Microvascular Complications in Type 1 Diabetes: A Comparative Analysis of Patients Treated with Autologous Nonmyeloablative Hematopoietic Stem-Cell Transplantation and Conventional Medical Therapy

• Published in: Frontiers in endocrinology (Lausanne) Vol. 8; p. 331
• Main Authors: Penaforte-Saboia, Jaquellyne G, Montenegro, Jr, Renan M, Couri, Carlos E, Batista, Livia A, Montenegro, Ana Paula D R, Fernandes, Virginia O, Akhtar, Hussain, Negrato, Carlos A, Malmegrim, Kelen Cristina Ribeiro, Moraes, Daniela Aparecida, Dias, Juliana B E, Simões, Belinda P, Gomes, Marilia Brito, Oliveira, Maria Carolina
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 23.11.2017
• Subjects: autologous nonmyeloablative hematopoietic stem-cell transplantation; Endocrinology; glycemic control; microvascular complications; residual B-cell function; type 1 diabetes; autologous nonmyeloablative hematopoietic stem-cell transplantation; residual B-cell function; type 1 diabetes; glycemic control; microvascular complications
• ISSN: 1664-2392; 1664-2392
• DOI: 10.3389/fendo.2017.00331

To explore the impact on microvascular complications, long-term preservation of residual B-cell function and glycemic control of patients with type 1 diabetes treated with autologous nonmyeloablative hematopoietic stem-cell transplantation (AHST) compared with conventional medical therapy (CT). Cross-sectional data of patients treated with AHST were compared with patients who received conventional therapy from the Brazilian Type 1 Diabetes Study Group, the largest multicenter observational study in type 1 diabetes mellitus in Brazil. Both groups of patients had diabetes for 8 years on average. An assessment comparison was made on the presence of microvascular complications, residual function of B cell, A1c, and insulin dose of the patients. After a median of 8 years of diagnosis, none of the AHST-treated patients (  = 24) developed microvascular complications, while 21.5% (31/144) had at least one (  < 0.005) complication in the CT group (  = 144). Furthermore, no case of nephropathy was reported in the AHST group, while 13.8% of CT group (  < 0.005) developed nephropathy during the same period. With regard of residual B-cell function, the percentage of individuals with predicted higher C-peptide levels (IDAA1C ≤ 9) was about 10-fold higher in the AHST group compared with CT (75 vs. 8.3%) (  < 0.001) group. Among AHST patients, 54.1% (13/24) had the HbA1c < 7.0 compared with 13.1% in the CT (  < 0.001) group. Patients with newly diagnosed type 1 diabetes treated with AHST presented lower prevalence of microvascular complications, higher residual B-cell function, and better glycemic control compared with the CT group.