Pancreatic islet cell transplantation as a treatment for brittle type 1 diabetes: a case report and review of the literature

ABSTRACT

Hypoglycaemia is the most common life-threatening acute complication in patients with type 1 diabetes mellitus [T1DM]. Approximately 30% of patients with T1DM will suffer from one episode per year of severe hypoglycaemia in which third-party assistance is required, and is associated with significant morbidity and mortality. Islet cell transplantation was approved by the National Commissioning Group [UK] for reducing the frequency of lifethreatening hypoglycaemic attacks in patients with impaired hypoglycaemia awareness. To date, five patients have undergone this procedure in Manchester, UK, since its approval in 2010. We present the case of a 56-year-old man with T1DM for 30 years on approximately 50 units of insulin per day with a glycated haemoglobin [HbA1c] of 9% [75 mmol/mol]. He scored 7 on the Gold Score and 6 on the Modified Clarke Scale for hypoglycaemia, making him eligible to undergo islet cell transplantation. He received two islet transplants, one in 2010 and the second in 2011. The patient did not achieve complete insulin independence post-transplant but reduced his daily insulin to approximately 17 U. However, the episodes of severe hypoglycaemia were reduced from approximately 50/year to 0.25/year, and he now has excellent glycaemic control with an HbA1c of 6.8% [51 mmol/mol]. The long-term microvascular complications, especially neuropathy, assessed by the novel technique of corneal confocal microscopy have not shown progression. He developed side effects from the immunosuppressive therapy, which included mouth ulcers, hypertension and moderate deterioration of renal function