Lower Insulin-Dose Adjusted A1c (IDAA1c) Is Associated With Less Complications in Individuals With Type 1 Diabetes Treated With Hematopoetic Stem-Cell Transplantation and Conventional Therapy

Jaquellyne Gurgel Penaforte-Saboia; Carlos Eduardo Barra Couri; Virginia Oliveira Fernandes; Ana Paula Dias Rangel Montenegro; Lívia Aline De Araújo Batista; Lenita Zajdenverg; Carlos Antonio Negrato; Kelen Cristina Ribeiro Malmegrim; Daniela Aparecida Moraes; Juliana Bernardes Elias Dias; Maria Carolina Oliveira; Akhtar Hussain; Marilia Brito Gomes; Renan Magalhães Montenegro Jr

doi:10.3389/fendo.2019.00747

Lower Insulin-Dose Adjusted A1c (IDAA1c) Is Associated With Less Complications in Individuals With Type 1 Diabetes Treated With Hematopoetic Stem-Cell Transplantation and Conventional Therapy

Front Endocrinol (Lausanne). 2019 Nov 19:10:747. doi: 10.3389/fendo.2019.00747. eCollection 2019.

Authors

Jaquellyne Gurgel Penaforte-Saboia^{1

2}, Carlos Eduardo Barra Couri^{3

4}, Virginia Oliveira Fernandes^{1

2

5}, Ana Paula Dias Rangel Montenegro^{1

2

5}, Lívia Aline De Araújo Batista^{1

5}, Lenita Zajdenverg⁶, Carlos Antonio Negrato⁷, Kelen Cristina Ribeiro Malmegrim³, Daniela Aparecida Moraes^{3

4}, Juliana Bernardes Elias Dias^{3

4}, Maria Carolina Oliveira^{3

4}, Akhtar Hussain^{1

8

9}, Marilia Brito Gomes¹⁰, Renan Magalhães Montenegro Jr^{1

2

5}

Affiliations

¹ Postgraduate Program in Medical Sciences, Department of Clinical Medicine, Federal University of Ceará, Fortaleza, Brazil.
² Clinical Research Unit, Walter Cantidio University Hospital, Federal University of Ceará/EBSERH, Fortaleza, Brazil.
³ Center for Cell-Based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
⁴ Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
⁵ Postgraduate Program in Public Health, Department of Community Health, Federal University of Ceará, Fortaleza, Brazil.
⁶ University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
⁷ Brazilian Society of Diabetes, São Paulo, Brazil.
⁸ Faculty of Health Sciences, Nord University, Bodø, Norway.
⁹ Centre for Global Health Research, Diabetic Association of Bangladesh, Dhaka, Bangladesh.
¹⁰ Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil.

Abstract

Objective: To evaluate the association between insulin-dose adjusted A1C (IDAA1c) and microvascular complications (MC) and hypoglycemia in a representative Brazilian population of Type 1 diabetes mellitus (T1DM) patients. Research Design and Methods: This was a cross-sectional study based on a previous study, "Microvascular Complications in Type 1 Diabetes: a comparative analysis of patients treated with autologous nonmyeloablative hematopoietic stem-cell transplantation (AHST) and conventional medical therapy (CT)". The 168 patients in that study (144 from CT plus 24 from AHST) were re-subdivided into two groups, according to their IDAA1c values (30 patients had IDAA1c ≤ 9; 138 had IDAA1c > 9). Then, the prevalence of MC (diabetic renal disease, neuropathy, and retinopathy), hypoglycemia (blood glucose <60 mg/dL), and severe hypoglycemic (episode of hypoglycemia that required the assistance of another person to treat) events were compared between the groups. The groups were well-matched on these factors: duration of disease, sex, and age at the time of diagnosis of T1DM. Results: After an average of 8 years after diagnosis, only 6.6% (2/30) of the patients from IDAA1c ≤ 9 group developed any MC, whereas 21.0% (29/138) from the IDAA1c > 9 group had at least one complication (p = 0.044). Regarding hypoglycemic events, the proportion of individuals who reported at least 1 episode of hypoglycemia in the last month was 43.3 and 64.7% from the IDAA1c ≤ 9 and IDAA1c > 9 groups, respectively (p = 0.030). Regarding severe hypoglycemia, the proportion of patients presenting at least one episode in the last month and the rate of episode/patient/month were similar between groups (6.7 vs. 13.2%; p = 0.535; and 0.1/patient/month vs. 0.25/patient/month; p = 0.321). Conclusion: In a representative Brazilian population of T1DM patients, those with IDAA1c ≤ 9 presented a lower frequency of MC, as well as fewer episodes of hypoglycemia, in the month prior to the analysis.

Keywords: IDAA1c; glycemic control; microvascular complications; residual B-cell function; type 1 diabetes (T1D).