title: Improved Insulin Secretion by Autologous Islet Transplantation, Compared to Oral Antidiabetic Agents, After Distal Pancreatectomy.
abstract: In this study, the effects of autologous islet transplantation (ITx) were compared to those of oral antidiabetic drugs (OAD) after distal pancreatectomy (NCT01922492). We enrolled nondiabetic patients who underwent distal pancreatectomy for benign tumors. In the ITx group, islets were isolated from the normal part of the resected pancreas and implanted via the portal vein. Patients who did not receive ITx were regularly monitored and were enrolled in the OAD group if diabetes mellitus developed. The OAD group was treated with metformin with or without vildagliptin. Metabolic parameters were monitored for 12 months postoperatively. Nine patients in the ITx group and 10 in the OAD group were included in the analysis. After 12 months, hemoglobin A1c significantly increased by 5% of the baseline in each group. Area under the curve for blood glucose (AUCglucose) of the 75-g oral glucose tolerance test increased similarly in the immediate postoperative period in both groups but significantly reduced only in the ITx group thereafter. Insulinogenic index (INSindex) significantly decreased from 25.6 ± 18.9 to 4.7 ± 3.7 in the OAD group, while no significant change was observed in the ITx group (from 15.0 ± 4.5 to 11.0 ± 8.2). In the multiple regression analysis, ITx was an independent factor for changes in AUCglucose and INSindex. In addition, changes in INSindex in the ITx group after postoperative 6 months were associated with the efficacy of islet isolation, amount of grafts, and peak serum HMGB1 and VEGF levels after ITx. ITx was superior to OAD in maintaining insulin secretory capacity and glucose tolerance after distal pancreatectomy.
authors: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors: Ji Won
authors: JW
authors: Yoon
authors: Hye Seung
authors: HS
authors: Jung
authors: Jin Young
authors: JY
authors: Jang
authors: Min Joo
authors: MJ
authors: Kim
authors: Jung Hee
authors: JH
authors: Kim
authors: Jung Hun
authors: JH
authors: Ohn
authors: Jae Hyeon
authors: JH
authors: Kim
authors: Hak Mo
authors: HM
authors: Lee
authors: Hyo Cheol
authors: HC
authors: Kim
authors: Kyoung Bun
authors: KB
authors: Lee
authors: Seung A
authors: SA
authors: Choi
authors: Sun-Whe
authors: SW
authors: Kim
authors: Kyong Soo
authors: KS
authors: Park
mesh_terms: D000218:Adamantane / Q000031:analogs & derivatives / Q000627:therapeutic use; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D024243:HMGB1 Protein / Q000097:blood; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000378:metabolism*; D007333:Insulin Resistance; D000078790:Insulin Secretion; D016381:Islets of Langerhans Transplantation; D008297:Male; D008687:Metformin / Q000627:therapeutic use; D008875:Middle Aged; D009570:Nitriles / Q000627:therapeutic use; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D011759:Pyrrolidines / Q000627:therapeutic use; D014182:Transplantation, Autologous; D042461:Vascular Endothelial Growth Factor A / Q000097:blood; D000077597:Vildagliptin
chemical_list: D000218:Adamantane; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D024243:HMGB1 Protein; D007004:Hypoglycemic Agents; D007328:Insulin; D008687:Metformin; D009570:Nitriles; D011759:Pyrrolidines; D042461:Vascular Endothelial Growth Factor A; D000077597:Vildagliptin