We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Spontaneous Hypoglycemia After Islet Autotransplantation for Chronic Pancreatitis.
- Authors
Lin, Yu Kuei; Faiman, Charles; Johnston, Philip C; Walsh, R Matthew; Stevens, Tyler; Bottino, Rita; Hatipoglu, Betul A
- Abstract
<bold>Context: </bold>Spontaneous hypoglycemia has been reported in patients after total pancreatectomy (TP) and islet autotransplantation (IAT) with maintained insulin independence. Details surrounding these events have not been well described.<bold>Objective: </bold>The objective of the study was to determine the frequency and characteristics of spontaneous hypoglycemia in patients undergoing TP-IAT and/or to ascertain predictive or protective factors of its development.<bold>Design: </bold>This was an observational cohort study in 40 patients who underwent TP-IAT from August 2008 to May 2014, with a median follow-up of 34 months.<bold>Setting: </bold>The study was conducted at a single institution (Cleveland Clinic).<bold>Patients: </bold>Patients included recipients of TP-IAT.<bold>Intervention: </bold>The intervention included small, frequent meals in those patients who developed spontaneous hypoglycemia.<bold>Main Outcome Measures: </bold>Incidence of spontaneous hypoglycemia development, characteristics of the patients developing hypoglycemia, and their response to small, frequent meals were measured.<bold>Results: </bold>Six of 12 patients, who maintained insulin independence, developed spontaneous hypoglycemia. The episodes could be fasting, postprandial, and/or exercise associated, with the frequency ranging from two to three times daily to once every 1-2 weeks. All patients experienced at least one episode that required external assistance, glucagon administration, and/or emergent medical attention. Patients who developed hypoglycemia had a lower median age and tended to have a lower median islet equivalent/kg body weight but a higher median total islet equivalent, body mass index, and homeostatic model assessment for insulin resistance score. All patients who received small, frequent meal intervention had improvement in severity and/or frequency of the hypoglycemic episodes.<bold>Conclusions: </bold>Spontaneous hypoglycemia is prevalent after TP-IAT. Although the underlying pathophysiology responsible for these hypoglycemia events remains to be elucidated, small, frequent meal intervention is helpful in ameliorating this condition.
- Subjects
ISLANDS of Langerhans transplantation; AGE distribution; AUTOGRAFTS; HYPOGLYCEMIA; LONGITUDINAL method; PANCREATECTOMY; DISEASE incidence; PANCREATITIS; ACUTE diseases; SURGERY
- Publication
Journal of Clinical Endocrinology & Metabolism, 2016, Vol 101, Issue 10, p3669
- ISSN
0021-972X
- Publication type
journal article
- DOI
10.1210/jc.2016-2111