Restoration of Hypoglycemia Awareness After Islet Transplantation

  1. Cristiane B. Leitão, MD, PHD12,
  2. Thipaporn Tharavanij, MD1,
  3. Pablo Cure, MD1,
  4. Antonello Pileggi, MD, PHD13,
  5. David A. Baidal, MD1,
  6. Camillo Ricordi, MD1345 and
  7. Rodolfo Alejandro, MD14
  1. 1Diabetes Research Institute, Miami, Florida
  2. 2Endocrine Division, Hospital de Clínicas de Porto Alegre, RS, Brazil
  3. 3Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
  4. 4Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
  5. 5Jackson Memorial Hospital–Transplant Institute, University of Miami Miller School of Medicine, Miami, Florida
  1. Corresponding author: Dr. Rodolfo Alejandro, ralejand{at}med.miami.edu

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; ≥4 = hypoglycemia unawareness). Subjects were grouped based on graft function: off-insulin (n = 8), graft dysfunction (on-insulin and stimulated C-peptide ≥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.

Footnotes

  • Published ahead of print at http://care.diabetesjournals.org on 12 August 2008.

    Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

    The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.

    • Accepted August 6, 2008.
    • Received July 1, 2008.
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  1. Published online before print August 12, 2008, doi: 10.2337/dc08-0741 Diabetes Care November 2008 vol. 31 no. 11 2113-2115
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