Relationship between full islet transplanted function and secondary diabetic complications: a case report
Bibliographic record
Abstract
Background: Islet transplantation is a standardized procedure that enables the replacement of beta cells function restoring endogenous insulin secretion in patients with type 1 diabetes. Previous studies have shown that restoration of c-peptide secretion with islet transplantation might be protective for long-term diabetic complications. Methods: Herein, we report a detailed follow-up in a 50 years old female who underwent two allogeneic islet infusions (under the Edmonton protocol), enjoying a 7-years lasting insulin-independence, but then experiencing the relapse of diabetic diseaseand the renewal of exogenous insulin therapy. Follow-up lasted 9 years; metabolic parameters and macro-microangiopathic and neuropathic complications of diabetes were evaluated yearly: fasting and Arginine-stimulated C-peptide (fC-pep ng/mL; sC-pep); glycaeted hemoglobin (HbA1c%); exogenous insulin requirement (EIR U/day); thickness of left and right carotid plaques (cPlaq mm); peak systolic velocity (PSV cm/sec) of bilateral retinal artery; endothelial-dependent dilatation (EDD) of brachial artery and endothelial progenitor cells (EPCs) function; electromyography. At the same time the liver structure was monitored with ultrasound. Results: The details of the single parameters during the follow-up were respectively pre transplant, at 1,2,3,4,5,6,7,8,9 years: – C pep ng/mL: 0,1; 1,3; 1,8; 1,5; 1,6; 2,7; 2,1;1,9;1,5; 0,5 – EIR U/day: 30; 0 (from 1 to 8 years); 19; 25 – HbA1c %: 8,1; 5,3; 5,9; 5,9; 6; 6; 6,4; 6,3; 7,6;; 7,6 – cPlaq mm: 1,5; 1,2; 1,5; 1,4; 1,5; 1,6; 1;1,5; 1,8; 2,8 – VPS cm/sec: 6,8; 5,5; 10,9; 18,2; 13,9; 12,7; 16,4; 21,1; 15,8; 8,1 – EDD %: 3; 15 at 4 years; 18 at 9 years – EPCs X 106:: 0.9;10 at 4 years; 6.1 at 9 years During the status of insulin-independence and of stable sustained C-pep secretion, all parameters correlated with chronic complications improved; when diabetes relapsed and exogenous insulin therapy was resumed, a significant decrease was observed, except for the percentage of EDD which was still preserved 1 year after diabetes recurrence. Electromyography showed a stability of neural function throughout the follow-up. After the loss of full islet function liver fatty changes developed and was detectable at ultrasound exam at 8th and 9th year. Conclusion: This case report confirms the beneficial role of full islet function on secondary diabetic complications and, for the first time, demonstrates a detrimental effect of the loss of full beta cell function on vascular diabetic complications, in particular on macro-microangiopathy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.004 | 0.002 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.005 | 0.004 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".