The second phase of insulin secretion in non-diabetic islet-grafted recipients is altered and can predict graft outcome.

The second phase of insulin secretion in non-diabetic islet-grafted recipients is altered and can predict graft outcome.

J Clin Endocrinol Metab. 2018 Jan 08;:

Authors: Villard O, Brun JF, Bories L, Molinari N, Benhamou PY, Berney T, Wojtusciszyn A

Abstract
INTRODUCTION: Islet transplantation (IT) can treat patients with severely unstable type 1 diabetes. Pre-hepatic kinetics of insulin-secretion (ISec) in two phases can be calculated by C-peptide levels during meal tests. We propose to describe insulin secretion profile after a Mixed-Meal Tolerance Test (MMTT) in IT patients and to determine whether the calculated indexes of ISec can predict graft outcome.
METHODS: We analyzed 34 MMTT among 11 patients who received an IT between 2011 and 2016 and compared them to healthy controls (C) and type 2 diabetic (T2D) patients. ISec indexes and insulin sensitivity (ISen) were calculated from models of Van Cauter, Breda and Mari after MMTT. Graft success was defined by total insulin-independence without any criteria of diabetes.
RESULTS: In IT patients with success, the first and second phase of ISec indexes were lower compared to C (p<0.001) and did not differ from T2D. Nevertheless, ISen of IT was similar to C and higher than T2D. The index of the second phase of ISec ɸS was correlated with total infused islet equivalent (IEQ), was a good predictor of diabetes (re)occurrence and allowed to calculate a dose of 9500 IEQ/kg as the minimal dose required to reach insulin-independence.
CONCLUSION: For the first time, we show that indexes from the first and second phases of ISec are altered in insulin-independent IT patients. Higher sensitivity distinguishes them from type 2 diabetes patients. IT, even in patient insulin-independent, remains a marginal mass model. Moreover, ɸS can estimate transplanted islet mass and predict IT patients outcome.

PMID: 29319810 [PubMed - as supplied by publisher]

http://ift.tt/2CZGxLs