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J Clin Endocrinol Metab. 2012 Nov;97(11):E2078-83. doi: 10.1210/jc.2012-2115. Epub 2012 Sep 20.

Continuous glucose monitoring after islet transplantation in type 1 diabetes: an excellent graft function (β-score greater than 7) Is required to abrogate hyperglycemia, whereas a minimal function is necessary to suppress severe hypoglycemia (β-score greater than 3).

Author information

1
Endocrinologie et Métabolisme, hôpital Huriez, Institut National de la Santé et de la Recherche Médicale Unité 859, Centre Hospitalier et Universitaire de Lille, 1 rue Polonovski, F-59045 Lille, France. mc-vantyghem@chru-lille.fr

Abstract

CONTEXT:

For the last 10 yr, continuous glucose monitoring (CGM) has brought up new insights into the accuracy of blood glucose analysis.

OBJECTIVE:

Our objective was to determine how islet graft function was able to influence the various components of dysglycemia after islet transplantation (IT).

DESIGN AND SETTING:

We conducted a single-arm open-labeled study with a 3-yr follow-up in a referral center (ClinicalTrial.gov identifiers NCT00446264 and NCT01123187).

PATIENTS:

Twenty-three consecutive patients with type 1 diabetes (14 islet alone, nine islet after kidney) received IT within 3 months using the Edmonton protocol.

INTERVENTION:

INTERVENTION included 72-h CGM before and 3, 6, 9, 12, 24, and 36 months after transplantation.

MAIN OUTCOME MEASURE:

Graft function was estimated via β-score, a previously validated index (range 0-8) based on treatment requirements, C-peptide, blood glucose, and glycated hemoglobin.

RESULTS:

At the 3-yr visit, graft function persisted in 19 patients (82%), and 10 (43%) remained insulin independent. Glycated hemoglobin decreased in the whole cohort from 8.3% (7.3-9.0%) at baseline to 6.7% (5.9-7.7%) at 3 yr [median (interquartile range), P < 0.01]. Mean glucose, glucose sd, and time spent with glycemia above 10 mmol/liter (hyperglycemia) and below 3 mmol/liter (hypoglycemia) were significantly lower after IT (P < 0.05 vs. baseline). The four CGM outcomes were related to β-score (P < 0.001). However, partial function (β-score >3) was sufficient to abrogate hypoglycemia; suboptimal function (β-score >5) was necessary to significantly improve mean glucose, glucose sd, and hyperglycemia; and optimal function (β score >7) was necessary to normalize them.

CONCLUSION:

The four components of dysglycemia were not equally affected by the degree of islet graft function, which could have important implications for future development of β-cell replacement. A β-score above 3 dramatically reduced the occurrence of hypoglycemia.

PMID:
22996144
PMCID:
PMC3485599
DOI:
10.1210/jc.2012-2115
[Indexed for MEDLINE]
Free PMC Article

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