Restoration of Hypoglycemia Awareness after Islet Transplantation
- Cristiane B. Leitão, MD, PhD1,2,
- Thipaporn Tharavanij, MD1,
- Pablo Cure, MD1,
- Antonello Pileggi, MD, PhD1,3,
- David A. Baidal, MD1,
- Camillo Ricordi, MD1,3,4,5 and
- Rodolfo Alejandro, MD (ralejand{at}med.miami.edu)1,4
- 1Diabetes Research Institute, Miami, FL, USA
- 2Endocrine Division of Hospital de Clínicas de Porto Alegre, RS, Brazil
- 3Department of Surgery,
- 4Medicine, and
- 5Jackson Memorial Hospital-Transplant Institute, University of Miami Miller School of Medicine, Miami, FL, USA
Abstract
Objective: To determine the impact of islet transplantation (ITx) on hypoglycemia awareness in patients with unstable type 1 diabetes mellitus (T1DM) and its relation to islet function.
Research design and methods: Thirty-one ITx recipients were studied. Hypoglycemia unawareness was assessed utilizing the Clarke hypoglycemic-score (0=no hypoglycemia; ≥4=hypoglycemia unawareness). Subjects were grouped based on graft function: off-insulin (n=8), graft dysfunction (GDF; on-insulin and stimulated C-peptide≥0.3 ng/ml, n=13) and graft failure (GF; stimulated C-peptide<0.3 ng/ml, n=10, evaluated 11.5±14.5 months after GF).
Results: The hypoglycemia score improved following ITx when compared to baseline values (pre vs. post: 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; GDF: 5.31±1.49 vs. 1.15±1.63, P<0.001 and GF: 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 T1DM, persisting even after islet GF.
Footnotes
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- Received July 1, 2008.
- Accepted August 6, 2008.
- Copyright © American Diabetes Association
