Assessment of the relationship between hypoglycaemia awareness and autonomic function following islet cell/pancreas transplantation. Issue 6 (16th June 2015)

• Record Type: Journal Article
• Authors: Kamel, Jordan T.; Goodman, David J.; Howe, Kathy; Cook, Mark J.; Ward, Glenn M.; Roberts, Leslie J.
• Is Part Of: Diabetes/metabolism research and reviews. Volume 31:Issue 6(2015:Sep.)
• Page Start: 646
• Page End: 650
• Publication Date: 2015-06-16
• Subjects: Diabetes -- Periodicals; Metabolism -- Periodicals; 616.642
• DOI: 10.1002/dmrr.2652
• Languages: English
• ISSNs: 1520-7552

Abstract

<abstract abstract-type="main" id="dmrr2652-abs-0001"> <title>Abstract</title> <sec id="dmrr2652-sec-0001" sec-type="section"> <title>Background</title> <p id="dmrr2652-para-0001">This study assesses the autonomic function of patients who have regained awareness of hypoglycaemia following islet cell or whole pancreas transplant.</p> </sec> <sec id="dmrr2652-sec-0002" sec-type="section"> <title>Methods</title> <p id="dmrr2652-para-0002">Five patients with type 1 diabetes and either islet cell (four patients) or whole pancreas (one patient) transplant were assessed. These patients were age‐matched and gender‐matched to five patients with type 1 diabetes without transplant and preserved hypoglycaemia awareness and five healthy control participants without diabetes. All participants underwent (i) a battery of five cardiovascular autonomic function tests, (ii) quantitative sudomotor axonal reflex testing, and (iii) sympathetic skin response testing.</p> </sec> <sec id="dmrr2652-sec-0003" sec-type="section"> <title>Results</title> <p id="dmrr2652-para-0003">Total recorded hypoglycaemia episodes per month fell from 76 pre‐transplant to 13 at 0‐ to 3‐month post‐transplant (83% reduction). The percentage of hypoglycaemia episodes that patients were unaware of decreased from 97 to 69% at 0–3 months (<italic>p</italic> < 0.001, Fisher's exact test) and to 20% after 12 months (<italic>p</italic> < 0.0001, Fisher's exact test). This amelioration was maintained at the time of testing (mean time: 4.1 years later, range: 2–6 years). Presence of significant autonomic neuropathy was seen in all five transplanted patients (at least 2/3 above modalities abnormal) but in only one of the patients with diabetes without transplantation.</p> </sec> <sec id="dmrr2652-sec-0004" sec-type="section"> <title>Conclusions</title> <p id="dmrr2652-para-0004">The long‐term maintenance of hypoglycaemia awareness that returns after islet cell/pancreas transplantation in patients with diabetes is not prevented by significant autonomic neuropathy and is better accounted for by other factors such as reversal of hypoglycaemia‐associated autonomic failure. Copyright © 2015 John Wiley & Sons, Ltd.</p> </sec> </abstract>