Long-term Effect of Islet Transplantation on Glycemic Variability

Abstract

Islet transplantation has been reported to restore normoglycemia and the overall metabolic control in type 1 diabetes mellitus (DM). In the most experienced centers, islet transplantation clinical outcome is similar to that of the whole pancreas transplantation. Long-term islet transplantation function remains a very interesting matter worth discussing. A progressive islet function decrease was reported, probably due to islet exhaustion. In 5 islet-transplanted patients with at least 3-yr follow-up and still insulin independent, their glycemic control was characterized by a blinded retrospective continuous glucose monitoring system (CGMS). Islet transplantation restored glycemic control and glucose variability. Data were compared with patients in the waiting list. All the parameters of glycemic variability tested had improved significantly in patients who had islet transplantation compared with those patients who were on the waiting list. In conclusion, islet transplantation is able to maintain a proper glucose control and normalize glycemic variability in selected patients. A blinded retrospective CGMS is a useful method to characterize glucose homeostasis deeply in vivo in islet-transplanted patients.

Keywords: continuous glucose monitoring; glycemic variability; islet transplantation.

Fig. 1.

Glucose profiles achieved by retrospective continuous glucose monitoring systems. Each panel represents the glucose profiles of single patients. The glucose profiles of consecutive days (represented by different lines) of single patients are overlapped by one another. In panel A, a representative glucose profile of a patient in the waiting list for a transplant (control group) is shown. In panel B, glucose profiles of the 5 transplanted patients are reported.