CGM Shows Islet Transplantation Prevents Hypoglycemia, Correcting Time in Range and Reducing Glycemic Variability, Despite Subnormal Beta-Cell Function

Forbes, Shareen; Olateju, Tolu; Lam, Anna; Casey, John; Campbell, John C.; Reid, Lesley Williams; Oram, Richard A.; Malcolm, Andrew J.; Shapiro, A.M. James; Senior, Peter

doi:10.2337/db18-143-or

Cited by 3 publications

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“…There are reductions in mean glucose, time spent in hyperglycaemia and hypoglycaemia and coefficient of variation (CV) of glucose. 36,42,43 Higher levels of C-peptide are required to reduce time in hyperglycaemia versus time in hypoglycaemia. 44 Our own work has related BETA-2 scores to CGM indices; at 1 year post-transplant, 39 ICT recipients had lower time in hypoglycaemia and decreased CV glucose versus those on open loop continuous subcutaneous insulin infusion (CSII) therapy.…”

Section: Graft Assessments and Outcomesmentioning

confidence: 99%

“…44 Our own work has related BETA-2 scores to CGM indices; at 1 year post-transplant, 39 ICT recipients had lower time in hypoglycaemia and decreased CV glucose versus those on open loop continuous subcutaneous insulin infusion (CSII) therapy. 43 Over time post-transplant, glycaemic variability increases as graft function falls. An area of intensive research currently is how glycaemic variability per se contributes to microvascular and macrovascular complications as well as quality of life measures independently from HbA1c.…”

Section: Graft Assessments and Outcomesmentioning

confidence: 99%

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Effects of islet transplantation on microvascular and macrovascular complications in type 1 diabetes

2021

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Type 1 diabetes is associated with high morbidity and mortality from microvascular and macrovascular disease with considerable economic cost to society. Islet cell transplantation (ICT) is a treatment option recommended by National Institute for Health and Care Excellence (NICE) for people with debilitating hypoglycaemia due to type 1 diabetes, including those with renal failure where kidney transplantation may also be indicated.The primary aim of ICT is to improve glycaemic control, reduce severe hypoglycaemia, stabilise glycaemic variability and restore awareness of hypoglycaemia where this is compromised. Insulin independence, although not a primary aim, should also be considered a therapeutic goal. The impact ICT has on the progression of microvascular and macrovascular diabetes complications is derived from small studies and has not been examined in large clinical trials. Lifelong immunosuppression, which is necessary to avoid transplant rejection, has adverse effects on lipid metabolism, hypertension and renal function, which must also be considered. In this review, we discuss the role of ICT in type 1 diabetes management and the available evidence with respect to microvascular and macrovascular disease progression post-transplantation. We conclude that, following ICT, microvascular complications including retinopathy and neuropathy are stabilised or improved. Effects on nephropathy can be complicated by coexisting kidney transplantation and the impact of immunosuppression, the latter leading to an early decline in renal function; however, there is evidence to suggest stable renal outcomes in the long term.Short-term studies have demonstrated a positive impact of ICT on surrogate markers of macrovascular disease; however, long-term studies and trials in this area are lacking. K E Y W O R D Sislet transplantation, macrovascular disease, microvascular disease, type 1 diabetes What's new?• Islet transplantation is a treatment option recommended by NICE for recurrent severe hypoglycaemia with impaired awareness of hypoglycaemia in Type 1 diabetes where conventional insulin therapy has been optimised. • Microvascular complications including retinopathy, sensory neuropathy and longterm renal function (eGFR) are stabilised or improved following islet transplantation.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

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Section: Graft Assessments and Outcomesmentioning

confidence: 99%

Section: Graft Assessments and Outcomesmentioning

confidence: 99%

Effects of islet transplantation on microvascular and macrovascular complications in type 1 diabetes

2021

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“…Recently, increased use of flash glucose monitoring and continuous glucose monitoring (CGM) have highlighted the impact of persistent C-peptide on glycemic variability and hypoglycemia [ 12 , 14 , 15 , 17-19 ]. Most data have been derived from studies of adults with long duration T1D or post islet transplantation where C-peptide persistence is associated with lower glycated hemoglobin A 1c (HbA 1c ) and/or insulin dose, fewer low-glucose events, decreased variation, and more time spent in range (3.9-10 mmol/L) [ 11 , 12 , 14 , 15 , 19 ]. Less is known about the impact of C-peptide close to diagnosis.…”

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confidence: 99%

Measurement of Peak C-Peptide at Diagnosis Informs Glycemic Control but not Hypoglycemia in Adults With Type 1 Diabetes

Oram

Marren

McDonald

et al. 2021

Journal of the Endocrine Society

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Context High residual C-peptide in longer duration type 1 diabetes associates with fewer hypoglycemic events and reduced glycemic variability. Little is known about the impact of C-peptide close-to-diagnosis. Objective Using continuous glucose monitoring (CGM) data from a study of newly diagnosed adults with type 1 diabetes, we aimed to explore if variation in C-peptide close-to-diagnosis influenced glycemic variability and risk of hypoglycemia. Design We studied newly diagnosed adults with type 1 diabetes who wore a Dexcom G4 CGM for 7 days as part the EXTOD study. We examined the relationship between peak stimulated C-peptide and glycemic metrics of variability and hypoglycemia for 36 CGM traces from 23 participants. Results For every 100 pmol/l increase in peak C-peptide, percentage time spent range 3.9-10 mmol/l was increased by 2.4% [95% CI: 0.5,4.3], p=0.01) with a reduction in time spent in level 1 hyperglycemia (> 10 mmol/l) and level 2 hyperglycemia (> 13.9 mmol/l) by 2.6% [95% CI: -4.9, -0.4, p=0.02) and 1.3% [95% CI: -2.7, -0.006], p= 0.04) respectively. Glucose levels were on average lower by 0.19 mmol/l ([95 % CI: -0.4,0.02], p=0.06) and standard deviation reduced by 0.14 [95% CI: -0.3, -0.02], p=0.02). Hypoglycemia was not common in this group and no association was observed between time spent in hypoglycemia (p=0.97) or hypoglycemic risk (p=0.72). There was no association between peak C-peptide and insulin dose adjusted HbA1c (IDAA1c, p=0.45). Conclusions C-peptide associates with time spent in normal glucose range and with less hyperglycemia, but not risk of hypoglycemia in newly diagnosed people with type 1 diabetes.

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Assessment of Risks and Benefits of Beta Cell Replacement Versus Automated Insulin Delivery Systems for Type 1 Diabetes

et al. 2020

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CGM Shows Islet Transplantation Prevents Hypoglycemia, Correcting Time in Range and Reducing Glycemic Variability, Despite Subnormal Beta-Cell Function

Cited by 3 publications

References 0 publications

Effects of islet transplantation on microvascular and macrovascular complications in type 1 diabetes

Effects of islet transplantation on microvascular and macrovascular complications in type 1 diabetes

Measurement of Peak C-Peptide at Diagnosis Informs Glycemic Control but not Hypoglycemia in Adults With Type 1 Diabetes

Assessment of Risks and Benefits of Beta Cell Replacement Versus Automated Insulin Delivery Systems for Type 1 Diabetes

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