Body Mass Index, Weight and Insulin Dose as Selection Criteria for Islet Transplantation R Smith Bristol UK 29th AIDPIT Workshop Igls

Islet Transplantation Exclusion 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

Insulin Sensitivity Important determinant of success of beta cell transplantation How do we assess/measure insulin sensitivity? Weight, BMI, insulin dose ?

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

Glucose Disposal Rate Reaven G.M. Banting Lecture, Diabetes 1988 Normal Population T1DM awaiting Transplantation

Correlation to BMI r 2 = P = 0.69

Correlation to Weight r 2 = P = 0.69

Correlation to Total Insulin Dose r 2 = P = 0.34

r 2 = P = 0.63 Correlation to Weight Adjusted Insulin Dose

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