Reach further, in an Open Access Journal Endocrinology, Diabetes & Metabolism Case Reports

ISSN 1470-3947 (print)
ISSN 1479-6848 (online)

Searchable abstracts of presentations at key conferences in endocrinology

Published by BioScientifica
Endocrine Abstracts (2012) 29 OC3.3 

Diabetic ketoacidosis at diagnosis influences complete remission after treatment of hematopoietic stem cell transplantation in adolescents with type 1 diabetes

W. Gu1, J. Hu1, D. Zhu2, W. Tang1, L. Li2, W. Cui2, J. Hong1, Y. Zhang1, W. Wang1 & G. Ning1

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Objective: To determine if autologous nonmyeloablative hematopoietic stem cell transplantation (AHSCT) was worthwhile to do in type 1 diabetes adolescents with diabetic ketoacidosis at diagnosis.

Research Design and Methods: We enrolled 28 type 1 diabetes patients aged 14–30 years in a prospective AHSCT phase II clinical trial. Hematopoietic stem cells were harvested from the peripheral blood following a pretreatment consisting of a combination of cyclophosphamide and antithymocyte globulin. Changes of exogenous insulin requirement were observed and serum levels of hemoglobin A1c, C-peptide secretion during the oral glucose tolerance test (OGTT) and anti-glutamic acid decarboxylase antibody (GAD) were measured before and after AHSCT.

Results: After transplantation, complete remission (CR) defined as insulin independence was observed in 15 (53.6%, 15/28) patients for a mean period of 19.3 months over a follow-up ranging 4–42 months. The non-DKA patients achieved greater CR rate than the DKA ones (70.6%, 12/17 in non-DKA vs 27.3%, 3/11 in DKA, P=0.051). In non-DKA group, levels of fasting C-peptide, Cmax(peak value during OGTT) and AUCC(area under C-peptide release curve during OGTT) were enhanced significantly one month after transplantation and remained high during 24 months follow-up (all P<0.05). In DKA group, significant elevation of fasting C-peptide level and Cmax level were only observed at 18-month and 6-month respectively. There was no mortality.

Conclusions: We have performed AHSCT in 28 cases of type 1 diabetes. The data demonstrate AHSCT to be an effective long-term treatment of insulin dependence with greater efficacy achieved in patients without ketoacidosis at diagnosis.

Trial Registration Identifier: NCT00807651

Fig 1. Time course of HbA1c, Insulin dose, fasting C-peptide, Cmax, AUCC and LnGAD level in non-DKA group and DKA group respectively Note: Cmax, peak value of C-peptide during OGTT; AUCC (area under C-peptide release curve during OGTT); LnGAD, log form of GAD because of the uneven data distribution. Solid line, non-DKA group; Dotted line, DKA group.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector

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