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.
Bibliographical noteAcknowledgements We thank the transplant nurses involved with the Scottish Islet Transplant Programme (T. McGilvray, J. Davidson, M. Phillips and C. Jansen) for help with participant assessment. We thank the Scottish National Blood Transfusion Services including the Histocompatibility and Immunogenetics Team for HLA typing and antibody
screening, and the Tissue and Cells Team (A. Timpson, L. Fraser, L. Irvine and P. Henry) for islet isolation and product release testing. We acknowledge the Departments of Transplantation, Diabetes and Interventional Radiology at NHS Lothian for all aspects of patient care and the organ procurement programme. We thank J. Shaw and A. Brooks
from the Department of Regenerative Medicine for Diabetes at the University of Newcastle for advice regarding CGMS. C-peptide assays were performed by the NIHR Cambridge Biomedical Research Centre, Core Biochemical Assay Laboratory.
The Scottish Islet Transplant Programme is funded by the National Services Division. This research was funded by Diabetes UK (Biomedical and Psychosocial Outcomes of Islet Transplantation; Grant no. BDA 06/0003362), Diabetes Research and Wellness Foundation, Diabetes Foundation, Juvenile Diabetes Research Foundation and the Royal Infirmary Diabetes Treatment Trust Fund.
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- impaired awareness of hypoglycaemia
- islet transplantation
- socioeconomic deprivation