Improved Insulin Sensitivity in Type 1 Diabetes

Islet transplantation helps correct hyperglycemia….

In type 1 diabetes, insulin sensitivity is impaired resulting in hyperglycemia with increased free fatty acids (FFAs). Intrahepatic islet transplantation can correct the hyperglycemia and restore the FFA metabolism which then can improve insulin sensitivity. However, current immunosuppression drugs containing tacrolimus and sirolimus has shown to induce resistance in rodents.

This study included 12 type 1 diabetes patients who underwent one or two intraportal infusions of islets to achieve insulin independence. Maintenance immunosuppression consisted of low-dose tacrolimus and sirolimus were given. The main outcomes were the total body, hepatic, and peripheral insulin sensitivity assessed by hyperinsulinemic euglycemic clamps.

The results of the study showed the glycosylated hemoglobin (HbA1c) was reduced from 7.0% ± 0.3% to 5.6% ± 0.1%. The basal insulin was greater in type 1 diabetes before than after transplant and controls which indicated that hepatic and peripheral insulin sensitivity was increased.

Limitations to the study is that type 1 diabetes patients lost weight after the transplant and a decreased in BMI may be associated with improved insulin sensitivity. But adjusting the BMI in this study did not contradict the positive effect of the transplantation on insulin sensitivity. Researchers concluded that insulin resistance in type 1 diabetes can be improved by islet transplantation by using glucocorticoid-free immunosuppression.

• Improved total body insulin sensitivity mediated by effects of both the liver and periphery.
• Islet transplantation can correct hyperglycemia in T1D.
• Hb1Ac was reduced in patients who received transplantation.

Journal of Clinical Endocrinology & Metabolism Nov, 2013