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- Title
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).
- Authors
Vantyghem MC; Raverdy V; Balavoine AS; Defrance F; Caiazzo R; Arnalsteen L; Gmyr V; Hazzan M; Noël C; Kerr-Conte J; Pattou F; Vantyghem, Marie-Christine; Raverdy, Violeta; Balavoine, Anne-Sophie; Defrance, Frédérique; Caiazzo, Robert; Arnalsteen, Laurent; Gmyr, Valéry; Hazzan, Marc; Noël, Christian
- Abstract
<bold>Context: </bold>For the last 10 yr, continuous glucose monitoring (CGM) has brought up new insights into the accuracy of blood glucose analysis.<bold>Objective: </bold>Our objective was to determine how islet graft function was able to influence the various components of dysglycemia after islet transplantation (IT).<bold>Design and Setting: </bold>We conducted a single-arm open-labeled study with a 3-yr follow-up in a referral center (ClinicalTrial.gov identifiers NCT00446264 and NCT01123187).<bold>Patients: </bold>Twenty-three consecutive patients with type 1 diabetes (14 islet alone, nine islet after kidney) received IT within 3 months using the Edmonton protocol.<bold>Intervention: </bold>INTERVENTION included 72-h CGM before and 3, 6, 9, 12, 24, and 36 months after transplantation.<bold>Main Outcome Measure: </bold>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.<bold>Results: </bold>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.<bold>Conclusion: </bold>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.
- Publication
Journal of Clinical Endocrinology & Metabolism, 2012, Vol 97, Issue 11, pE2078
- ISSN
0021-972X
- Publication type
journal article
- DOI
10.1210/jc.2012-2115