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Restoration of hypoglycemia awareness after islet transplantation.

Leitão CB, Tharavanij T, Cure P, Pileggi A, Baidal DA, Ricordi C, Alejandro R - Diabetes Care (2008)

Bottom Line: A total of 31 ITx recipients were studied.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).The improved metabolic control achieved with ITx can restore hypoglycemia awareness in patients with type 1 diabetes, persisting even after islet graft failure.

View Article: PubMed Central - PubMed

Affiliation: Diabetes Research Institute, Miami, Florida, USA.

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.

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Related in: MedlinePlus

Hypoglycemic score (Clarke score; 4) (A) and proportion of subjects with hypoglycemia unawareness (hypoglycemic score ≥4) (B) pre- and post-ITx, according to islet function. P = 0.007 for comparison of posttransplant hypoglycemic score between off-insulin and graft failure groups. *P value is not applicable, since no hypoglycemia was reported posttransplant.
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f1: Hypoglycemic score (Clarke score; 4) (A) and proportion of subjects with hypoglycemia unawareness (hypoglycemic score ≥4) (B) pre- and post-ITx, according to islet function. P = 0.007 for comparison of posttransplant hypoglycemic score between off-insulin and graft failure groups. *P value is not applicable, since no hypoglycemia was reported posttransplant.

Mentions: Mean hypoglycemic score pre-ITx was 5.29 ± 1.51 and was inversely correlated with pre-ITx glycemic control, as measured by A1C (r = −0.370, P = 0.040). A decrease in hypoglycemic score was observed post-ITx (1.35 ± 1.92, P < 0.001). Similarly, there was a reduction in the proportion of patients with hypoglycemia unawareness (pre- vs. post-ITx: 87 vs. 13%, P < 0.001) and an increase in glycemic threshold that resulted in symptoms (pre- vs. post-ITx: 41.4 ± 17.6 vs. 58.4 ± 10.3 mg/dl, P = 0.001). Results were sustained even after the patient's stratification based on islet function (pre- vs. post-ITx 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) (Fig. 1); however, an increase in post-ITx hypoglycemic score was observed as patients lost graft function (P = 0.007).


Restoration of hypoglycemia awareness after islet transplantation.

Leitão CB, Tharavanij T, Cure P, Pileggi A, Baidal DA, Ricordi C, Alejandro R - Diabetes Care (2008)

Hypoglycemic score (Clarke score; 4) (A) and proportion of subjects with hypoglycemia unawareness (hypoglycemic score ≥4) (B) pre- and post-ITx, according to islet function. P = 0.007 for comparison of posttransplant hypoglycemic score between off-insulin and graft failure groups. *P value is not applicable, since no hypoglycemia was reported posttransplant.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2571057&req=5

f1: Hypoglycemic score (Clarke score; 4) (A) and proportion of subjects with hypoglycemia unawareness (hypoglycemic score ≥4) (B) pre- and post-ITx, according to islet function. P = 0.007 for comparison of posttransplant hypoglycemic score between off-insulin and graft failure groups. *P value is not applicable, since no hypoglycemia was reported posttransplant.
Mentions: Mean hypoglycemic score pre-ITx was 5.29 ± 1.51 and was inversely correlated with pre-ITx glycemic control, as measured by A1C (r = −0.370, P = 0.040). A decrease in hypoglycemic score was observed post-ITx (1.35 ± 1.92, P < 0.001). Similarly, there was a reduction in the proportion of patients with hypoglycemia unawareness (pre- vs. post-ITx: 87 vs. 13%, P < 0.001) and an increase in glycemic threshold that resulted in symptoms (pre- vs. post-ITx: 41.4 ± 17.6 vs. 58.4 ± 10.3 mg/dl, P = 0.001). Results were sustained even after the patient's stratification based on islet function (pre- vs. post-ITx 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) (Fig. 1); however, an increase in post-ITx hypoglycemic score was observed as patients lost graft function (P = 0.007).

Bottom Line: A total of 31 ITx recipients were studied.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).The improved metabolic control achieved with ITx can restore hypoglycemia awareness in patients with type 1 diabetes, persisting even after islet graft failure.

View Article: PubMed Central - PubMed

Affiliation: Diabetes Research Institute, Miami, Florida, USA.

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.

Show MeSH
Related in: MedlinePlus