title: Reduction of blood glucose variability in type 1 diabetic patients treated by pancreatic islet transplantation: interest of continuous glucose monitoring.
abstract: 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).
  
  
  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.
authors.affiliation: Department of Endocrinology, University Hospital, Strasbourg, France. laurence.kessler@medecine.u-strasbg.fr
authors.forename: Laurence
authors.initials: L
authors.lastname: Kessler
authors.forename: Raphael
authors.initials: R
authors.lastname: Passemard
authors.forename: Jose
authors.initials: J
authors.lastname: Oberholzer
authors.forename: Pierre Yves
authors.initials: PY
authors.lastname: Benhamou
authors.forename: Pascal
authors.initials: P
authors.lastname: Bucher
authors.forename: Christian
authors.initials: C
authors.lastname: Toso
authors.forename: Pierre
authors.initials: P
authors.lastname: Meyer
authors.forename: Alfred
authors.initials: A
authors.lastname: Penfornis
authors.forename: Lionel
authors.initials: L
authors.lastname: Badet
authors.forename: Philippe
authors.initials: P
authors.lastname: Wolf
authors.forename: Cyrille
authors.initials: C
authors.lastname: Colin
authors.forename: Philippe
authors.initials: P
authors.lastname: Morel
authors.forename: Michel
authors.initials: M
authors.lastname: Pinget
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D002940:Circadian Rhythm; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology; D016381:Islets of Langerhans Transplantation / Q000502:physiology*; D016030:Kidney Transplantation / Q000502:physiology; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D016035:Pancreas Transplantation / Q000502:physiology; D013997:Time Factors
chemical_list: D001786:Blood Glucose