title: Islet transplantation from a nationally funded UK centre reaches socially deprived groups and improves metabolic outcomes.
abstract: OBJECTIVE
  Type 1 diabetes complicated by hypoglycaemia is prevalent in socioeconomically deprived populations. Islet transplantation is of proven efficacy in type 1 diabetes complicated by hypoglycaemia, but it is not known if nationally funded programmes reach the socioeconomically deprived. Our aim was to determine: (1) socioeconomic indices in participants referred to our nationally funded programme; and (2) if metabolic outcomes in our transplant recipients were improved.
  
  
  METHODS
  Participants referred (n = 106) and receiving transplants (n = 18; 32 infusions) were examined with respect to socioeconomic status (deprivation category score) and their ability to work and drive. In participants followed for ≥12 months after transplantation, metabolic and anthropometric measurements (n = 14) were recorded pre- and post-transplant (assessed ~1, ~3, ~6 and ~12 months with mixed-meal tolerance tests and 6 day continuous glucose monitoring assessments). Donor data was also examined.
  
  
  RESULTS
  There was a greater prevalence of socioeconomic deprivation in referred and transplant recipients than the general population (p < 0.05). Of the transplant recipients, 73% were socioeconomically deprived, 88% did not hold a driver's license and 94% had reduced ability to work (all p < 0.01 vs referred participants). Donors were predominantly obese and included circulatory death donors. At 12 months, 93% of participants who had received transplants had graft function, diminished frequency of hypoglycaemia (10 [4-11] vs 0 [0-2] hypoglycaemic episodes/week), improved awareness of hypoglycaemia (Gold score 7 [5-7] vs 1 [1-2]) and glycaemic control (HbA1c: 7.9% [7.2-8.5%]; 63 [55-69] mmol/mol vs 7.2% [6.8-7.5%]; 55 [51-58] mmol/mol), diminished glycaemic lability and decreased central adiposity (all p < 0.05).
  
  
  CONCLUSIONS
  A nationally funded islet transplant programme reaches the socioeconomically deprived and outcomes are significantly improved in this group.
authors: Islet Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK, Shareen.Forbes@ed.ac.uk.
authors: Shareen
authors: S
authors: Forbes
authors: Neil W A
authors: NW
authors: McGowan
authors: Kirsty
authors: K
authors: Duncan
authors: Debbie
authors: D
authors: Anderson
authors: Janet
authors: J
authors: Barclay
authors: Donna
authors: D
authors: Mitchell
authors: Kevin
authors: K
authors: Docherty
authors: David
authors: D
authors: Turner
authors: John D M
authors: JD
authors: Campbell
authors: John J
authors: JJ
authors: Casey
mesh_terms: D050154:Adiposity; D000328:Adult; D000886:Anthropometry; D001334:Automobile Driving; D001786:Blood Glucose / Q000032:analysis; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D005380:Financing, Government; D006297:Health Services Accessibility; D006801:Humans; D007003:Hypoglycemia / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D016381:Islets of Langerhans Transplantation / Q000191:economics / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012923:Social Class; D014019:Tissue Donors; D066027:Transplant Recipients; D006113:United Kingdom; D055815:Young Adult
chemical_list: D001786:Blood Glucose