Islet Transplantation Provides Superior Glycemic Control With Less Hypoglycemia Compared With Continuous Subcutaneous Insulin Infusion or Multiple Daily Insulin Injections
Islet Transplantation Provides Superior Glycemic Control With Less Hypoglycemia Compared With Continuous Subcutaneous Insulin Infusion or Multiple Daily Insulin Injections
复制标题
DOI：
10.1097/tp.0000000000001381
复制
发表时间：
2017-06-01
期刊：
影响因子：
6.2
通讯作者：
O'Connell, Philip J.
中科院分区：
文献类型：
--
作者：
Holmes-Walker, Deborah Jane;Gunton, Jenny E.;O'Connell, Philip J.
背景目的是比较每日多次注射（MDI）、持续皮下胰岛素输注（CSII）和胰岛移植在降低1型糖尿病严重低血糖患者低血糖和血糖变异性方面的疗效。方法.这是一项在10名患有严重低血糖的1型糖尿病受试者中进行的MDI和CSII以及CSII与12个月胰岛移植后的受试者内配对比较，适用于胰岛移植。采用HbA 1c、埃德蒙顿低血糖评分（HYPO评分）、连续血糖监测（CGM）对个体进行评估，并在8名受试者中使用CGM的血糖标准差（SD血糖）和使用4小时间隔（CONGA 4）的连续重叠净血糖作用测量血糖变异性。结果在移植前从MDI改为CSII后，10例受试者的中位HYPO评分从2028降至1085（P < 0.05），低血糖事件从24例/患者年降至8例/患者年（P < 0.05）。CSII治疗后，血糖、糖化血红蛋白、CGM平均血糖和中位低血糖时间百分比无明显变化，而SD血糖和CONGA 4显著降低（P < 0.05）。移植后12个月，10例中有9例C肽阳性（5例不依赖胰岛素）。与CSII相比，小组织移植后12个月，所有基线参数均显著降低，HbA 1c（6.4% cf 8.2%）、中位HYPO评分（0 cf 1085）、平均血糖（7.1 cf 8.6 mmol L-1）、SD血糖（1.7 cf 3.2 mmol/L）和CONGA 4（1.6 cf 3.0）。结论.在适合胰岛移植的严重低血糖受试者中，与MDI相比，CSII降低了低血糖频率和血糖变异性，而胰岛移植解决了低血糖，并进一步改善了血糖变异性，无论胰岛素依赖性如何。
Background. The aim was to compare efficacy of multiple daily injections (MDI), continuous subcutaneous insulin infusion (CSII) and islet transplantation to reduce hypoglycemia and glycemic variability in type 1 diabetes subjects with severe hypoglycemia. Methods. This was a within-subject, paired comparison of MDI and CSII and CSII with 12 months postislet transplantation in 10 type 1 diabetes subjects referred with severe hypoglycemia, suitable for islet transplantation. Individuals were assessed with HbA1c, Edmonton Hypoglycemia Score (HYPOscore), continuous glucose monitoring (CGM) and in 8 subjects measurements of glucose variability using standard deviation of glucose (SD glucose) from CGM and continuous overlapping net glycemic action using a 4 hour interval (CONGA4). Results. After changing from MDI to CSII before transplantation, 10 subjects reduced median HYPOscore from 2028 to 1085 (P < 0.05) and hypoglycemia events from 24 to 8 per patient-year (P < 0.05). While HbA1c, mean glucose and median percent time hypoglycemic on CGM were unchanged with CSII, SD glucose and CONGA4 reduced significantly (P < 0.05). At 12 months posttransplant 9 of 10 were C-peptide positive, (5 insulin independent). Twelve months postislet transplantation, there were significant reductions in all baseline parameters versus CSII, respectively, HbA1c (6.4% cf 8.2%), median HYPOscore (0 cf 1085), mean glucose (7.1 cf 8.6 mmol L-1), SD glucose (1.7 cf 3.2 mmol/L), and CONGA4 (1.6 cf 3.0). Conclusions. In subjects with severe hypoglycemia suitable for islet transplantation, CSII decreased hypoglycemia frequency and glycemic variability compared with MDI whereas islet transplantation resolved hypoglycemia and further improved glycemic variability regardless of insulin independence.