Assessment of the relationship between hypoglycaemia awareness and autonomic function following islet cell/pancreas transplantation.
Diabetes Metab Res Rev
; 31(6): 646-50, 2015 Sep.
Article
em En
| MEDLINE
| ID: mdl-25865170
ABSTRACT
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.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Doenças do Sistema Nervoso Autônomo
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Transplante das Ilhotas Pancreáticas
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Transplante de Pâncreas
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Diabetes Mellitus Tipo 1
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Neuropatias Diabéticas
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Autoavaliação Diagnóstica
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Hipoglicemia
Tipo de estudo:
Diagnostic_studies
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Etiology_studies
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Incidence_studies
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Observational_studies
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Risk_factors_studies
Limite:
Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2015
Tipo de documento:
Article