Islet transplantation from a nationally funded UK centre reaches socially deprived groups and improves metabolic outcomes

Shareen Forbes, Neil W A McGowan, Kirsty Duncan, Debbie Anderson, Janet Barclay, Donna Mitchell, Kevin Docherty, David Turner, John D M Campbell, John J Casey

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Abstract

AIMS/HYPOTHESIS: Type 1 diabetes complicated by hypoglycaemia is prevalent in socioeconomically deprived populations. Islet transplantation is of proven efficacy in type 1 diabetes complicated by hypoglycaemia, but it is not known if nationally funded programmes reach the socioeconomically deprived. Our aim was to determine: (1) socioeconomic indices in participants referred to our nationally funded programme; and (2) if metabolic outcomes in our transplant recipients were improved.

METHODS: Participants referred (n = 106) and receiving transplants (n = 18; 32 infusions) were examined with respect to socioeconomic status (deprivation category score) and their ability to work and drive. In participants followed for ≥12 months after transplantation, metabolic and anthropometric measurements (n = 14) were recorded pre- and post-transplant (assessed ~1, ~3, ~6 and ~12 months with mixed-meal tolerance tests and 6 day continuous glucose monitoring assessments). Donor data was also examined.

RESULTS: There was a greater prevalence of socioeconomic deprivation in referred and transplant recipients than the general population (p < 0.05). Of the transplant recipients, 73% were socioeconomically deprived, 88% did not hold a driver's license and 94% had reduced ability to work (all p < 0.01 vs referred participants). Donors were predominantly obese and included circulatory death donors. At 12 months, 93% of participants who had received transplants had graft function, diminished frequency of hypoglycaemia (10 [4-11] vs 0 [0-2] hypoglycaemic episodes/week), improved awareness of hypoglycaemia (Gold score 7 [5-7] vs 1 [1-2]) and glycaemic control (HbA1c: 7.9% [7.2-8.5%]; 63 [55-69] mmol/mol vs 7.2% [6.8-7.5%]; 55 [51-58] mmol/mol), diminished glycaemic lability and decreased central adiposity (all p < 0.05).

CONCLUSIONS/INTERPRETATION: A nationally funded islet transplant programme reaches the socioeconomically deprived and outcomes are significantly improved in this group.

Original languageEnglish
Pages (from-to)1300-1308
Number of pages9
JournalDiabetologia
Volume58
Issue number6
Early online date26 Mar 2015
DOIs
Publication statusPublished - Jun 2015

Keywords

  • hypoglycaemia
  • impaired awareness of hypoglycaemia
  • islet transplantation
  • socioeconomic deprivation

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    Forbes, S., McGowan, N. W. A., Duncan, K., Anderson, D., Barclay, J., Mitchell, D., Docherty, K., Turner, D., Campbell, J. D. M., & Casey, J. J. (2015). Islet transplantation from a nationally funded UK centre reaches socially deprived groups and improves metabolic outcomes. Diabetologia, 58(6), 1300-1308. https://doi.org/10.1007/s00125-015-3554-3