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Islet Transplantation Provides Superior Glycemic Control With Less Hypoglycemia Compared With Continuous Subcutaneous Insulin Infusion or Multiple Daily Insulin Injections.
Transplantation. 2017 06; 101(6):1268-1275.T

Abstract

BACKGROUND

The aim was to compare efficacy of multiple daily injections (MDI), continuous subcutaneous insulin infusion (CSII) and islet transplantation to reduce hypoglycemia and glycemic variability in type 1 diabetes subjects with severe hypoglycemia.

METHODS

This was a within-subject, paired comparison of MDI and CSII and CSII with 12 months postislet transplantation in 10 type 1 diabetes subjects referred with severe hypoglycemia, suitable for islet transplantation. Individuals were assessed with HbA1c, Edmonton Hypoglycemia Score (HYPOscore), continuous glucose monitoring (CGM) and in 8 subjects measurements of glucose variability using standard deviation of glucose (SD glucose) from CGM and continuous overlapping net glycemic action using a 4 hour interval (CONGA4).

RESULTS

After changing from MDI to CSII before transplantation, 10 subjects reduced median HYPOscore from 2028 to 1085 (P < 0.05) and hypoglycemia events from 24 to 8 per patient-year (P < 0.05). While HbA1c, mean glucose and median percent time hypoglycemic on CGM were unchanged with CSII, SD glucose and CONGA4 reduced significantly (P < 0.05). At 12 months posttransplant 9 of 10 were C-peptide positive, (5 insulin independent). Twelve months postislet transplantation, there were significant reductions in all baseline parameters versus CSII, respectively, HbA1c (6.4% cf 8.2%), median HYPOscore (0 cf 1085), mean glucose (7.1 cf 8.6 mmol L), SD glucose (1.7 cf 3.2 mmol/L), and CONGA4 (1.6 cf 3.0).

CONCLUSIONS

In subjects with severe hypoglycemia suitable for islet transplantation, CSII decreased hypoglycemia frequency and glycemic variability compared with MDI whereas islet transplantation resolved hypoglycemia and further improved glycemic variability regardless of insulin independence.

Authors+Show Affiliations

1 Department of Endocrinology, University of Sydney at Westmead Hospital, NSW, Australia. 2 Centre for Diabetes, Obesity and Endocrinology Research, The Westmead Institute, University of Sydney at Westmead Hospital, Sydney, Australia. 3 Department of Diabetes and Endocrinology, Westmead Hospital Westmead, NSW, Australia. 4 National Pancreas Transplant Unit, University of Sydney at Westmead Hospital, Westmead Hospital, Westmead, NSW, Australia. 5 Centre for Renal and Transplant Research, Westmead Millennium Institute, University of Sydney at Westmead, NSW, Australia. 6 Department of Renal Medicine, Westmead Hospital, NSW, Australia. 7 Department of Paediatrics, Murdoch Children's Research Institute and University of Melbourne, Victoria, Australia. 8 St Vincent's Institute, University of Melbourne, Victoria, Australia. 9 Departments of Endocrinology and Clinical Biochemistry, St Vincent's Hospital, Melbourne, Victoria, Australia. 10 Department of Pathology, University of Melbourne, Melbourne, Victoria, Australia.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

27490410

Citation

Holmes-Walker, Deborah Jane, et al. "Islet Transplantation Provides Superior Glycemic Control With Less Hypoglycemia Compared With Continuous Subcutaneous Insulin Infusion or Multiple Daily Insulin Injections." Transplantation, vol. 101, no. 6, 2017, pp. 1268-1275.
Holmes-Walker DJ, Gunton JE, Hawthorne W, et al. Islet Transplantation Provides Superior Glycemic Control With Less Hypoglycemia Compared With Continuous Subcutaneous Insulin Infusion or Multiple Daily Insulin Injections. Transplantation. 2017;101(6):1268-1275.
Holmes-Walker, D. J., Gunton, J. E., Hawthorne, W., Payk, M., Anderson, P., Donath, S., Loudovaris, T., Ward, G. M., Kay, T. W., & OʼConnell, P. J. (2017). Islet Transplantation Provides Superior Glycemic Control With Less Hypoglycemia Compared With Continuous Subcutaneous Insulin Infusion or Multiple Daily Insulin Injections. Transplantation, 101(6), 1268-1275. https://doi.org/10.1097/TP.0000000000001381
Holmes-Walker DJ, et al. Islet Transplantation Provides Superior Glycemic Control With Less Hypoglycemia Compared With Continuous Subcutaneous Insulin Infusion or Multiple Daily Insulin Injections. Transplantation. 2017;101(6):1268-1275. PubMed PMID: 27490410.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Islet Transplantation Provides Superior Glycemic Control With Less Hypoglycemia Compared With Continuous Subcutaneous Insulin Infusion or Multiple Daily Insulin Injections. AU - Holmes-Walker,Deborah Jane, AU - Gunton,Jenny E, AU - Hawthorne,Wayne, AU - Payk,Marlene, AU - Anderson,Patricia, AU - Donath,Susan, AU - Loudovaris,Tom, AU - Ward,Glenn M, AU - Kay,Thomas Wh, AU - OʼConnell,Philip J, PY - 2016/8/5/pubmed PY - 2017/8/31/medline PY - 2016/8/5/entrez SP - 1268 EP - 1275 JF - Transplantation JO - Transplantation VL - 101 IS - 6 N2 - BACKGROUND: The aim was to compare efficacy of multiple daily injections (MDI), continuous subcutaneous insulin infusion (CSII) and islet transplantation to reduce hypoglycemia and glycemic variability in type 1 diabetes subjects with severe hypoglycemia. METHODS: This was a within-subject, paired comparison of MDI and CSII and CSII with 12 months postislet transplantation in 10 type 1 diabetes subjects referred with severe hypoglycemia, suitable for islet transplantation. Individuals were assessed with HbA1c, Edmonton Hypoglycemia Score (HYPOscore), continuous glucose monitoring (CGM) and in 8 subjects measurements of glucose variability using standard deviation of glucose (SD glucose) from CGM and continuous overlapping net glycemic action using a 4 hour interval (CONGA4). RESULTS: After changing from MDI to CSII before transplantation, 10 subjects reduced median HYPOscore from 2028 to 1085 (P < 0.05) and hypoglycemia events from 24 to 8 per patient-year (P < 0.05). While HbA1c, mean glucose and median percent time hypoglycemic on CGM were unchanged with CSII, SD glucose and CONGA4 reduced significantly (P < 0.05). At 12 months posttransplant 9 of 10 were C-peptide positive, (5 insulin independent). Twelve months postislet transplantation, there were significant reductions in all baseline parameters versus CSII, respectively, HbA1c (6.4% cf 8.2%), median HYPOscore (0 cf 1085), mean glucose (7.1 cf 8.6 mmol L), SD glucose (1.7 cf 3.2 mmol/L), and CONGA4 (1.6 cf 3.0). CONCLUSIONS: In subjects with severe hypoglycemia suitable for islet transplantation, CSII decreased hypoglycemia frequency and glycemic variability compared with MDI whereas islet transplantation resolved hypoglycemia and further improved glycemic variability regardless of insulin independence. SN - 1534-6080 UR - https://www.unboundmedicine.com/medline/citation/27490410/Islet_Transplantation_Provides_Superior_Glycemic_Control_With_Less_Hypoglycemia_Compared_With_Continuous_Subcutaneous_Insulin_Infusion_or_Multiple_Daily_Insulin_Injections_ L2 - http://dx.doi.org/10.1097/TP.0000000000001381 DB - PRIME DP - Unbound Medicine ER -