RESUMEN
BACKGROUND: Neuropathy is a common diabetic complication that can result in significant disability. Few treatment options exist to reverse this process. METHODS: We conducted a one-way crossover cohort study comparing intensive medical treatment and islet cell transplantation for type 1 diabetes on the change in nerve conduction velocity over six years. FINDINGS: For subjects with some neuropathy at baseline (Z score below -1), nerve conduction velocity significantly improved post-transplant (slope (0.073±0.042) while it worsened in medically treated patients (-0.136±0.081) (p<.05). INTERPRETATION: Islet cell transplantation improves nerve conduction velocity and could be further investigated as a treatment for neuropathy in type 1 diabetes.
Asunto(s)
Cuidados Críticos/métodos , Diabetes Mellitus Tipo 1/complicaciones , Neuropatías Diabéticas/terapia , Trasplante de Islotes Pancreáticos/métodos , Conducción Nerviosa/fisiología , Adulto , Estudios Cruzados , Diabetes Mellitus Tipo 1/terapia , Neuropatías Diabéticas/etiología , Neuropatías Diabéticas/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Factores de TiempoRESUMEN
BACKGROUND: The effect of islet cell transplantation (ICT) on the progression of diabetic microvascular complications is not well understood. METHODS: We have conducted a prospective, crossover, cohort study comparing ICT with intensive medical therapy on the progression of diabetic nephropathy, retinopathy, and neuropathy. RESULTS: The rate of decline in glomerular filtration rate is slower after ICT than on medical therapy. There was significantly more progression of retinopathy in medically treated patients than post-ICT. There was a nonsignificant trend for improved nerve conduction velocity post-ICT. CONCLUSIONS: ICT is associated with less progression of microvascular complications than intensive medical therapy. Multicenter, randomized trials are needed to further study the role of ICT in slowing the progression of diabetic complications.
Asunto(s)
Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 1/terapia , Angiopatías Diabéticas/etiología , Angiopatías Diabéticas/prevención & control , Progresión de la Enfermedad , Insulina/uso terapéutico , Trasplante de Islotes Pancreáticos , Adulto , Estudios de Cohortes , Estudios Cruzados , Angiopatías Diabéticas/fisiopatología , Nefropatías Diabéticas/epidemiología , Neuropatías Diabéticas/epidemiología , Retinopatía Diabética/epidemiología , Femenino , Humanos , Hipoglucemiantes/uso terapéutico , Incidencia , Masculino , Microvasos/fisiopatología , Persona de Mediana Edad , Estudios Prospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: The effect of islet cell transplantation (ICT) on renal function in type 1 diabetes is uncertain and some recent studies report a significant decline in estimated glomerular filtration rate (GFR) and worsening of albuminuria. METHODS: We are conducting a prospective crossover study comparing medical treatment with islet transplantation on the progression of diabetic complications, including renal function. The primary endpoint is change in GFR measured by Tc-diethylenetriaminepentaacetate with secondary endpoints including estimated GFR and albumin excretion. RESULTS: We have followed 21 patients after islet transplantation a median of 29 months (range 13-45) and compared their results with medically treated patients followed a median 29.5 months (range 13-56). There is no difference in the rate of decline in measured GFR between medically treated patients (-0.35+/-0.89; 95% CI: -0.57 to -0.13 mL/min/month/1.73 m) and those after ICT (-0.31+/-1.18; 95% CI: -0.61 to -0.01) and neither is significantly different from that expected for the general population. The rate of decline in our estimated GFR results is lower than that reported in other studies and we did not find any worsening of albuminuria. CONCLUSIONS: We do not find evidence of worsening of renal function after islet transplantation compared with medically treated patients.
