title: Spontaneous Hypoglycemia After Islet Autotransplantation for Chronic Pancreatitis.
abstract: Spontaneous hypoglycemia has been reported in patients after total pancreatectomy (TP) and islet autotransplantation (IAT) with maintained insulin independence. Details surrounding these events have not been well described.
  
  
  
  The objective of the study was to determine the frequency and characteristics of spontaneous hypoglycemia in patients undergoing TP-IAT and/or to ascertain predictive or protective factors of its development.
  
  
  
  This was an observational cohort study in 40 patients who underwent TP-IAT from August 2008 to May 2014, with a median follow-up of 34 months.
  
  
  
  The study was conducted at a single institution (Cleveland Clinic).
  
  
  
  Patients included recipients of TP-IAT.
  
  
  
  The intervention included small, frequent meals in those patients who developed spontaneous hypoglycemia.
  
  
  
  Incidence of spontaneous hypoglycemia development, characteristics of the patients developing hypoglycemia, and their response to small, frequent meals were measured.
  
  
  
  Six of 12 patients, who maintained insulin independence, developed spontaneous hypoglycemia. The episodes could be fasting, postprandial, and/or exercise associated, with the frequency ranging from two to three times daily to once every 1-2 weeks. All patients experienced at least one episode that required external assistance, glucagon administration, and/or emergent medical attention. Patients who developed hypoglycemia had a lower median age and tended to have a lower median islet equivalent/kg body weight but a higher median total islet equivalent, body mass index, and homeostatic model assessment for insulin resistance score. All patients who received small, frequent meal intervention had improvement in severity and/or frequency of the hypoglycemic episodes.
  
  
  
  Spontaneous hypoglycemia is prevalent after TP-IAT. Although the underlying pathophysiology responsible for these hypoglycemia events remains to be elucidated, small, frequent meal intervention is helpful in ameliorating this condition.
authors.affiliation: Department of Endocrinology, Diabetes, and Metabolism (Y.K.L., C.F., P.C.J., B.A.H.), Endocrinology and Metabolism Institute, Departments of General Surgery (R.M.W.) and Gastroenterology and Hepatology (T.S.), Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio 44195; and Islet Isolation Laboratory (R.B.), Institute of Cellular Therapeutics, Allegheny Health Network, Pittsburgh, Pennsylvania 15212.
authors.forename: Yu Kuei
authors.initials: YK
authors.lastname: Lin
authors.affiliation: Department of Endocrinology, Diabetes, and Metabolism (Y.K.L., C.F., P.C.J., B.A.H.), Endocrinology and Metabolism Institute, Departments of General Surgery (R.M.W.) and Gastroenterology and Hepatology (T.S.), Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio 44195; and Islet Isolation Laboratory (R.B.), Institute of Cellular Therapeutics, Allegheny Health Network, Pittsburgh, Pennsylvania 15212.
authors.forename: Charles
authors.initials: C
authors.lastname: Faiman
authors.affiliation: Department of Endocrinology, Diabetes, and Metabolism (Y.K.L., C.F., P.C.J., B.A.H.), Endocrinology and Metabolism Institute, Departments of General Surgery (R.M.W.) and Gastroenterology and Hepatology (T.S.), Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio 44195; and Islet Isolation Laboratory (R.B.), Institute of Cellular Therapeutics, Allegheny Health Network, Pittsburgh, Pennsylvania 15212.
authors.forename: Philip C
authors.initials: PC
authors.lastname: Johnston
authors.affiliation: Department of Endocrinology, Diabetes, and Metabolism (Y.K.L., C.F., P.C.J., B.A.H.), Endocrinology and Metabolism Institute, Departments of General Surgery (R.M.W.) and Gastroenterology and Hepatology (T.S.), Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio 44195; and Islet Isolation Laboratory (R.B.), Institute of Cellular Therapeutics, Allegheny Health Network, Pittsburgh, Pennsylvania 15212.
authors.forename: R Matthew
authors.initials: RM
authors.lastname: Walsh
authors.affiliation: Department of Endocrinology, Diabetes, and Metabolism (Y.K.L., C.F., P.C.J., B.A.H.), Endocrinology and Metabolism Institute, Departments of General Surgery (R.M.W.) and Gastroenterology and Hepatology (T.S.), Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio 44195; and Islet Isolation Laboratory (R.B.), Institute of Cellular Therapeutics, Allegheny Health Network, Pittsburgh, Pennsylvania 15212.
authors.forename: Tyler
authors.initials: T
authors.lastname: Stevens
authors.affiliation: Department of Endocrinology, Diabetes, and Metabolism (Y.K.L., C.F., P.C.J., B.A.H.), Endocrinology and Metabolism Institute, Departments of General Surgery (R.M.W.) and Gastroenterology and Hepatology (T.S.), Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio 44195; and Islet Isolation Laboratory (R.B.), Institute of Cellular Therapeutics, Allegheny Health Network, Pittsburgh, Pennsylvania 15212.
authors.forename: Rita
authors.initials: R
authors.lastname: Bottino
authors.affiliation: Department of Endocrinology, Diabetes, and Metabolism (Y.K.L., C.F., P.C.J., B.A.H.), Endocrinology and Metabolism Institute, Departments of General Surgery (R.M.W.) and Gastroenterology and Hepatology (T.S.), Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio 44195; and Islet Isolation Laboratory (R.B.), Institute of Cellular Therapeutics, Allegheny Health Network, Pittsburgh, Pennsylvania 15212.
authors.forename: Betul A
authors.initials: BA
authors.lastname: Hatipoglu
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007003:Hypoglycemia / Q000178:diet therapy / Q000453:epidemiology / Q000209:etiology*; D015994:Incidence; D016381:Islets of Langerhans Transplantation / Q000009:adverse effects* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects* / Q000706:statistics & numerical data; D050500:Pancreatitis, Chronic / Q000453:epidemiology / Q000601:surgery*; D014182:Transplantation, Autologous; D055815:Young Adult