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根据发表于美国临床内分泌学会第17届年会与临床会议上的一项新研究显示，胰岛细胞移植可以维持近乎正常的代谢性控制且减少低血糖现象。
胰岛细胞移植，已经被实验性地用于治疗第一型糖尿病，是将器官捐赠者的细胞移植到罹患第一型糖尿病病患的胰脏中；胰岛细胞群聚在整个胰脏中，胰岛本身含有贝他细胞，这些细胞会制造胰岛素，这是协助身体利用葡萄糖调控能量的荷尔蒙。
在为期18个月的研究中，医师使用一种连续性葡萄糖监测系统（CGMS）监测胰岛细胞移植措施对第一型糖尿病患者的效果，其结果是令人感到有兴趣的。
佛州迈阿密大学糖尿病研究机构的Lisa Gorn骨科博士在发表会中指出，我们确实发现CGMS在告诉我们，这些病患在接受移植后控制得有多好。
为了进行这项研究，25位罹患第一型糖尿病病患接受血糖控制，12位接受胰岛细胞移植（ITx组）、另外13位作为控制组，所有病患都接受体重、身体质量指数、使用胰岛素、糖化血红素（HBA1c）、混合饮食90分钟血糖耐受度测试、以及空腹C-胜与血糖比值（CPGR）监测。
控制组在试验前、ITx组在胰岛移植后3、6、9、12、15与18个月时，以CGMS在72小时之间监测平均肠道葡萄糖、血糖变异程度、处于高血糖时间（%葡萄糖耐受度[GT]>140 mg/dl）、低血糖（%GT <54 mg/dl）、与正常血糖（%GT介于54~140 mg/dl之间）；这些被分析作为移植功能不佳的指标。若在移植功能不佳时，CGMS结果与之前时间点有显著差别，则进行线性混合模式回归分析。
在所有的时间点中，除了第3与第15个月，平均肠道葡萄糖与血糖变异程度，ITx组都显著低于控制组；在所有的时间点中，ITx组低血糖时间的百分比显著地比控制组低。
在ITx组中，胰岛素使用与低血糖时间之间并无关系；ITx组处于正常血糖的时间比控制组长，除了在第15个月时。处于高血糖的时间，ITx组于第6、9、12与18个月时，都显著低于控制组。HBA1c、90分钟血糖耐受度测试、与CPGR，在移植后的所有时间点都比移植前佳。平均肠道葡萄糖、标准差、血糖变异程度、与高血糖时间长度都是移植功能不佳的指标，当发生移植功能不佳时，分别增加了19.4 mg/dl、15.1 mg/dl、19.8 mg/dl与19.4%。
纽约Mount Sinai医学中心医学临床教授，同时也是美国内分泌医学会前任总裁的Rhoda Cobin医师表示，这可以是黄金标准，但是需要一些修改；Cobin医师并未参与这项研究。
国家卫生研究院（NIH）国家研究资源中心、青少年糖尿病研究基金会、国家糖尿病、消化道与肾脏疾病机构赞助这项研究。Gorn医师表示无相关资金上的往来。
Experimental Diabetes Treatmen
By Stephanie Doyle
Medscape Medical News
New research monitoring the effects of islet cell transplantation resulted in near-normal metabolic control and decreased hypoglycemia, according to the findings presented here at American Association of Clinical Endocrinologists 17th Annual Meeting and Clinical Congress.
Islet cell transplantation, which has been used experimentally to treat type?1 diabetes, places cells from an organ donor into the pancreas of a person with type?1 diabetes. Islets are cells found in clusters throughout the pancreas. The islets themselves contain beta cells, which make insulin, the hormone that helps the body use glucose for energy.
During the 18-month study, physicians used a continuous glucose monitoring system (CGMS) to monitor the effects of the islet cell transplant procedure on patients with type?1 diabetes. The results were intriguing.
"We did find CGMS to be useful in telling us how well our patients were doing after transplantation," Lisa Gorn, DO, from the Diabetes Research Institute at the University of Miami, in Florida, said during her presentation. "It was also useful in telling us when our patients were not doing well after transplantation."
For the study, glycemic control was assessed in 25 patients with type?1 diabetes — 12 underwent islet transplantation (ITx group) and 13 were controls. In all patients, weight, body mass index, insulin use, hemoglobin A1c (HbA1c), 90-minute glucose after a mixed-meal tolerance test, and fasting C-peptide/glucose ratio (CPGR) were monitored.
Mean interstitial glucose, standard deviation, glucose variability, and time in hyperglycemia (% glucose tolerance [GT]?> 140?mg/dL), hypoglycemia (%GT?< 54?mg/dL), and normoglycemia (%GT between 54 and 140?mg/dL) were measured in 72-hour periods with CGMS, in the control group at baseline and in the ITx group at 3, 6, 9, 12, 15, and 18 months after transplantation; these measurements were analyzed as indicators of graft dysfunction. Linear mixed-model regressions were assessed if CGMS findings at the time of graft dysfunction were significantly different than those at preceding time points.
At all time points except at 3 and 15 months, mean interstitial glucose and glucose variability were significantly lower in the ITx group than in the control group. At all time points, the percentage of time in hypoglycemia was significantly lower in the ITx group than in the control group.
In the ITx group, there was no association between insulin use and time in hypoglycemia. Time in normoglycemia was higher in the ITx group than in the control group at all times except at 15 months. Time in hyperglycemia was significantly lower at 6, 9, 12, and 18 months in the ITx group than in the control group. HbA1C, 90-minute glucose, and CPGR were significantly better at all time points after transplantation. Mean interstitial glucose, standard deviation, glucose variability, and percent time in hyperglycemia were indicators of graft dysfunction, and increased by 19.4?mg/dL,15.1?mg/dL,19.8?mg/dL, and 19.4%, respectively, when graft dysfunction occurred.
"This could be the gold standard — but with some modifications to it,'' said Rhoda Cobin, MD, a clinical professor of medicine at Mount Sinai Medical Center in New York, and a past president of the American Association of Clinical Endocrinologists. Dr. Cobin was not involved in the study.
Funding was provided from the National Institutes of Health (NIH) National Center for Research Resources, the Juvenile Diabetes Research Foundation, and the National Institute of Diabetes and Digestive and Kidney Diseases. Dr. Gorn disclosed no relevant financial relationships.
American Association of Clinical Endocrinologists 17th Annual Meeting and Clinical Congress: Abstract 225. Presented May 16, 2008.