Back to Search
Start Over
Long term (4 years) improved insulin sensitivity following islet cell transplant in type 1 diabetes.
- Source :
-
Diabetes/metabolism research and reviews [Diabetes Metab Res Rev] 2018 Mar; Vol. 34 (3). Date of Electronic Publication: 2018 Jan 11. - Publication Year :
- 2018
-
Abstract
- Background: Impaired insulin sensitivity (IS) predicts complications and mortality in type 1 diabetes (T1D). Insulin sensitivity improves shortly after islet cell transplant for T1D, yet long-term changes in IS and associated factors such as patient characteristics, transplant factors, clinical management, and IS-related biomarkers are unknown.<br />Methods: Up to 9 years (mean 4) of longitudinal data were available on 22 adults (18 female) with T1D who received 1 to 3 transplants in Phase 1/2 or 3 clinical trials (2004-2014). Metabolic testing posttransplant estimated IS by the Homeostasis Model Assessment for Insulin Resistance (HOMA-IR; 111 observations) and the Simple Index of Insulin Sensitivity (SI <subscript>is</subscript> ; 95 observations).<br />Results: Simple Index of Insulin Sensitivity significantly increased the first year posttransplant (P = .02), then stabilized (P = .39); HOMA-IR remained stable posttransplant (P = .92). Adjusting for age and BMI, higher SI <subscript>is</subscript> was associated with lower HbA1c following transplant (P = .03). Greater IS as measured by lower HOMA-IR and higher SI <subscript>is</subscript> was associated with lower fasting C-peptide (both P ≤ .04) and also with higher exenatide dose (both P ≤ .01). More islets transplanted were associated with higher SI <subscript>is</subscript> (P < .0001). Lower leptin at transplant predicted lower HOMA-IR and higher SI <subscript>is</subscript> after transplant, and lower bone marker receptor activator of nuclear factor kappa-B ligand predicted lower HOMA-IR (all P ≤ .01).<br />Conclusions: Insulin sensitivity measured by SI <subscript>is</subscript> was improved several years following transplant, while IS measured by HOMA-IR did not worsen. Higher exenatide dose, more islets transplanted, and diet and exercise (lowering leptin and receptor activator of nuclear factor kappa-B ligand) may improve IS, which may enhance glycaemic control and lower metabolic demand on transplanted islets. Long-term clamp studies are needed to confirm these results.<br /> (Copyright © 2017 John Wiley & Sons, Ltd.)
- Subjects :
- Biomarkers analysis
Blood Glucose analysis
Clinical Trials, Phase I as Topic
Diabetes Mellitus, Type 1 surgery
Female
Follow-Up Studies
Glucose Tolerance Test
Glycated Hemoglobin analysis
Homeostasis
Humans
Longitudinal Studies
Male
Middle Aged
Prognosis
Diabetes Mellitus, Type 1 drug therapy
Hypoglycemic Agents therapeutic use
Insulin therapeutic use
Insulin Resistance
Islets of Langerhans Transplantation
Subjects
Details
- Language :
- English
- ISSN :
- 1520-7560
- Volume :
- 34
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Diabetes/metabolism research and reviews
- Publication Type :
- Academic Journal
- Accession number :
- 29230944
- Full Text :
- https://doi.org/10.1002/dmrr.2972