title: A multi-year analysis of islet transplantation compared with intensive medical therapy on progression of complications in type 1 diabetes.
abstract: BACKGROUND
  We hypothesized that transplantation of islets into type 1 diabetics could improve outcomes of glucose metabolism, renal function, retinopathy, and neuropathy compared with intensive medical therapy.
  
  
  METHODS
  We conducted a prospective, crossover, cohort study of intensive medical therapy (group 1) versus islet cell transplantation (group 2) in 42 patients. All were enrolled in group 1 then 31 crossed over with group 2 when islet donation became available. Transplantation was performed by portal venous embolization of more than 12,000 islet equivalents/kg body weight under cover of immunosuppression with antithymocyte globulin, tacrolimus, and mycophenolate. Outcome measures were HbA1c, change in glomerular filtration rate (GFR), progression of retinopathy, and change in nerve conduction velocity. This report details interim analysis of outcomes after 34+/-18 months (group 1) and 38+/-18 months (group 2).
  
  
  RESULTS
  HbA1c (%) in group 1 was 7.5+/-0.9 versus 6.6+/-0.7 in group 2 (P<0.01). GFR (mL/min/month) declined in both groups (group 1 -0.45+/-0.7 vs. group 2 -0.12+/-0.7, P=0.1). Slope of the GFR decline in group 1 was significantly more than 0. Retinopathy progressed in 10 of 82 eyes in group 1 versus 0 of 51 in group 2 (P<0.01). Nerve conduction velocity (m/sec) remained stable in group 1 (47.8+/-5 to 47.1+/-5 m/sec) and group 2 (47.2+/-4.5 to 47.7+/-3.5).
  
  
  CONCLUSIONS
  Islet transplantation yields improved HbA1c and less progression of retinopathy compared with intensive medical therapy during 3 years follow-up.
authors.affiliation: Departments of Surgery, Ophthalmology & Visual Sciences, and Medicine, Ike Barber Human Islet Transplantation Laboratory, University of British Columbia, Vancouver, BC, Canada. gwarnock@interchange.ubc.ca
authors.forename: Garth L
authors.initials: GL
authors.lastname: Warnock
authors.forename: David M
authors.initials: DM
authors.lastname: Thompson
authors.forename: R Mark
authors.initials: RM
authors.lastname: Meloche
authors.forename: R Jean
authors.initials: RJ
authors.lastname: Shapiro
authors.forename: Ziliang
authors.initials: Z
authors.lastname: Ao
authors.forename: Paul
authors.initials: P
authors.lastname: Keown
authors.forename: James D
authors.initials: JD
authors.lastname: Johnson
authors.forename: C Bruce
authors.initials: CB
authors.lastname: Verchere
authors.forename: Nilufar
authors.initials: N
authors.lastname: Partovi
authors.forename: Iain S
authors.initials: IS
authors.lastname: Begg
authors.forename: Michelle
authors.initials: M
authors.lastname: Fung
authors.forename: Sharon E
authors.initials: SE
authors.lastname: Kozak
authors.forename: Suet On
authors.initials: SO
authors.lastname: Tong
authors.forename: Khalid M
authors.initials: KM
authors.lastname: Alghofaili
authors.forename: Claire
authors.initials: C
authors.lastname: Harris
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D018592:Cross-Over Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery*; D003928:Diabetic Nephropathies / Q000601:surgery*; D003929:Diabetic Neuropathies / Q000503:physiopathology; D003930:Diabetic Retinopathy / Q000503:physiopathology; D018450:Disease Progression; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000187:drug effects / Q000502:physiology; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D016381:Islets of Langerhans Transplantation / Q000502:physiology*; D007677:Kidney Function Tests; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin