Diabetic Ketoacidosis at Diagnosis Influences Complete Remission After Treatment With Hematopoietic Stem Cell Transplantation in Adolescents With Type 1 Diabetes

Autor: Yifei Zhang, Jie Hong, Lirong Li, Dalong Zhu, Shou-yue Sun, Weijuan Cui, Wei Tang, Jiong Hu, Weiqing Wang, Weiqiong Gu, Guang Ning, Ye Lei
Rok vydání: 2012
Předmět:
Adult
Blood Glucose
Male
medicine.medical_specialty
endocrine system diseases
Adolescent
Diabetic ketoacidosis
Endocrinology
Diabetes and Metabolism
medicine.medical_treatment
Hematopoietic stem cell transplantation
Transplantation
Autologous
Gastroenterology
Diabetic Ketoacidosis
chemistry.chemical_compound
Diabetes mellitus
Internal medicine
Internal Medicine
Humans
Insulin
Medicine
Prospective Studies
Original Research
Advanced and Specialized Nursing
Glucose tolerance test
Type 1 diabetes
C-Peptide
medicine.diagnostic_test
Glutamate Decarboxylase
business.industry
C-peptide
Remission Induction
Hematopoietic Stem Cell Transplantation
nutritional and metabolic diseases
Glucose Tolerance Test
medicine.disease
Transplantation
Diabetes Mellitus
Type 1
Endocrinology
chemistry
Diabetes Care Symposium
Female
business
Zdroj: Diabetes Care
ISSN: 1935-5548
0149-5992
Popis: OBJECTIVE To determine if autologous nonmyeloablative hematopoietic stem cell transplantation (AHSCT) was beneficial for type 1 diabetic adolescents with diabetic ketoacidosis (DKA) at diagnosis. RESEARCH DESIGN AND METHODS We enrolled 28 patients with type 1 diabetes, aged 14–30 years, in a prospective AHSCT phase II clinical trial. HSCs were harvested from the peripheral blood after pretreatment consisting of a combination of cyclophosphamide and antithymocyte globulin. Changes in the exogenous insulin requirement were observed and serum levels of HbA1c, C-peptide, and anti-glutamic acid decarboxylase antibody were measured before and after the AHSCT. RESULTS After transplantation, complete remission (CR), defined as insulin independence, was observed in 15 of 28 patients (53.6%) over a mean period of 19.3 months during a follow-up ranging from 4 to 42 months. The non-DKA patients achieved a greater CR rate than the DKA patients (70.6% in non-DKA vs. 27.3% in DKA, P = 0.051). In the non-DKA group, the levels of fasting C-peptide, peak value during oral glucose tolerance test (Cmax), and area under C-peptide release curve during oral glucose tolerance test were enhanced significantly 1 month after transplantation and remained high during the 24-month follow-up (all P < 0.05). In the DKA group, significant elevation of fasting C-peptide levels and Cmax levels was observed only at 18 and 6 months, respectively. There was no mortality. CONCLUSIONS We have performed AHSCT in 28 patients with type 1 diabetes. The data show AHSCT to be an effective long-term treatment for insulin dependence that achieved a greater efficacy in patients without DKA at diagnosis.
Databáze: OpenAIRE
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