Continuous Glucose Monitoring after Islet Transplantation in Type 1 Diabetes: An Excellent Graft Function (β-Score Greater Than 7) Is Required to Abrogate Hyperglycemia, Whereas a Minimal Function Is Necessary to Suppress Severe Hypoglycemia (β-Score Greater Than 3)
Open accessAbstract
CONTEXT: For the last 10 yr, continuous glucose monitoring (CGM) has brought up new insights into the accuracy of blood glucose analysis. OBJECTIVE: Our objective was to determine how islet graft function was able to influence the various components of dysglycemia after islet transplantation (IT). DESIGN AND SETTING: We conducted a single-arm open-labeled study with a 3-yr follow-up in a referral center (ClinicalTrial.gov identifiers NCT00446264 and NCT01123187). PATIENTS: Twenty-three consecutive patients with type 1 diabetes (14 islet alone, nine islet after kidney) received IT within 3 months using the Edmonton protocol. INTERVENTION: INTERVENTION included 72-h CGM before and 3, 6, 9, 12, 24, and 36 months after transplantation. MAIN OUTCOME MEASURE: Graft function was estimated via β-score, a previously validated index (range 0-8) based on treatment requirements, C-peptide, blood glucose, and glycated hemoglobin. RESULTS: At the 3-yr visit, graft function persisted in 19 patients (82%), and 10 (43%) remained insulin independent. Glycated hemoglobin decreased in the whole cohort from 8.3% (7.3-9.0%) at baseline to 6.7% (5.9-7.7%) at 3 yr [median (interquartile range), P < 0.01]. Mean glucose, glucose sd, and time spent with glycemia above 10 mmol/liter (hyperglycemia) and below 3 mmol/liter (hypoglycemia) were significantly lower after IT (P < 0.05 vs. baseline). The four CGM outcomes were related to β-score (P < 0.001). However, partial function (β-score >3) was sufficient to abrogate hypoglycemia; suboptimal function (β-score >5) was necessary to significantly improve mean glucose, glucose sd, and hyperglycemia; and optimal function (β score >7) was necessary to normalize them. CONCLUSION: The four components of dysglycemia were not equally affected by the degree of islet graft function, which could have important implications for future development of β-cell replacement. A β-score above 3 dramatically reduced the occurrence of hypoglycemia.
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Even without insulin independence, a small amount of islet graft function can prevent severe life-threatening hypoglycaemia.
“Even if insulin independence is not achieved, severe life-threatening hypoglycaemia can be prevented with minimal islet transplant function.162,163”
From Type 1 diabetes (2018) · cites this paper as [162]
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- Authors
- Vantyghem, M.-C., Raverdy, V., Balavoine, A.-S., Defrance, F., Caiazzo, R., Arnalsteen, L., Gmyr, V., Hazzan, M., Noël, C., Kerr-Conte, J., & Pattou, F.
- Affiliations
- Inserm (FR)
- Centre Hospitalier Universitaire de Lille (FR)
- Corresponding author
- Vantyghem, Marie-Christine
- ORCID
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2012-11
- Volume
- 97
- Issue
- 11
- Pages
- E2078-E2083
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- PMC
- PMC3485599
- OpenAlex
- W2039152804
- Cited by
- 103
- References
- 22
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 4 · 2023: 8 · 2022: 8 · 2021: 10 · 2020: 5 · 2019: 14 · 2018: 14 · 2017: 4 · 2016: 7 · 2015: 9 · 2014: 9 · 2013: 3 · 2012: 1
- FWCI
- 7.17
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Pancreatic function and diabetes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Keywords
- islet transplantation, type 1 diabetes, continuous glucose monitoring, islet graft function, hyperglycemia, hypoglycemia, HbA1c, Edmonton protocol, insulin independence, glycemic variability, C-peptide, glycemic control, hypoglycemia prevention, hyperglycemia prevention
- MeSH terms
- Adult, Blood Glucose, C-Peptide, Diabetes Mellitus, Type 1, Female, Follow-Up Studies, Glycated Hemoglobin, Humans, Hyperglycemia, Hypoglycemia, Male, Middle Aged, Blood Glucose Self-Monitoring, Islets of Langerhans Transplantation, Treatment Outcome
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