The Second Phase of Insulin Secretion in Nondiabetic Islet-Grafted Recipients Is Altered and Can Predict Graft Outcome.
- Villard O Laboratory of Cell Therapy for Diabetes, Institute of Regenerative Medicine and Biotherapy, University Hospital of Montpellier, Saint Eloi Hospital, Montpellier, France.
- Brun JF Unité Mixte de Recherche, Centre National de la Recherche Scientifique 9214, Institut National de la Santé et de la Recherche Médicale U1046, Physiologie et Médecine Experimentale du coeur et des muscles, Montpellier University, Montpellier, France.
- Bories L Department of Endocrinology, Diabetes and Nutrition, University Hospital of Montpellier, Lapeyronie Hospital, Montpellier, France.
- Molinari N Department of Medical Information, University Hospital of Montpellier, La Colombière Hospital, Montpellier, France.
- Benhamou PY Department of Diabetology, Pôle DigiDune, Grenoble University Hospital, Grenoble Alpes University, Grenoble, France.
- Berney T Visceral and Transplant Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
- Wojtusciszyn A Laboratory of Cell Therapy for Diabetes, Institute of Regenerative Medicine and Biotherapy, University Hospital of Montpellier, Saint Eloi Hospital, Montpellier, France.
- 2018-01-11
Published in:
- The Journal of clinical endocrinology and metabolism. - 2018
Adult
Blood Glucose
Case-Control Studies
Diabetes Mellitus, Type 1
Diabetes Mellitus, Type 2
Diagnostic Techniques, Endocrine
Female
Humans
Insulin
Insulin Secretion
Islets of Langerhans Transplantation
Male
Middle Aged
Postoperative Period
Prognosis
Treatment Outcome
English
Context
Islet transplantation (IT) can treat patients with severely unstable type 1 diabetes. Prehepatic kinetics of insulin secretion (ISec) in two phases can be calculated by C-peptide levels during meal tests. We proposed to describe the ISec profile after a mixed-meal tolerance test (MMTT) in IT recipients and to determine whether the calculated ISec indexes can predict graft outcome.
Methods
We analyzed 34 MMTT among 11 patients who underwent IT between 2011 and 2016 and compared them with healthy controls and patients with type 2 diabetes (T2D). ISec indexes and insulin sensitivity were calculated from models of Van Cauter, Breda, and Mari after MMTT. Graft success was defined by total insulin independence without any criteria for diabetes.
Results
In patients with successful IT, the first- and second-phase ISec indexes were lower than those of controls (P < 0.001) and did not differ from those of the T2D group. Nevertheless, insulin sensitivity of IT recipients was similar to that of the control group and higher than that of the T2D group. The index of the second phase of ISec ɸS was correlated with total infused islet equivalents (IEQs), was a good predictor of diabetes (re)occurrence, and allowed us to calculate 9500 IEQ/kg as the minimum needed to reach insulin independence.
Conclusion
We showed that indexes from the first and second phases of ISec are altered in insulin-independent IT recipients. Higher sensitivity distinguishes them from patients with T2D. Even in insulin-independent patients, IT remains a marginal mass model. Moreover, ɸS can estimate transplanted islet mass and predict IT recipient outcomes.
Islet transplantation (IT) can treat patients with severely unstable type 1 diabetes. Prehepatic kinetics of insulin secretion (ISec) in two phases can be calculated by C-peptide levels during meal tests. We proposed to describe the ISec profile after a mixed-meal tolerance test (MMTT) in IT recipients and to determine whether the calculated ISec indexes can predict graft outcome.
Methods
We analyzed 34 MMTT among 11 patients who underwent IT between 2011 and 2016 and compared them with healthy controls and patients with type 2 diabetes (T2D). ISec indexes and insulin sensitivity were calculated from models of Van Cauter, Breda, and Mari after MMTT. Graft success was defined by total insulin independence without any criteria for diabetes.
Results
In patients with successful IT, the first- and second-phase ISec indexes were lower than those of controls (P < 0.001) and did not differ from those of the T2D group. Nevertheless, insulin sensitivity of IT recipients was similar to that of the control group and higher than that of the T2D group. The index of the second phase of ISec ɸS was correlated with total infused islet equivalents (IEQs), was a good predictor of diabetes (re)occurrence, and allowed us to calculate 9500 IEQ/kg as the minimum needed to reach insulin independence.
Conclusion
We showed that indexes from the first and second phases of ISec are altered in insulin-independent IT recipients. Higher sensitivity distinguishes them from patients with T2D. Even in insulin-independent patients, IT remains a marginal mass model. Moreover, ɸS can estimate transplanted islet mass and predict IT recipient outcomes.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1210/jc.2017-01342
- PMID 29319810
- Persistent URL
- https://sonar.ch/global/documents/46508
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