OBJECTIVE: The purpose of this article was to compare two strategies for insulin delivery in brittle type 1 diabetic patients: intraperitoneal insulin infusion (IPII) through an implantable pump and intraportal islet transplantation (IIT). METHODS: Thirteen consecutive patients (6 islet after kidney and 7 islet transplantation alone), treated with IIT according to the Edmonton protocol, were compared with 17 patients treated with IPII in the same center in a nonrandomized study. Both groups of patients were assessed for clinical profile, metabolic results, and adverse events during the 3-year period after implantation. RESULTS: Sex ratio, mean age, body mass index, diabetes duration, daily insulin need (DIN), blood creatinine, lipid and HbA1c levels, and frequency of diabetic complications did not differ significantly between the two groups before inclusion. The comparison of metabolic results 3, 6, and 12 months after IIT or IPII showed that while mean HbA1c significantly decreased over time in both groups, mean DIN, glycemia, and number of hypoglycemias less than 3.3 mmol/L per patient per week (Hypo) only significantly decreased in the IIT group versus baseline. At 12 months, mean DIN, HbA1c, and Hypo were significantly lower in the IIT versus IPII group. After 24 and 36 months, mean DIN, HbA1c, and Hypo remained significantly lower in the IIT group versus baseline, and mean HbA1c and DIN versus IPII. Adverse events were, however, fourfold more frequent with IIT versus IPII, though their numbers decreased over time. CONCLUSION: These results suggest that metabolic results improve with both methods, but were significantly better with IIT versus IPII, though with more frequent side effects.
OBJECTIVE: The purpose of this article was to compare two strategies for insulin delivery in brittle type 1 diabeticpatients: intraperitoneal insulin infusion (IPII) through an implantable pump and intraportal islet transplantation (IIT). METHODS: Thirteen consecutive patients (6 islet after kidney and 7 islet transplantation alone), treated with IIT according to the Edmonton protocol, were compared with 17 patients treated with IPII in the same center in a nonrandomized study. Both groups of patients were assessed for clinical profile, metabolic results, and adverse events during the 3-year period after implantation. RESULTS: Sex ratio, mean age, body mass index, diabetes duration, daily insulin need (DIN), blood creatinine, lipid and HbA1c levels, and frequency of diabetic complications did not differ significantly between the two groups before inclusion. The comparison of metabolic results 3, 6, and 12 months after IIT or IPII showed that while mean HbA1c significantly decreased over time in both groups, mean DIN, glycemia, and number of hypoglycemias less than 3.3 mmol/L per patient per week (Hypo) only significantly decreased in the IIT group versus baseline. At 12 months, mean DIN, HbA1c, and Hypo were significantly lower in the IIT versus IPII group. After 24 and 36 months, mean DIN, HbA1c, and Hypo remained significantly lower in the IIT group versus baseline, and mean HbA1c and DIN versus IPII. Adverse events were, however, fourfold more frequent with IIT versus IPII, though their numbers decreased over time. CONCLUSION: These results suggest that metabolic results improve with both methods, but were significantly better with IIT versus IPII, though with more frequent side effects.
Authors: Stephen T Bartlett; James F Markmann; Paul Johnson; Olle Korsgren; Bernhard J Hering; David Scharp; Thomas W H Kay; Jonathan Bromberg; Jon S Odorico; Gordon C Weir; Nancy Bridges; Raja Kandaswamy; Peter Stock; Peter Friend; Mitsukazu Gotoh; David K C Cooper; Chung-Gyu Park; Phillip OʼConnell; Cherie Stabler; Shinichi Matsumoto; Barbara Ludwig; Pratik Choudhary; Boris Kovatchev; Michael R Rickels; Megan Sykes; Kathryn Wood; Kristy Kraemer; Albert Hwa; Edward Stanley; Camillo Ricordi; Mark Zimmerman; Julia Greenstein; Eduard Montanya; Timo Otonkoski Journal: Transplantation Date: 2016-02 Impact factor: 4.939
Authors: Andrea Vergani; Francesca Gatti; Kang M Lee; Francesca D'Addio; Sara Tezza; Melissa Chin; Roberto Bassi; Ze Tian; Erxi Wu; Paola Maffi; Moufida Ben Nasr; James I Kim; Antonio Secchi; James F Markmann; David M Rothstein; Laurence A Turka; Mohamed H Sayegh; Paolo Fiorina Journal: Cell Transplant Date: 2014-03-07 Impact factor: 4.064
Authors: Klearchos K Papas; Theodore Karatzas; Thierry Berney; Thomas Minor; Paris Pappas; François Pattou; James Shaw; Christian Toso; Henk-Jan Schuurman Journal: Clin Transplant Date: 2013-01-18 Impact factor: 2.863