217-OR: Islet Transplantation vs. Standard of Care for Type 1 Diabetes Complicated by Severe Hypoglycemia from the Collaborative Islet Transplant Registry (CITR) and T1D Exchange (T1DX) Registry
06/2019
Conference Paper
Authors:
Rickels, M;
Foster N;
Ballou C;
Hering B;
Alejandro R;
Beck R;
Miller K;
Barton F
Secondary:
American Diabetes Association 79th Scientific Sessions
Volume:
68 (Supplement_1)
Pagination:
217-OR
Journal:
Diabetes
Location: San Francisco, CA
DOI:
https://doi.org/10.2337/db19-217-OR
Abstract:
Islet transplantation is an emerging treatment for T1D, in particular for those with long standing disease experiencing severe hypoglycemia events (SHE). A phase 3 trial of islet transplantation in T1D complicated by SHE demonstrated > 80% of islet recipients achieved HbA1c < 7.0% and absence of SHE at 1 year. To better understand the long-term benefit for glycemic control and risk of immunosuppression to kidney function associated with islet transplantation vs. standard of care, we selected patients from CITR with at least one SHE in the year prior to transplant, and compared them to patients from T1DX with at least one SHE in the prior year and followed over 5 years. The cohorts from CITR (n = 58) and T1DX (n = 213) were aged 42 ± 9 and 43 ± 17 with disease duration 29 ± 10 and 26 ± 15 years (P < 0.01) and experienced 5 ± 11 and 2 ± 1 SHE (P < 0.01) in the year prior to baseline with HbA1c 7.3 ± 1.0 vs. 7.8 ± 1.5 (P < 0.001). Mean HbA1c decreased to 6.3% vs. ranging 7.8-7.6% over 5 years (P < 0.001), and the % experiencing recurrent SHE was less in CITR than T1DX (P < 0.01), such that 78-77% vs. 23-28% met the primary endpoint of HbA1c < 7.0% and absence of SHE (P < 0.001). Insulin requirements were slightly less at baseline in CITR than T1DX (0.52 ± 0.14 vs. 0.64 ± 0.31 U/kg/d; P < 0.001), and decreased to 0.06-0.17 vs. remaining 0.66-0.56 U/kg/d over 5 years (P <0.001) with 80-48% insulin independent in CITR. GFR was 92 ± 17 and 90 ± 29 ml/min/1.73 m2 at baseline, and decreased to 83-78 vs. 87-81 ml/min/1.73 m2 over 5 years (P < 0.001). These data demonstrate long-term durability of islet transplantation to achieve near-normal glycemic control in the absence of SHE more often than that observed with standard of care delivered by specialized diabetes practice. Initial reduction in GFR observed during the first-year post-transplant may be attributable to the initiation of immunosuppression, but was not associated with further decline during 5 year follow-up.
