Reduction of Blood Glucose Variability in Type 1 Diabetic Patients Treated By Pancreatic Islet Transplantation
Interest of continuous glucose monitoring
- Laurence Kessler, MD, PHD1,
- Raphael Passemard1,
- Jose Oberholzer, MD, PHD2,
- Pierre Yves Benhamou, MD, PHD3,
- Pascal Bucher, MD2,
- Christian Toso, MD2,
- Pierre Meyer, MD, PHD4,
- Alfred Penfornis, MD, PHD5,
- Lionel Badet, MD, PHD6,
- Philippe Wolf, MD, PHD7,
- Cyrille Colin, MD, PHD8,
- Philippe Morel, MD, PHD2,
- Michel Pinget, MD, PHD1 and
- on behalf of the GRAGIL Group
- 1Department of Endocrinology, University Hospital, Strasbourg, France
- 2Department of Surgery, University Hospital, Geneva, Switzerland
- 3Department of Endocrinology, University Hospital, Grenoble, France
- 4Department of Medical Information, University Hospital, Strasbourg, France
- 5Department of Endocrinology, University Hospital, Besancon, France
- 6Department of Urology, Hospices Civils, Lyon, France
- 7Department of Transplantation, University Hospital, Strasbourg, France
- 8Department of Medical Information, Hospices Civils, Lyon, France
OBJECTIVE—To compare the glycemic profiles of patients with type 1 diabetes treated with either an implantable insulin pump or pancreas or islet transplantation by the means of the continuous glucose monitoring system (CGMS; Minimed, Sylmar, CA).
RESEARCH DESIGN AND METHODS—The CGMS enabled recording of subcutaneous glucose concentrations (range 2.2–22 mmol/l) over 72 h (288 measurements per day). Over 3 days, 26 patients with type 1 diabetes were connected to a CGMS: 10 patients were treated with intraperitoneal insulin infusion through an implantable pump (IPII), 9 patients were treated with simultaneous pancreas-kidney transplantation (SPK), and 7 patients were treated with pancreatic islet transplantation after kidney grafting (IAK). All SPK patients and four IAK patients were insulin independent, whereas three IAK patients had partial graft function and reduced exogenous insulin needs. Glucose control was evaluated by the mean glucose concentration, glucose variability, and the number and duration of hypoglycemic events (<3.3 mmol/l) over 3 days.
RESULTS—The mean glucose concentration and the glucose variability in SPK and IAK patients were significantly lower than those observed in patients treated with IPII: 5.38 ± 1.12 and 5.83 ± 0.81 vs. 7.81 ± 1.55 mmol/l (P < 0.001) and 1.40 ± 0.42 and 1.32 ± 0.53 vs. 3.47 ± 1.66 mmol/l (P < 0.001), respectively. Furthermore, the mean glucose concentration and the glucose variability were comparable between SPK and IAK patients. Over 3 days, no hypoglycemic events were observed in SPK patients and insulin-independent IAK patients. A total of 4.12 ± 1.66 hypoglycemic events were detected in the IPII patient group, whereas only 0.66 ± 0.57 events were observed in IAK patients with partial graft function (P < 0.001). The duration of the hypoglycemic events was significantly longer in IPII patients as compared with IAK patients: 64 ± 33 vs. 30 ± 15 min for the day period and 130 ± 62 vs. 30 ± 27 min for the night period (P < 0.001).
CONCLUSIONS—Use of subcutaneous CGMS confirms that islet transplantation can be as efficient as pancreas transplantation in restoring good metabolic control and reducing blood glucose variability. Metabolic improvement due to use of an implantable insulin pump requires insulin delivery by a closed loop.
- CGMS, continuous glucose monitoring system
- EIN, equivalent islet number
- IAK, islet transplantation after kidney grafting
- IPII, intraperitoneal insulin infusion through an implantable pump
- MAGE, mean amplitude of glycemic excursion
- SPK, simultaneous pancreas-kidney transplantation
Address correspondence and reprint requests to Dr. L. Kessler, Service d’Endocrinologie et de Diabétologie, Hôpitaux Universitaires, 1, Place de l’Hôpital, 67091 Strasbourg Cedex, France. E-mail:.
Received for publication 3 June 2002 and accepted in revised form 20 August 2002.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
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