title: Assessment of the relationship between hypoglycaemia awareness and autonomic function following islet cell/pancreas transplantation.
abstract: BACKGROUND
  This study assesses the autonomic function of patients who have regained awareness of hypoglycaemia following islet cell or whole pancreas transplant.
  
  
  METHODS
  Five patients with type 1 diabetes and either islet cell (four patients) or whole pancreas (one patient) transplant were assessed. These patients were age-matched and gender-matched to five patients with type 1 diabetes without transplant and preserved hypoglycaemia awareness and five healthy control participants without diabetes. All participants underwent (i) a battery of five cardiovascular autonomic function tests, (ii) quantitative sudomotor axonal reflex testing, and (iii) sympathetic skin response testing.
  
  
  RESULTS
  Total recorded hypoglycaemia episodes per month fell from 76 pre-transplant to 13 at 0- to 3-month post-transplant (83% reduction). The percentage of hypoglycaemia episodes that patients were unaware of decreased from 97 to 69% at 0-3 months (p < 0.001, Fisher's exact test) and to 20% after 12 months (p < 0.0001, Fisher's exact test). This amelioration was maintained at the time of testing (mean time: 4.1 years later, range: 2-6 years). Presence of significant autonomic neuropathy was seen in all five transplanted patients (at least 2/3 above modalities abnormal) but in only one of the patients with diabetes without transplantation.
  
  
  CONCLUSIONS
  The long-term maintenance of hypoglycaemia awareness that returns after islet cell/pancreas transplantation in patients with diabetes is not prevented by significant autonomic neuropathy and is better accounted for by other factors such as reversal of hypoglycaemia-associated autonomic failure.
authors: Centre for Clinical Neurosciences and Neurological Research, St. Vincent's Hospital Melbourne, Victoria, Australia.|Department of Medicine, University of Melbourne, Victoria, Australia.
authors: Jordan T
authors: JT
authors: Kamel
authors: Nephrology, St. Vincent's Hospital Melbourne, Victoria, Australia.|On behalf of the Australian Islet Transplant Consortium.
authors: David J
authors: DJ
authors: Goodman
authors: Endocrinology and Diabetes, St. Vincent's Hospital Melbourne, Victoria, Australia.|On behalf of the Australian Islet Transplant Consortium.
authors: Kathy
authors: K
authors: Howe
authors: Centre for Clinical Neurosciences and Neurological Research, St. Vincent's Hospital Melbourne, Victoria, Australia.|Department of Medicine, University of Melbourne, Victoria, Australia.
authors: Mark J
authors: MJ
authors: Cook
authors: Endocrinology and Diabetes, St. Vincent's Hospital Melbourne, Victoria, Australia.|On behalf of the Australian Islet Transplant Consortium.
authors: Glenn M
authors: GM
authors: Ward
authors: Centre for Clinical Neurosciences and Neurological Research, St. Vincent's Hospital Melbourne, Victoria, Australia.|Department of Medicine, University of Melbourne, Victoria, Australia.
authors: Leslie J
authors: LJ
authors: Roberts
mesh_terms: D001341:Autonomic Nervous System / Q000503:physiopathology; D001342:Autonomic Nervous System Diseases / Q000150:complications / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D002319:Cardiovascular System / Q000294:innervation / Q000503:physiopathology; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D003929:Diabetic Neuropathies / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D059026:Diagnostic Self Evaluation; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000175:diagnosis* / Q000503:physiopathology / Q000517:prevention & control; D016381:Islets of Langerhans Transplantation / Q000009:adverse effects*; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009431:Neural Conduction; D016035:Pancreas Transplantation / Q000009:adverse effects*; D012720:Severity of Illness Index; D012867:Skin / Q000294:innervation / Q000503:physiopathology; D013545:Sweat Glands / Q000294:innervation / Q000503:physiopathology; D013564:Sympathetic Nervous System / Q000503:physiopathology
keywords: autonomic function testing; autonomic neuropathy; hypoglycaemia awareness