Restoration of hypoglycemia awareness after islet transplantation.
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.


METHODS
A total of 31 ITx recipients were studied. Hypoglycemia unawareness was assessed using the Clarke hypoglycemic score (0 = no hypoglycemia; >or=4 = hypoglycemia unawareness). Subjects were grouped based on graft function: off-insulin (n = 8), graft dysfunction (on-insulin and stimulated C-peptide >or=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.
Leitão
Cristiane B
CB
Diabetes Research Institute, Miami, Florida, USA.
Tharavanij
Thipaporn
T
Cure
Pablo
P
Pileggi
Antonello
A
Baidal
David A
DA
Ricordi
Camillo
C
Alejandro
Rodolfo
R
D000328:Adult; D001786:Blood Glucose / Q000032:analysis*; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000601:surgery; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000097:blood* / Q000175:diagnosis; D016381:Islets of Langerhans Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
D001786:Blood Glucose