title: Successful Application of Closed-Loop Artificial Pancreas Therapy After Islet Autotransplantation.
abstract: Total pancreatectomy with islet autotransplantation (TPIAT) may relieve the pain of chronic pancreatitis while avoiding postsurgical diabetes. Minimizing hyperglycemia after TPIAT limits beta cell apoptosis during islet engraftment. Closed-loop (CL) therapy combining an insulin pump with a continuous glucose monitor (CGM) has not been investigated previously in islet transplant recipients. Our objective was to determine the feasibility and efficacy of CL therapy to maintain glucose profiles close to normoglycemia following TPIAT. Fourteen adult subjects (36% male; aged 35.9 ± 11.4 years) were randomized to subcutaneous insulin via CL pump (n = 7) or multiple daily injections with blinded CGM (n = 7) for 72 h at transition from intravenous to subcutaneous insulin. Mean serum glucose values were significantly lower in the CL pump group than in the control group (111 ± 4 vs. 130 ± 13 mg/dL; p = 0.003) without increased risk of hypoglycemia (percentage of time <70 mg/dL: CL pump 1.9%, control 4.8%; p = 0.46). Results from this pilot study suggest that CL therapy is superior to conventional therapy in maintaining euglycemia without increased hypoglycemia. This technology shows significant promise to safely maintain euglycemic targets during the period of islet engraftment following islet transplantation.
authors.affiliation: Department of Pediatrics, University of Minnesota Medical Center, Minneapolis, MN.|Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Denver, CO.
authors.forename: G P
authors.initials: GP
authors.lastname: Forlenza
authors.affiliation: Department of Pediatrics, University of Minnesota Medical Center, Minneapolis, MN.
authors.forename: B M
authors.initials: BM
authors.lastname: Nathan
authors.affiliation: Department of Pediatrics, University of Minnesota Medical Center, Minneapolis, MN.
authors.forename: A M
authors.initials: AM
authors.lastname: Moran
authors.affiliation: Department of Surgery, University of Minnesota Medical Center, Minneapolis, MN.
authors.forename: T B
authors.initials: TB
authors.lastname: Dunn
authors.affiliation: Department of Surgery, University of Minnesota Medical Center, Minneapolis, MN.
authors.forename: G J
authors.initials: GJ
authors.lastname: Beilman
authors.affiliation: Department of Surgery, University of Minnesota Medical Center, Minneapolis, MN.
authors.forename: T L
authors.initials: TL
authors.lastname: Pruett
authors.affiliation: Department of Pediatrics, University of Minnesota Medical Center, Minneapolis, MN.
authors.forename: M D
authors.initials: MD
authors.lastname: Bellin
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis*; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007003:Hypoglycemia / Q000517:prevention & control*; D016381:Islets of Langerhans Transplantation; D008297:Male; D008875:Middle Aged; D019397:Pancreas, Artificial; D010180:Pancreatectomy; D050500:Pancreatitis, Chronic / Q000628:therapy*; D010865:Pilot Projects; D011183:Postoperative Complications; D011379:Prognosis; D012307:Risk Factors; D014182:Transplantation, Autologous; D055815:Young Adult
chemical_list: D001786:Blood Glucose
keywords: artificial organs; autotransplantation; clinical research; diabetology; endocrinology; islet transplantation; islets of Langerhans; practice; support devices; type 1