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Body Mass Index, Weight and Insulin Dose as Selection Criteria for Islet Transplantation
R SmithBristol UK
29th AIDPIT Workshop Igls
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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
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Insulin Sensitivity
Important determinant of success of beta cell transplantation
How do we assess/measure insulin sensitivity?
Weight, BMI, insulin dose ?
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• 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
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Glucose Disposal Rate
Reaven G.M. Banting Lecture, Diabetes 1988
Normal Population T1DM awaiting Transplantation
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Correlation to BMI
r2 = -0.1126
P = 0.69
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Correlation to Weight
r2 = -0.1126
P = 0.69
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Correlation to Total Insulin Dose
r2 = -0.2772
P = 0.34
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r2 = -0.1408
P = 0.63
Correlation to Weight Adjusted Insulin Dose
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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