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Presenter: David, Goodman, Fitzroy, Australia
Authors: David J Goodman, Glen M Ward, Jane Holmes-Walker, Howe Katherine, Patricia Anderson, Toni Radford, P T Coates, Thomas Kay, Phillip OConnell
D. Goodman1, G. Ward2, J. Holmes-Walker3, H. Katherine1, P. Anderson4, T. Radford5, P. Coates5, T. Kay6, P. OConnell4.
1Nephrology & Islet cell transplantation, St Vincent's Hospital Melbourne, Melbourne, Australia, ; 2Endocrinology & Islet cell transplantation, St Vincent's Hospital Melbourne, Melbourne, Australia, ; 3Endocrinology, Westmead Hospital, Sydney, Australia, ; 4Nephrology & Islet cell Transplantation, Westmead Hospital, Sydney, Australia, ; 5Nephrology & Islet cell transplantation, Royal Adelaide Hospital, Adelaide, Australia, ; 6Immunology & Islet cell transplantation, St Vincent's Research Institute, Melbourne, Australia, ; 7Nephrology & Islet cell transplantation, Royal Adelaide Hospital, Adelaide, Australia, ; 8St Vincent's Research Institute, St Vincent's Research Institute, Melbourne, Australia, ; 9Nephrology & Islet cell Transplantation, Westmead, Sydney, Australia,
Aims: ICT is a treatment option for patients with T1DM, recurrent hypoglycaemia and hypoglycaemic unawareness. Patients referred for ICT need to fulfil stringent inclusion/exclusion criteria. We describe a patient cohort who died following referral but prior to ICT.
Methods: We retrospectively collected data on patients who were referred for consideration for ICT at 3 Australian centres. Medical records were reviewed for medical co-morbidities and the cause of death obtained from medical records or the coroner if the patient underwent post mortem examination.
Results: Of the 325 patients referred for ICT, 9 patient deaths (8 females and 1 male) were reported (2.8%). There were no deaths in the 39 patients who received 1 or more ICT.<span lang="EN-US">The mean patient age of the deceased was 44 years (27-55). Duration of DM was greater than 14y. All Edmonton hypo scores were greater than 1500. Two patients had used insulin pump therapy in the past and 2 had never trialed an insulin pump.<span lang="EN-US">Only one of the nine patients fulfilled the criteria for ICT. Reasons not listed for ICT include renal impairment GFR <80ml/min in (2), diabetic gastroparesis affecting ability to take medications (1), mental illness/depression (1), kidney transplant (1) and smoker (1).<span lang="EN-US">The cause of death was hypoglycaemia (5), Diabetic ketoacidosis (1), sepsis following bowel perforation (1), unknown presumed hypo/”dead in bed”(2). One of the deaths attributed to hypoglycaemia was due to deliberate insulin overdose.
Conclusions: ICT can be a life-saving procedure for patients with unstable T1DM. Our patient demographics are different from the “dead in the bed syndrome” which typically affects younger male patients. Our mortality rate of 2.8% may be an underestimate as we are yet to systematically follow up all the patients who were referred but did not proceed to ICT. The data suggests we should review our inclusion/exclusion criteria for islet cell transplantation and ensure patients who are not suitable for ICT are managed in specialized clinics for problematic hypoglycaemia.
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