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Assessment of the relationship between hypoglycaemia awareness and autonomic function following islet cell/pancreas transplantation
Author(s) -
Kamel Jordan T.,
Goodman David J.,
Howe Kathy,
Cook Mark J.,
Ward Glenn M.,
Roberts Leslie J.
Publication year - 2015
Publication title -
diabetes/metabolism research and reviews
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.307
H-Index - 110
eISSN - 1520-7560
pISSN - 1520-7552
DOI - 10.1002/dmrr.2652
Subject(s) - medicine , diabetes mellitus , transplantation , sudomotor , islet , pancreas , type 1 diabetes , pancreas transplantation , hypoglycemia , pancreatic polypeptide , autonomic neuropathy , exact test , surgery , endocrinology , insulin , kidney transplantation , glucagon , biology , cell culture , genetics , neuroblastoma
Background This study assesses the autonomic function of patients who have regained awareness of hypoglycaemia following islet cell or whole pancreas transplant. Methods 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. Results 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 ( p < 0.001, Fisher's exact test) and to 20% after 12 months ( p < 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. Conclusions 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.