Outcomes for Adults with Type 1 Diabetes Referred with Severe Hypoglycaemia and/or Referred for Islet Transplantation to a Specialist Hypoglycaemia Service

M. L. Byrne; D. Hopkins; W. Littlejohn; R. Beckford; P. Srinivasan; N. Heaton; S. A. Amiel; P. Choudhary

doi:10.1055/s-0034-1394455

Hormone and Metabolic Research, Table of Contents

Horm Metab Res 2015; 47(01): 9-15
DOI: 10.1055/s-0034-1394455

Endocrine Care

Outcomes for Adults with Type 1 Diabetes Referred with Severe Hypoglycaemia and/or Referred for Islet Transplantation to a Specialist Hypoglycaemia Service

M. L. Byrne

¹Diabetes Research Group, King’s College London, London, UK

,

D. Hopkins

²Department of Diabetes, King’s College Hospital, London, UK

,

W. Littlejohn

³Institute of Liver Studies, King’s College Hospital, London, UK

,

R. Beckford

³Institute of Liver Studies, King’s College Hospital, London, UK

,

P. Srinivasan

³Institute of Liver Studies, King’s College Hospital, London, UK

,

N. Heaton

³Institute of Liver Studies, King’s College Hospital, London, UK

,

S. A. Amiel

¹Diabetes Research Group, King’s College London, London, UK

,

P. Choudhary

¹Diabetes Research Group, King’s College London, London, UK

› Author Affiliations

Abstract

Islet transplantation alone (ITA) is indicated for patients with type 1 diabetes (T1D) with disabling severe hypoglycaemia (SH) despite optimised medical therapy. We examined outcomes for patients referred to an islet transplant unit with recurrent SH. Retrospective case note audit of 45 patients with ≥1 SH per year who were referred to our ITA unit between 2009–2012; 36 patients attended follow-up appointments. The cohort was 52.8% male, mean (± SD) age 43.9 (± 11.4) years, and duration of diabetes 26.5 (± 12.9) years. Baseline HbA1c was 8.3% (± 1.7) (67.2 mmol/mol), median (IQR) frequency of SH was 6.0 (2.0–24.0) per/patient/year and 83.3% had impaired awareness of hypoglycaemia (IAH). 80.6% of patients were referred from other secondary diabetes services, 22.2% had completed structured education, and 30.6% were using continuous subcutaneous insulin infusion (CSII). Seventeen patients were optimised with conventional therapy; SH reduced from 2.0 (1.5–9.0) to 0.0 (0.0–0.5) episodes/patient/year; p<0.001, and there was concurrent improvement in HbA1c (8.1–7.7%; 65.0 vs. 60.7 mmol/mol; p=0.072). Ten patients were listed for transplantation as they were not optimised despite structured education, CSII, and continuous glucose monitoring (CGM). The remaining 9 had a reduction in SH [7.0 (4.8–40.5) to 4.0 (2.5–6.3) episodes/patient/year; p=0.058] and either left the service (n=5) or are still being optimised (n=4). In conclusion, 47.2% of patients presenting with problematic hypoglycaemia resolved with optimal medical therapy, with a further 25% achieving clinically relevant improvement, however 27.8% required transplantation despite access to all therapies. Provision of expertise in hypoglycaemia management is essential to focus limited transplant resources on those who need it most.

Key words

severe hypoglycaemia - islet transplantation - pancreas transplantation - type 1 diabetes

Full Text

References

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