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)
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)
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DOI：
10.1210/jc.2012-2115
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发表时间：
2012-11-01
影响因子：
5.8
通讯作者：
Pattou, Francois
中科院分区：
文献类型：
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作者：
Vantyghem, Marie-Christine;Raverdy, Violeta;Pattou, Francois
内容：在过去的10年里，连续血糖监测（CGM）为血糖分析的准确性带来了新的见解。目的：我们的目的是确定胰岛移植功能如何影响胰岛移植（IT）后功能障碍的各种成分。设计和设置：我们进行了一项单臂开放标签研究，在转诊中心进行了3年随访（ClinicalTrial.gov标识符NCT 00446264和NCT 01123187）。（14个单独的胰岛，9个在肾脏之后的胰岛）使用埃德蒙顿方案在3个月内接受IT。干预包括移植前和移植后3、6、9、12、24和36个月的72小时CGM。主要结果测量：移植物功能通过先前验证的指标β评分进行评估根据治疗要求、C肽、血糖和糖化血红蛋白，对患者的血糖水平进行评估（范围0-8）。在3年随访时，19例患者（82%）的移植物功能持续存在，10例（43%）保持胰岛素非依赖性。整个队列的糖化血红蛋白从基线时的8.3%（7.3-9.0%）降至3年时的6.7%（5.9-7.7%）[中位数（四分位距），P < 0.01]。IT后平均血糖、血糖SD和血糖高于10 mmol/L（高血糖）和低于3 mmol/L（低血糖）的时间显著降低（与基线相比P < 0.05）。4种CGM结果与β评分相关（P < 0.001）。但是，部分功能（β评分>3）足以消除低血糖;功能欠佳（β评分>5）是显著改善平均葡萄糖、葡萄糖SD和高血糖症所必需的;（beta得分>7）是使它们正常化所必需的。胰岛移植物功能的不同程度对功能障碍的四种成分的影响不同，这可能对β细胞替代的未来发展具有重要意义。β评分高于3显著降低了低血糖的发生率。（临床内分泌代谢杂志97：E2078-E2083，2012）
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 beta-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 beta-score (P < 0.001). However, partial function (beta-score >3) was sufficient to abrogate hypoglycemia; suboptimal function (beta-score >5) was necessary to significantly improve mean glucose, glucose SD, and hyperglycemia; and optimal function (beta 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 beta-cell replacement. A beta-score above 3 dramatically reduced the occurrence of hypoglycemia. (J Clin Endocrinol Metab 97: E2078-E2083, 2012)