Continuous Monitoring of Islet-Cell-Transplant Patients Helps Predict Graft Dysfunction: Presented at AACE

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Title: Continuous Monitoring of Islet-Cell-Transplant Patients Helps Predict Graft Dysfunction: Presented at AACE
URL: http://www.pslgroup.com/dg/221B52.htm
Doctor's Guide
May 21, 2008

By Ric Susman

ORLANDO, Fla -- May 21, 2008 -- Patients with type 1 diabetes who received an islet-cell transplantation experienced benefit from a continuous glucose-monitoring system that predicts graft dysfunction for at least 18 months after the transplant, researchers reported here at the 17th Annual Meeting and Clinical Congress of the American Association of Clinical Endocrinologists (AACE).

Lisa Gorn, DO, Endocrinology Fellow, University of Miami Miller School of Medicine, Miami, Florida, and colleagues recruited 25 patients with type 1 (juvenile) diabetes, 12 of whom had received islet-cell transplants and 13 of whom acted as control subjects.

The researchers followed patients' weight, body mass indices, insulin use, haemoglobin (Hb) A1C, 90-minute glucose after a mixed meal tolerance test, and fasting C-peptide/glucose ratio. Patients underwent follow-up with the research team every 3 months for 18 months.

After 18 months, the researchers noted that the mean interstitial glucose and glucose variability were significantly lower in the islet-transplantation group (P < .05) at all times, except at 3 months and 15 months.

Compared with controls, the percentage of time spent in a hypoglycaemic state was significantly and consistently lower in the transplant group. "There was no association between insulin use and hypoglycaemia in the transplantation group," Dr. Gorn explained in her poster presentation here May 17.

Time in normoglycaemia was increased in the transplantation group at all times except 15 months. Decreased time in hyperglycaemia was significant at 6, 9, 12, and 18 months in the transplantation group. Hb A1C, 90-minute glucose reading, and C-peptide/glucose ratios were significantly improved at all times after transplantation.

Several factors indicated the occurrence of graft dysfunction when compared with other timepoints: mean interstitial glucose levels increased by 19.4 mg/dL, standard deviation increased by 15.1 mg/dL; glucose variability was 19.8 mg/dL; and glucose tolerance level was greater than 140 mg/dL more than 19.4% of the time.

By continuously monitoring patients' glucose, Dr. Gorn suggested, earlier detection of graft dysfunction and prediction of graft dysfunction could be accomplished.

"The benefits [of islet-cell transplantation were seen] regardless of insulin independence -- including decreases in hypoglycaemia, maintenance of glucose stability, and increases in normoglycaemia," said Dr. Gorn. "[These benefits] were still apparent after 18 months postprocedure."

[Presentation title: Continuous Glucose Monitoring System as an Indicator of Graft Dysfunction in Islet Transplantation. Abstract 225]

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