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Abstract：
BACKGROUND: Mesenchymal stem cell infusion and vitamin D supplementation may have immunomodulatory actions that could prolong the preservation of residual insulin secretion in patients with type 1 diabetes (T1D). Intervention with these agents after onset of T1D could favor the development of a remission phase, with potential clinical impact. We aimed to compare the presence of clinical remission (CR), glycemic control and daily insulin requirement at 6, 12, 18, 24 and 36 months after the diagnosis of T1D using IDAA1c in patients who received therapy with adipose tissue-derived mesenchymal stem cell (ASC) infusion and vitamin D supplementation and a control group.
METHODS: This retrospective cohort study analyzed data from the medical records of patients with T1D diagnosed between 15 and 40 years. Partial CR was defined as an IDAA1c index < 9. Patients in the intervention group received an infusion of adipose tissued-derived mesenchymal stem cells (ASCs) within 3 months after diagnosis and supplementation with 2000 IU of cholecalciferol for 1 year, started on the day following the infusion. Partial CR was also determined using the ISPAD criteria, to assess its agreement with IDAA1c.
RESULTS: A total of 28 patients were evaluated: 7 in the intervention group (group 1) and 21 in the control group (group 2). All patients in group 1 evolved with partial CR while only 46.7% of patients in group 2 had this outcome. Group 1 had a higher frequency of CR when evaluated with IDAA1c and ISPAD criteria. The mean duration of CR varied between the two criteria. Although HbA1c was similar between groups during follow-up, group 1 had a lower total daily insulin requirement (p < 0.005) at all time points. At 36 months, group 1 used 49% of the total daily insulin dose used by group 2 with similar glycemic control.
CONCLUSIONS: The intervention with infusion of ASC + vitamin D supplementation was associated with partial CR at 6 months. Although there were no differences in CR established by the IDAA1c and ISPAD criteria after three years of follow-up, patients who underwent intervention had nearly the half insulin requirement of controls with conventional treatment, with similar glycemic control.
BACKGROUND: 37001514.0.0000.5257.
METHODS: This retrospective cohort study analyzed data from the medical records of patients with T1D diagnosed between 15 and 40 years. Partial CR was defined as an IDAA1c index < 9. Patients in the intervention group received an infusion of adipose tissued-derived mesenchymal stem cells (ASCs) within 3 months after diagnosis and supplementation with 2000 IU of cholecalciferol for 1 year, started on the day following the infusion. Partial CR was also determined using the ISPAD criteria, to assess its agreement with IDAA1c.
RESULTS: A total of 28 patients were evaluated: 7 in the intervention group (group 1) and 21 in the control group (group 2). All patients in group 1 evolved with partial CR while only 46.7% of patients in group 2 had this outcome. Group 1 had a higher frequency of CR when evaluated with IDAA1c and ISPAD criteria. The mean duration of CR varied between the two criteria. Although HbA1c was similar between groups during follow-up, group 1 had a lower total daily insulin requirement (p < 0.005) at all time points. At 36 months, group 1 used 49% of the total daily insulin dose used by group 2 with similar glycemic control.
CONCLUSIONS: The intervention with infusion of ASC + vitamin D supplementation was associated with partial CR at 6 months. Although there were no differences in CR established by the IDAA1c and ISPAD criteria after three years of follow-up, patients who underwent intervention had nearly the half insulin requirement of controls with conventional treatment, with similar glycemic control.
BACKGROUND: 37001514.0.0000.5257.
摘要：
背景：间充质干细胞输注和补充维生素D可能具有免疫调节作用，可以延长1型糖尿病（T1D）患者残余胰岛素分泌的保存时间。在T1D发作后对这些药物进行干预可能有利于缓解期的发展，具有潜在的临床影响。我们的目的是比较临床缓解(CR)的存在，在接受脂肪组织来源的间充质干细胞（ASC）输注和维生素D补充治疗的患者和对照组中，使用IDA1c诊断T1D后6、12、18、24和36个月的血糖控制和每日胰岛素需求。
方法：这项回顾性队列研究分析了诊断为15至40岁的T1D患者的病历数据。部分CR定义为IDA1c指数<9。干预组患者在诊断后3个月内接受脂肪组织间充质干细胞（ASCs）输注，并补充2000IU胆钙化醇1年，从输液后的第二天开始。部分CR也使用ISPAD标准确定，评估其与IDAA1c的协议。
结果：共评估了28例患者：干预组（第1组）7例，对照组（第2组）21例。第1组的所有患者均出现部分CR，而第2组只有46.7％的患者出现这种结果。当用IDAA1c和ISPAD标准评估时，第1组的CR频率更高。CR的平均持续时间在两个标准之间变化。虽然HbA1c在随访期间组间相似，在所有时间点,第1组的每日胰岛素总需求量较低(p<0.005).36个月时,第1组使用了第2组每日胰岛素总剂量的49%,血糖控制相似.
结论：在6个月时，输注ASC+维生素D的干预与部分CR相关。尽管经过三年的随访，IDAA1c和ISPAD标准确定的CR没有差异，接受干预的患者胰岛素需求量接近常规治疗对照组的一半，血糖控制相似。
背景：37001514.0.0000.5257。
方法：这项回顾性队列研究分析了诊断为15至40岁的T1D患者的病历数据。部分CR定义为IDA1c指数<9。干预组患者在诊断后3个月内接受脂肪组织间充质干细胞（ASCs）输注，并补充2000IU胆钙化醇1年，从输液后的第二天开始。部分CR也使用ISPAD标准确定，评估其与IDAA1c的协议。
结果：共评估了28例患者：干预组（第1组）7例，对照组（第2组）21例。第1组的所有患者均出现部分CR，而第2组只有46.7％的患者出现这种结果。当用IDAA1c和ISPAD标准评估时，第1组的CR频率更高。CR的平均持续时间在两个标准之间变化。虽然HbA1c在随访期间组间相似，在所有时间点,第1组的每日胰岛素总需求量较低(p<0.005).36个月时,第1组使用了第2组每日胰岛素总剂量的49%,血糖控制相似.
结论：在6个月时，输注ASC+维生素D的干预与部分CR相关。尽管经过三年的随访，IDAA1c和ISPAD标准确定的CR没有差异，接受干预的患者胰岛素需求量接近常规治疗对照组的一半，血糖控制相似。
背景：37001514.0.0000.5257。
