID 19885346

Citations 10

Authors

Lisa Gorn

Raquel N Faradji

Shari Messinger

Kathy Monroy

David A Baidal

Tatiana Froud

John Mastrototaro

Camillo Ricordi

Rodolfo Alejandro

Affiliations

Soon will be listed here.

Abstract

Background: This study evaluated the effects of islet allotransplantation (ITx) on metabolic control utilizing a continuous glucose monitoring system (CGMS) and assessed its effectiveness as an indicator and predictor of graft dysfunction (GD).

Methods: Glycemic control was assessed in 25 patients with type 1 diabetes mellitus (T1DM); 12 ITx recipients and 13 controls. Mean interstitial glucose, standard deviation (SD), glucose variability, and percentage of time in hyperglycemia (%GT >140 mg/dl), hypoglycemia (%GT <54 mg/dl), and normoglycemia (%GT 54-140 mg/dl) were measured in 72-hour time periods from CGMS recordings in the control group at baseline and in the ITx group at 3, 6, 9, 12, 15, and 18 months after ITx completion and were analyzed as predictors and indicators of GD. Hemoglobin A1c (HbA1c), 90-minute glucose after a mixed meal tolerance test, fasting C-peptide/glucose ratio, and insulin requirements were followed.

Results: Compared to the control group, the percentage of time in hypoglycemia was significantly lower in the ITx group at all time points; time in normoglycemia was increased at all times except at 15 months; and time in hyperglycemia was significantly lower at 6, 9, 12, and 18 months. Mean glucose and glucose variability were significantly lower in the ITx group at all times except at 3 and 15 months, whereas HbA1c and 90-minute glucose were significantly lower in the ITx group at all time points. Mean glucose, SD, glucose variability, and %GT >140 mg/dl were significant as indicators but not as predictors of GD.

Conclusions: The CGMS demonstrated the benefits of ITx in T1DM, with improvements in glycemic control apparent up to 18 months after transplant. CGMS measures were found to be indicators of GD.

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References

Nathan D, Genuth S, Lachin J, Cleary P, Crofford O, Davis M . The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993; 329(14):977-86. DOI: 10.1056/NEJM199309303291401. View

Kessler L, Passemard R, Oberholzer J, Benhamou P, Bucher P, Toso C . Reduction of blood glucose variability in type 1 diabetic patients treated by pancreatic islet transplantation: interest of continuous glucose monitoring. Diabetes Care. 2002; 25(12):2256-62. DOI: 10.2337/diacare.25.12.2256. View

Ryan E, Shandro T, Green K, Paty B, Senior P, Bigam D . Assessment of the severity of hypoglycemia and glycemic lability in type 1 diabetic subjects undergoing islet transplantation. Diabetes. 2004; 53(4):955-62. DOI: 10.2337/diabetes.53.4.955. View

Shapiro A, Ricordi C, Hering B, Auchincloss H, Lindblad R, Robertson R . International trial of the Edmonton protocol for islet transplantation. N Engl J Med. 2006; 355(13):1318-30. DOI: 10.1056/NEJMoa061267. View

Hay L, Wilmshurst E, Fulcher G . Unrecognized hypo- and hyperglycemia in well-controlled patients with type 2 diabetes mellitus: the results of continuous glucose monitoring. Diabetes Technol Ther. 2003; 5(1):19-26. DOI: 10.1089/152091503763816427. View

Rickels M, Schutta M, Mueller R, Markmann J, Barker C, Naji A . Islet cell hormonal responses to hypoglycemia after human islet transplantation for type 1 diabetes. Diabetes. 2005; 54(11):3205-11. DOI: 10.2337/diabetes.54.11.3205. View

Shapiro A, Lakey J, Ryan E, Korbutt G, Toth E, Warnock G . Islet transplantation in seven patients with type 1 diabetes mellitus using a glucocorticoid-free immunosuppressive regimen. N Engl J Med. 2000; 343(4):230-8. DOI: 10.1056/NEJM200007273430401. View

Faradji R, Monroy K, Riefkohl A, Lozano L, Gorn L, Froud T . Continuous glucose monitoring system for early detection of graft dysfunction in allogenic islet transplant recipients. Transplant Proc. 2006; 38(10):3274-6. PMC: 1918052. DOI: 10.1016/j.transproceed.2006.10.036. View

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

10.

Pileggi A, Ricordi C, Kenyon N, Froud T, Baidal D, Kahn A . Twenty years of clinical islet transplantation at the Diabetes Research Institute--University of Miami. Clin Transpl. 2006; :177-204. View

11.

Poggioli R, Faradji R, Ponte G, Betancourt A, Messinger S, Baidal D . Quality of life after islet transplantation. Am J Transplant. 2006; 6(2):371-8. DOI: 10.1111/j.1600-6143.2005.01174.x. View

12.

Paty B, Senior P, Lakey J, Shapiro A, Ryan E . Assessment of glycemic control after islet transplantation using the continuous glucose monitor in insulin-independent versus insulin-requiring type 1 diabetes subjects. Diabetes Technol Ther. 2006; 8(2):165-73. DOI: 10.1089/dia.2006.8.165. View

13.

Faradji R, Monroy K, Messinger S, Pileggi A, Froud T, Baidal D . Simple measures to monitor beta-cell mass and assess islet graft dysfunction. Am J Transplant. 2006; 7(2):303-8. DOI: 10.1111/j.1600-6143.2006.01620.x. View

14.

Ricordi C, Lacy P, FINKE E, Olack B, Scharp D . Automated method for isolation of human pancreatic islets. Diabetes. 1988; 37(4):413-20. DOI: 10.2337/diab.37.4.413. View

15.

Pedersen-Bjergaard U, Pramming S, Heller S, Wallace T, Rasmussen A, Jorgensen H . Severe hypoglycaemia in 1076 adult patients with type 1 diabetes: influence of risk markers and selection. Diabetes Metab Res Rev. 2004; 20(6):479-86. DOI: 10.1002/dmrr.482. View

16.

Ryan E, Paty B, Senior P, Bigam D, Alfadhli E, Kneteman N . Five-year follow-up after clinical islet transplantation. Diabetes. 2005; 54(7):2060-9. DOI: 10.2337/diabetes.54.7.2060. View

17.

Mastrototaro J . The MiniMed continuous glucose monitoring system. Diabetes Technol Ther. 2001; 2 Suppl 1:S13-8. DOI: 10.1089/15209150050214078. View

18.

Geiger M, Ferreira J, Hafiz M, Froud T, Baidal D, Meneghini L . Evaluation of metabolic control using a continuous subcutaneous glucose monitoring system in patients with type 1 diabetes mellitus who achieved insulin independence after islet cell transplantation. Cell Transplant. 2005; 14(2-3):77-84. DOI: 10.3727/000000005783983214. View

19.

Guerci B, Floriot M, Bohme P, Durain D, Benichou M, Jellimann S . Clinical performance of CGMS in type 1 diabetic patients treated by continuous subcutaneous insulin infusion using insulin analogs. Diabetes Care. 2003; 26(3):582-9. DOI: 10.2337/diacare.26.3.582. View