Introduction: Islet cell transplantation (ICT) is a treatment option for people with type 1 diabetes (T1D), hypoglycaemia unawareness and recurrent hypoglycaemia. Those referred for consideration of ICT need to fulfil stringent inclusion/exclusion criteria.
Aims: We describe a cohort of individuals who died following referral to the Islet Transplant Clinic but prior to ICT.
Methods: We retrospectively collected data on people referred for consideration of ICT at three Australian centres from 2005 to 2016. Medical records were reviewed for severity of hypoglycaemia and hypoglycaemia unawareness; medical comorbidities and cause of death if documented or if a coroner’s report was available.
Results: Of the 325 people referred for ICT, 9 deaths (8 females, 1 male) were reported (2.8%). The mean age of the deceased was 44 years (27-55). Duration of diabetes was >14 years and all Edmonton HYPO scores were >1500. Only 1 person fulfilled the criteria for ICT. Reasons for ineligibility for ICT included renal impairment (eGFR<80ml/min) (2), gastroparesis affecting ability to take medications (1), depression (1), kidney transplant (1) and smoker (1). Cause of deaths was hypoglycaemia (5), diabetic ketoacidosis (1), sepsis (1), and unknown, presumed “dead-in-bed” (2). One death attributed to hypoglycaemia was due to deliberate insulin overdose. There were no deaths in the 39 people who received ≥1 ICT.
Conclusions: ICT can be a life-saving procedure for people with unstable T1D. Our cohort demographics are different from the classical “dead-in-bed” syndrome, typically affecting younger males. Our mortality rate of 2.8% may be an underestimate as follow-up of all referrals has not been completed. The data suggests that severe recurrent hypoglycaemia is a serious complication for those living with T1D, and supports the view that these high-risk individuals should be managed in specialised clinics.