title: Reduction in carotid intima-media thickness after pancreatic islet transplantation in patients with type 1 diabetes.
abstract: OBJECTIVE
  Determine the impact of islet transplantation on carotid intima-media thickness (CIMT), a marker for atherosclerosis, in type 1 diabetes without kidney disease.
  
  
  METHODS
  Consecutive case series of 15 adults (mean age [SD], 49 years [10 years]; 87% female) with type 1 diabetes for ≥5 years (mean duration [SD], 30 years [12 years]; mean HbA(1c) [SD], 7.2% [0.9%]), without kidney disease, presenting with severe hypoglycemic unawareness to undergo allogeneic pancreatic islet transplant(s) (one to three each) in a phase 1/2 and 3 clinical trial. Current follow-up ranges from 1 to 5 years (2005-2011). CIMT of the common and internal carotid arteries was measured before and every 12-16 months after the first transplant (two to six CIMTs each) by one ultrasonographer and one blinded reader. CIMT was analyzed as change from baseline to 12- and 50-month follow-up; a combined CIMT score was calculated as the sum of the standardized IMT scores (SD units [SDs]) of both arteries.
  
  
  RESULTS
  All patients achieved insulin independence after one to three transplants. CIMT decreased at 12 months (n = 15) for the common carotid (-0.058 mm; P = 0.006) and combined score (-1.28 SDs; P = 0.004). In those with 50-month follow-up (n = 7), the decrease in the combined score continued from 12 (-1.59 SDs; P = 0.04) to 50 months (-0.77 SDs; P = 0.04). During follow-up, the decreasing slope of change in CIMT was associated with decreasing slopes of change in HbA(1c), lipoproteins, and cardiovascular/inflammatory markers.
  
  
  CONCLUSIONS
  Islet transplantation may ameliorate diabetes-related atherosclerosis through improved glycemic control consequent to restoring endogenous insulin secretion, and optimal lipid management posttransplant also contributes.
authors.affiliation: Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA. kdaniel@uic.edu
authors.forename: Kirstie K
authors.initials: KK
authors.lastname: Danielson
authors.forename: Betul
authors.initials: B
authors.lastname: Hatipoglu
authors.forename: Katie
authors.initials: K
authors.lastname: Kinzer
authors.forename: Bruce
authors.initials: B
authors.lastname: Kaplan
authors.forename: Joan
authors.initials: J
authors.lastname: Martellotto
authors.forename: Meirigeng
authors.initials: M
authors.lastname: Qi
authors.forename: Alessandra
authors.initials: A
authors.lastname: Mele
authors.forename: Enrico
authors.initials: E
authors.lastname: Benedetti
authors.forename: José
authors.initials: J
authors.lastname: Oberholzer
mesh_terms: D000328:Adult; D001786:Blood Glucose; D059168:Carotid Intima-Media Thickness; D003922:Diabetes Mellitus, Type 1 / Q000378:metabolism / Q000601:surgery*; D005260:Female; D006801:Humans; D016381:Islets of Langerhans Transplantation; D008297:Male; D008875:Middle Aged
chemical_list: D001786:Blood Glucose