Reduced progression of diabetic retinopathy after islet cell transplantation compared with intensive medical therapy

Transplantation. 2008 May 27;85(10):1400-5. doi: 10.1097/TP.0b013e318172ca07.

Abstract

Background: Diabetic retinopathy is a major complication of type 1 diabetes and remains a leading cause of visual loss. There have been no comparisons of the effectiveness of intensive medical therapy and islet cell transplantation on preventing progression of diabetic retinopathy.

Methods: The British Columbia islet transplant program is conducting a prospective, crossover study comparing medical therapy and islet cell transplantation on the progression of diabetic retinopathy. Progression was defined as the need for laser treatment or a one step worsening along the international disease severity scale. An interim data analysis was performed after a mean 36-month follow-up postislet transplantation and these results are presented.

Results: The medical and postislet transplant groups were similar at baseline. Subjects after islet transplantation had better glucose control than the medically treated subjects (mean HbA1c 6.7%+/-0.9% vs. 7.5+/-1.2, P<0.01) and were C-peptide positive. Progression occurred significantly more often in all subjects in the medical group (10/82 eyes, 12.2%) than after islet transplantation (0/51 eyes, 0%) (P<0.01). Considering only subjects who have received transplants, progression occurred in 6/51 eyes while on medical treatment and 0/51 posttransplant (P<0.02).

Conclusions: Progression of diabetic retinopathy was more likely to occur during medical therapy than after islet cell transplantation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Cohort Studies
  • Cross-Over Studies
  • Diabetes Mellitus, Type 1 / drug therapy*
  • Diabetes Mellitus, Type 1 / surgery*
  • Diabetic Nephropathies / surgery*
  • Diabetic Retinopathy / physiopathology*
  • Diabetic Retinopathy / prevention & control*
  • Disease Progression
  • Female
  • Glycated Hemoglobin A / metabolism
  • Humans
  • Islets of Langerhans Transplantation / physiology*
  • Macular Edema / epidemiology
  • Male
  • Middle Aged
  • Prospective Studies
  • Visual Acuity

Substances

  • Glycated Hemoglobin A