J Korean Diabetes.  2016 Mar;17(1):6-10. 10.4093/jkd.2016.17.1.6.

Management of Hypoglycemic Unawareness and the Current Status of Clinical Allogeneic Islet Transplantation

• Jin SM

• KMID: 2161124
• DOI: http://doi.org/10.4093/jkd.2016.17.1.6

Abstract

Problematic hypoglycemia is defined as a condition in which episodes of severe hypoglycemia are unpredictable and/or cannot be easily explained or prevented, typically associated with impaired awareness of hypoglycemia. The treatment algorithm for patients with type 1 diabetes and problematic hypoglycemia emphasizes the stepwise approach including structured education regarding multiple daily injections of insulin, use of technology such as sensor-augmented pump with low glucose suspension, and islet or pancreas transplantation. Although the prevalence of insulin independence at 5 years is 25~50% in most recent clinical trials of islet transplantation, both islet and pancreas transplantation are equally efficient to cure severe hypoglycemia for more than 5 years in about 70% of the recipients. To date, international cohorts of clinical islet transplantation such as the French-Swiss GRAGIL Network have successfully reproduced the long-term C-peptide positivity initially achieved with the Edmonton protocol, with long-term insulin independence demonstrated in selected cases. Several cases with partial islet graft function have been reported in Korea, with the first case of long-term insulin independence being reported in late 2015. Therefore, islet transplantation can offer freedom from life-threatening severe hypoglycemia for type 1 diabetes patients with problematic hypoglycemia, even in non-responders to the latest technology-based treatment.

Keyword

Hypoglycemia; Islet transplantation; Type 1 diabetes

MeSH Terms

C-Peptide
Cohort Studies
Education
Freedom
Glucose
Humans
Hypoglycemia
Insulin
Islets of Langerhans Transplantation*
Korea
Pancreas Transplantation
Prevalence
Transplants
C-Peptide
Glucose
Insulin

Figure

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  Fig. 1. Proposed treatment algorithm for patients with type 1 diabetes and problematic hypoglycemia. Data from the article of Choudhary et al. (Diabetes Care 2015;38:1016–29)[2] with original copyright holder's permission. MDI, multiple daily injection; SMBG, self-monitoring of blood glucose; CSII, continuous subcutaneous insulin infusion; SAP, sensor-augmented pump; LGS, low-glucose suspension, RT-CGM, real-time continuous glucose monitoring.

Reference

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