Islet transplantation versus insulin therapy in patients with type 1 diabetes with severe hypoglycaemia or poorly controlled glycaemia after kidney transplantation (TRIMECO): a multicentre, randomised controlled trial

Details

Serval ID
serval:BIB_6144B225F247
Type
Article: article from journal or magazin.
Collection
Publications
Title
Islet transplantation versus insulin therapy in patients with type 1 diabetes with severe hypoglycaemia or poorly controlled glycaemia after kidney transplantation (TRIMECO): a multicentre, randomised controlled trial
Journal
Lancet Diabetes Endocrinol
Author(s)
Lablanche S., Vantyghem M. C., Kessler L., Wojtusciszyn A., Borot S., Thivolet C., Girerd S., Bosco D., Bosson J. L., Colin C., Tetaz R., Logerot S., Kerr-Conte J., Renard E., Penfornis A., Morelon E., Buron F., Skaare K., Grguric G., Camillo-Brault C., Egelhofer H., Benomar K., Badet L., Berney T., Pattou F., Benhamou P. Y.
Working group(s)
Trimeco trial investigators
ISSN
2213-8595 (Electronic)
ISSN-L
2213-8587
Publication state
Published
Issued date
07/2018
Volume
6
Number
7
Pages
527-537
Language
english
Notes
Lablanche, Sandrine
Vantyghem, Marie-Christine
Kessler, Laurence
Wojtusciszyn, Anne
Borot, Sophie
Thivolet, Charles
Girerd, Sophie
Bosco, Domenico
Bosson, Jean-Luc
Colin, Cyrille
Tetaz, Rachel
Logerot, Sophie
Kerr-Conte, Julie
Renard, Eric
Penfornis, Alfred
Morelon, Emmanuel
Buron, Fanny
Skaare, Kristina
Grguric, Gwen
Camillo-Brault, Coralie
Egelhofer, Harald
Benomar, Kanza
Badet, Lionel
Berney, Thierry
Pattou, Francois
Benhamou, Pierre-Yves
eng
Clinical Trial, Phase III
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
England
Lancet Diabetes Endocrinol. 2018 Jul;6(7):527-537. doi: 10.1016/S2213-8587(18)30078-0. Epub 2018 May 15.
Abstract
BACKGROUND: Islet transplantation is indicated for patients with type 1 diabetes with severe hypoglycaemia or after kidney transplantation. We did a randomised trial to assess the efficacy and safety of islet transplantation compared with insulin therapy in these patients. METHODS: In this multicentre, open-label, randomised controlled trial, we randomly assigned (1:1) patients with type 1 diabetes at 15 university hospitals to receive immediate islet transplantation or intensive insulin therapy (followed by delayed islet transplantation). Eligible patients were aged 18-65 years and had severe hypoglycaemia or hypoglycaemia unawareness, or kidney grafts with poor glycaemic control. We used computer-generated randomisation, stratified by centre and type of patient. Islet recipients were scheduled to receive 11 000 islet equivalents per kg bodyweight in one to three infusions. The primary outcome was proportion of patients with a modified beta-score (in which an overall score of 0 was not allocated when stimulated C-peptide was negative) of 6 or higher at 6 months after first islet infusion in the immediate transplantation group or 6 months after randomisation in the insulin group. The primary analysis included all patients who received the allocated intervention; safety was assessed in all patients who received islet infusions. This trial is registered with ClinicalTrials.gov, number NCT01148680, and is completed. FINDINGS: Between July 8, 2010, and July 29, 2013, 50 patients were randomly assigned to immediate islet transplantation (n=26) or insulin treatment (n=24), of whom three (one in the immediate islet transplantation group and two in the insulin therapy group) did not receive the allocated intervention. Median follow-up was 184 days (IQR 181-186) in the immediate transplantation group and 185 days (172-201) in the insulin therapy group. At 6 months, 16 (64% [95% CI 43-82]) of 25 patients in the immediate islet transplantation group had a modified beta-score of 6 or higher versus none (0% [0-15]) of the 22 patients in the insulin group (p<0.0001). At 12 months after first infusion, bleeding complications had occurred in four (7% [2-18]) of 55 infusions, and a decrease in median glomerular filtration rate from 90.5 mL/min (IQR 76.6-94.0) to 71.8 mL/min (59.0-89.0) was observed in islet recipients who had not previously received a kidney graft and from 63.0 mL/min (55.0-71.0) to 57.0 mL/min (45.5-65.1) in islet recipients who had previously received a kidney graft. INTERPRETATION: For the indications assessed in this study, islet transplantation effectively improves metabolic outcomes. Although studies with longer-term follow-up are needed, islet transplantation seems to be a valid option for patients with severe, unstable type 1 diabetes who are not responding to intensive medical treatments. However, immunosuppression can affect kidney function, necessitating careful selection of patients. FUNDING: Programme Hospitalier de Recherche Clinique grant from the French Government.
Keywords
Adult, Diabetes Mellitus, Type 1/complications/*drug therapy/*surgery, Female, Glycated Hemoglobin A/metabolism, Humans, Hypoglycemia/*complications, Hypoglycemic Agents/*therapeutic use, Insulin/*therapeutic use, *Islets of Langerhans Transplantation, *Kidney Transplantation, Male, Middle Aged, Quality of Life, Treatment Outcome
Pubmed
Create date
14/06/2021 8:59
Last modification date
18/09/2021 5:38
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