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Socially funded islet transplant program yields improved outcomes
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In socioeconomically deprived patients with type 1 diabetes, a nationally funded islet transplantation program appears to significantly improve outcomes, according to recent study findings.
In the study, Shareen Forbes, PhD, of the University of Edinburgh and Queen’s Medical Research Institute in the United Kingdom, and colleagues evaluated 106 patients (57% women) referred for islet transplantation assessment and 18 patients who received transplants (32 infusions) between November 2009 and May 2014 in the Scottish Islet Transplant Programme.
The patients had C-peptide–negative diabetes exacerbated by recurrent, severe hypoglycemia in spite of robust conventional treatment. Patients were assigned a Deprivation Category score, which classified postal code sectors based on income, employment, health, housing and education to determine socioeconomic status. Ability to conduct normal tasks, such as driving and working, was also evaluated.
Of the 18 patients who underwent transplantation, 14 were followed for 12 or more months after the procedure, and metabolic and athropometric measurements were taken before and after transplant. Mixed-meal tolerance tests and 6-day continuous glucose monitoring were conducted at approximately 1, 3, 6 and 12-month follow-ups. The researchers also assessed the characteristics of donors, and at each visit the researchers recorded data about the participants’ insulin therapy, awareness of hypoglycemia and frequency of severe hypoglycemia.
Compared with the general population, referred patients and those who underwent transplant had a higher prevalence of socioeconomic deprivation (P < .05).
Compared with referred patients, socioeconomically deprived status was identified in 73% of patients who underwent transplant; moreover, 88% of recipients did not have a driver’s license and 94% had decreased capacity to work (P < .01).
Obesity was prevalent among pancreas donors, including circulatory death donors. At the 12-month follow-up, 93% of patients who underwent transplantation had graft function and decreased incidence of hypoglycemia with no events recorded at 12-months post-transplant compared with four episodes per week before the transplant. There were also an improved awareness of hypoglycemia after transplantation and improvements in glycemic control as reflected by HbA1c levels seen at about 3 and 6 months after the first transplant. Reductions in glycemic fluctuation and central adiposity were also noted (P < .05).
“Islet transplantation reduced the frequency of hypoglycemia and improved awareness of hypoglycemia and glycemic control,” the researchers wrote. “Transplantation also diminished insulin requirements and decreased central obesity and fat mass. Furthermore, there was evidence of endogenous insulin secretion post-transplantation. Our studies indicate that quality of life may be improved post-transplantation, as assessed by driving status, an increased ability to work and increased personal income; however, prospective studies are required to demonstrate long-term socioeconomic benefit.” – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.
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