To evaluate the effect of ICT on progression of long-term complications, as compared with controls with recurrent hypoglycemia.
18 subjects with recurrent hypoglycemia, 9 receiving ICT, were followed prospectively with baseline HbA1c, Hyposcore, mean glucose, SD, and percent time hypoglycemic and hyperglycemic from CGM. Complication screening was performed baseline and 2 years following medical treatment or ICT. Peripheral neuropathy was evaluated using thresholds for hot, cold and vibration; retinopathy was graded by retinal photography or external ophthalmologist; nephopathy by microalbumin excretion; autonomic dysfunction with pupillary response time1.
Clinical characteristics of control and ICT groups were similar at baseline. Two years post transplant (Table 1), there were significant between group differences in HbA1c, total daily insulin, Hyposcore, mean CGM glucose and SD glucose and percent time hyperglycemia. At 2 years peripheral neuropathy showed less progression in ICT than group (0% vs 33%, chi2=0.13). Using GEE, differences were predicted by Hyposcore (p=0.006), HbA1c (p=0.04), mean glucose (p=0.007), total daily insulin (p=0.01) and percent time hyperglycemic (p=0.02). Differences in pupillary response time were predicted by mean glucose (P=0.005) and percent time hyperglycemic (p=0.04) at 2 years. There were no significant differences at 2 years in retinopathy progression or microalbumin excretion but microalbumin excretion at 2 years was predicted by HbA1c (p=0.002), mean glucose (p=0.01) and baseline microalbumin excretion (p=0.02).
Improved glucose control and reduced hypoglycemia is achieved after ICT. Peripheral neuropathy progression was predicted by reduced hypoglycemia and improved glycemic control, post ICT and improvements in autonomic nerve function were predicted by improvements in glycemic control only.