body mass index, weight and insulin dose as selection criteria for islet transplantation r smith...

Body Mass Index, Weight and Insulin Dose as Selection Criteria for Islet Transplantation

R SmithBristol UK

29th AIDPIT Workshop Igls

Islet TransplantationExclusion criteria for islet transplantation include BMI, weight and insulin dose

ITN• BMI > 26• Weight:

– Men >75kg– Women >70kg

• Insulin requirement > 0.7 IU/kg/day

Edmonton• BMI > 28• Weight > 90kg• Insulin requirement > 1.0

IU/kg/day

Ensure realistic chance of achieving adequate beta cell mass

Insulin Sensitivity

Important determinant of success of beta cell transplantation

How do we assess/measure insulin sensitivity?

Weight, BMI, insulin dose ?

• Currently in Bristol:• 12 patients awaiting islet transplantation• 20 Patients currently awaiting pancreas transplantation

alone

• Formal assessment of insulin sensitivity by euglycaemic hyperinsulinaemic clamp

• 15 Patients studied so far

Glucose Disposal Rate

Reaven G.M. Banting Lecture, Diabetes 1988

Normal Population T1DM awaiting Transplantation

Correlation to BMI

r2 = -0.1126

P = 0.69

Correlation to Weight

r2 = -0.1126

P = 0.69

Correlation to Total Insulin Dose

r2 = -0.2772

P = 0.34

r2 = -0.1408

P = 0.63

Correlation to Weight Adjusted Insulin Dose

Conclusions

• Range of insulin resistance similar to that seen in normal non-diabetic population

• Counter intuitive to transplant low beta cell mass in patients with high insulin resistance

• Surrogate markers not available• Studies assessing the impact of insulin

resistance on graft outcome should be undertaken