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The beta score, a composite measure of beta cell function after islet transplantation, has limited sensitivity because of its categorical nature and requires a mixed‐meal tolerance test ( MMTT ). We developed a novel score based on a single fasting blood sample. The  BETA ‐2 score used stepwise forward linear regression incorporating glucose (in millimoles per liter), C‐peptide (in nanomoles per liter), hemoglobin A1c (as a percentage) and insulin dose (U/kg per day) as continuous variables from the original beta score data set (n = 183  MMTT s). Primary and secondary analyses assessed the score's ability to detect glucose intolerance (90‐min  MMTT  glucose ≥8 mmol/L) and insulin independence, respectively. A validation cohort of islet transplant recipients (n = 114  MMTT s) examined 12 mo after transplantation was used to compare the score's ability to detect these outcomes. The  BETA ‐2 score was expressed as follows (range 0–42):BETA  −  2    score   =fasting    C  −  peptide    (  nmol  /  L  )   ×  (   1  −  insulin    dose    [  units  /  kg  ]   )Fasting    plasma    glucose    (  mmol  /  L  )   ×   HbA  1  c(  %  )    ×  1000    A score <20 and ≥15 detected glucose intolerance and insulin independence, respectively, with >82% sensitivity and specificity. The  BETA ‐2 score demonstrated greater discrimination than the beta score for these outcomes (p < 0.05). Using a fasting blood sample, the  BETA ‐2 score estimates graft function as a continuous variable and shows greater discrimination of glucose intolerance and insulin independence after transplantation versus the beta score, allowing frequent assessments of graft function. Studies examining its utility to track long‐term graft function are required.

american journal of transplantation

Validation of the  BETA ‐2 Score: An Improved Tool to Estimate Beta Cell Function After Clinical Islet Transplantation Using a Single Fasting Blood Sample