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Minimal Functional β-Cell Mass in Intraportal Implants That Reduces Glycemic Variability in Type 1 Diabetic Recipients
OBJECTIVE: Previous work has shown a correlation between β-cell number in cultured islet cell grafts and their ability to induce C-peptide secretion after intraportal implantation in C-peptide–negative type1 diabetic patients. In this cross-sectional study, we examined the minimal functional β-cell...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
American Diabetes Association
2013
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3816855/ https://www.ncbi.nlm.nih.gov/pubmed/24041683 http://dx.doi.org/10.2337/dc13-0128 |
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author | Gillard, Pieter Hilbrands, Robert Van de Velde, Ursule Ling, Zhidong Lee, Da Hae Weets, Ilse Gorus, Frans De Block, Christophe Kaufman, Leonard Mathieu, Chantal Pipeleers, Daniel Keymeulen, Bart |
author_facet | Gillard, Pieter Hilbrands, Robert Van de Velde, Ursule Ling, Zhidong Lee, Da Hae Weets, Ilse Gorus, Frans De Block, Christophe Kaufman, Leonard Mathieu, Chantal Pipeleers, Daniel Keymeulen, Bart |
author_sort | Gillard, Pieter |
collection | PubMed |
description | OBJECTIVE: Previous work has shown a correlation between β-cell number in cultured islet cell grafts and their ability to induce C-peptide secretion after intraportal implantation in C-peptide–negative type1 diabetic patients. In this cross-sectional study, we examined the minimal functional β-cell mass (FBM) in the implant that induces metabolic improvement. RESEARCH DESIGN AND METHODS: Glucose clamps assessed FBM in 42 recipients with established implants. C-peptide release during each phase was expressed as percentage of healthy control values. Its relative magnitude during a second hyperglycemic phase was most discriminative and therefore selected as a parameter to be correlated with metabolic effects. RESULTS: Recipients with functioning β-cell implants exhibited average FBM corresponding to 18% of that in normal control subjects (interquartile range 10–33%). Its relative magnitude negatively correlated with HbA(1c) levels (r = −0.47), daily insulin dose (r = −0.75), and coefficient of variation of fasting glycemia (CVfg) (r = −0.78, retained in multivariate analysis). A correlation between FBM and CVfg <25% appeared from the receiver operating characteristic curve (0.97 [95% CI 0.93–1.00]). All patients with FBM >37% exhibited CVfg <25% and a >50% reduction of their pretransplant CVfg; this occurred in none with FBM <5%. Implants with FBM >18% reduced CVfg from a median pretransplant value of 46 to <25%. CONCLUSIONS: Glucose clamping assesses the degree of restoration in FBM achieved by islet cell implants. Values >37% of normal control subjects appear needed to reduce glycemic variability in type 1 diabetic recipients. Further studies should examine whether the test can help guide decisions on additional islet cell transplants and on adjusting or stopping immunotherapy. |
format | Online Article Text |
id | pubmed-3816855 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2013 |
publisher | American Diabetes Association |
record_format | MEDLINE/PubMed |
spelling | pubmed-38168552014-11-01 Minimal Functional β-Cell Mass in Intraportal Implants That Reduces Glycemic Variability in Type 1 Diabetic Recipients Gillard, Pieter Hilbrands, Robert Van de Velde, Ursule Ling, Zhidong Lee, Da Hae Weets, Ilse Gorus, Frans De Block, Christophe Kaufman, Leonard Mathieu, Chantal Pipeleers, Daniel Keymeulen, Bart Diabetes Care Original Research OBJECTIVE: Previous work has shown a correlation between β-cell number in cultured islet cell grafts and their ability to induce C-peptide secretion after intraportal implantation in C-peptide–negative type1 diabetic patients. In this cross-sectional study, we examined the minimal functional β-cell mass (FBM) in the implant that induces metabolic improvement. RESEARCH DESIGN AND METHODS: Glucose clamps assessed FBM in 42 recipients with established implants. C-peptide release during each phase was expressed as percentage of healthy control values. Its relative magnitude during a second hyperglycemic phase was most discriminative and therefore selected as a parameter to be correlated with metabolic effects. RESULTS: Recipients with functioning β-cell implants exhibited average FBM corresponding to 18% of that in normal control subjects (interquartile range 10–33%). Its relative magnitude negatively correlated with HbA(1c) levels (r = −0.47), daily insulin dose (r = −0.75), and coefficient of variation of fasting glycemia (CVfg) (r = −0.78, retained in multivariate analysis). A correlation between FBM and CVfg <25% appeared from the receiver operating characteristic curve (0.97 [95% CI 0.93–1.00]). All patients with FBM >37% exhibited CVfg <25% and a >50% reduction of their pretransplant CVfg; this occurred in none with FBM <5%. Implants with FBM >18% reduced CVfg from a median pretransplant value of 46 to <25%. CONCLUSIONS: Glucose clamping assesses the degree of restoration in FBM achieved by islet cell implants. Values >37% of normal control subjects appear needed to reduce glycemic variability in type 1 diabetic recipients. Further studies should examine whether the test can help guide decisions on additional islet cell transplants and on adjusting or stopping immunotherapy. American Diabetes Association 2013-11 2013-10-15 /pmc/articles/PMC3816855/ /pubmed/24041683 http://dx.doi.org/10.2337/dc13-0128 Text en © 2013 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details. |
spellingShingle | Original Research Gillard, Pieter Hilbrands, Robert Van de Velde, Ursule Ling, Zhidong Lee, Da Hae Weets, Ilse Gorus, Frans De Block, Christophe Kaufman, Leonard Mathieu, Chantal Pipeleers, Daniel Keymeulen, Bart Minimal Functional β-Cell Mass in Intraportal Implants That Reduces Glycemic Variability in Type 1 Diabetic Recipients |
title | Minimal Functional β-Cell Mass in Intraportal Implants That Reduces Glycemic Variability in Type 1 Diabetic Recipients |
title_full | Minimal Functional β-Cell Mass in Intraportal Implants That Reduces Glycemic Variability in Type 1 Diabetic Recipients |
title_fullStr | Minimal Functional β-Cell Mass in Intraportal Implants That Reduces Glycemic Variability in Type 1 Diabetic Recipients |
title_full_unstemmed | Minimal Functional β-Cell Mass in Intraportal Implants That Reduces Glycemic Variability in Type 1 Diabetic Recipients |
title_short | Minimal Functional β-Cell Mass in Intraportal Implants That Reduces Glycemic Variability in Type 1 Diabetic Recipients |
title_sort | minimal functional β-cell mass in intraportal implants that reduces glycemic variability in type 1 diabetic recipients |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3816855/ https://www.ncbi.nlm.nih.gov/pubmed/24041683 http://dx.doi.org/10.2337/dc13-0128 |
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