Forbes Shareen, McGowan Neil W A, Duncan Kirsty, Anderson Debbie, Barclay Janet, Mitchell Donna, Docherty Kevin, Turner David, Campbell John D M, Casey John J
Islet Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK,
Diabetologia. 2015 Jun;58(6):1300-8. doi: 10.1007/s00125-015-3554-3. Epub 2015 Mar 26.
AIMS/HYPOTHESIS: Type 1 diabetes complicated by hypoglycaemia is prevalent in socioeconomically deprived populations. Islet transplantation is of proven efficacy in type 1 diabetes complicated by hypoglycaemia, but it is not known if nationally funded programmes reach the socioeconomically deprived. Our aim was to determine: (1) socioeconomic indices in participants referred to our nationally funded programme; and (2) if metabolic outcomes in our transplant recipients were improved.
Participants referred (n = 106) and receiving transplants (n = 18; 32 infusions) were examined with respect to socioeconomic status (deprivation category score) and their ability to work and drive. In participants followed for ≥12 months after transplantation, metabolic and anthropometric measurements (n = 14) were recorded pre- and post-transplant (assessed ~1, ~3, ~6 and ~12 months with mixed-meal tolerance tests and 6 day continuous glucose monitoring assessments). Donor data was also examined.
There was a greater prevalence of socioeconomic deprivation in referred and transplant recipients than the general population (p < 0.05). Of the transplant recipients, 73% were socioeconomically deprived, 88% did not hold a driver's license and 94% had reduced ability to work (all p < 0.01 vs referred participants). Donors were predominantly obese and included circulatory death donors. At 12 months, 93% of participants who had received transplants had graft function, diminished frequency of hypoglycaemia (10 [4-11] vs 0 [0-2] hypoglycaemic episodes/week), improved awareness of hypoglycaemia (Gold score 7 [5-7] vs 1 [1-2]) and glycaemic control (HbA1c: 7.9% [7.2-8.5%]; 63 [55-69] mmol/mol vs 7.2% [6.8-7.5%]; 55 [51-58] mmol/mol), diminished glycaemic lability and decreased central adiposity (all p < 0.05).
CONCLUSIONS/INTERPRETATION: A nationally funded islet transplant programme reaches the socioeconomically deprived and outcomes are significantly improved in this group.
目的/假设：1型糖尿病合并低血糖在社会经济贫困人群中很普遍。胰岛移植在1型糖尿病合并低血糖患者中已被证明有效，但国家资助项目是否惠及社会经济贫困人群尚不清楚。我们的目的是确定：（1）被转诊至我们国家资助项目的参与者的社会经济指标；（2）我们的移植受者的代谢结局是否得到改善。
对被转诊（n = 106）并接受移植（n = 18；32次输注）的参与者进行社会经济状况（贫困类别评分）以及工作和驾驶能力方面的检查。对移植后随访≥12个月的参与者，在移植前后记录代谢和人体测量指标（n = 14）（通过混合餐耐量试验和6天连续血糖监测评估，分别在约1、约3、约6和约12个月时进行评估）。还对供体数据进行了检查。
被转诊者和移植受者中社会经济贫困的患病率高于普通人群（p < 0.05）。在移植受者中，73%的人社会经济贫困，88%没有驾照，94%的人工作能力下降（与被转诊参与者相比，所有p < 0.01）。供体主要为肥胖者，包括循环死亡供体。在12个月时，93%接受移植的参与者移植器官功能良好，低血糖发作频率降低（10 [4 - 11]次/周 vs 0 [0 - 2]次/周低血糖发作），低血糖意识提高（戈尔德评分7 [5 - 7] vs 1 [1 - 2]），血糖控制改善（糖化血红蛋白：7.9% [7.2 - 8.5%]；63 [55 - 69] mmol/mol vs 7.2% [6.8 - 7.5%]；55 [51 - 58] mmol/mol），血糖波动减小，中心性肥胖减轻（所有p < 0.05）。
结论/解读：国家资助的胰岛移植项目惠及了社会经济贫困人群，且该群体的结局得到显著改善。
