Background: Type 1 diabetes (T1D) is an autoimmune-mediated disease that causes progressive beta cell death. At the time of diagnosis up to 20% of remaining beta cell mass is still able to produce insulin. Methods to halt autoimmunity in those newly diagnosed with T1D are a promising research avenue. To date, three clinical trials have been performed using non-myeloablative autologous hematopoietic stem cell transplants (AHSCT). We performed a meta-analysis of the results from the three clinical trials to determine positive and negative prognostic factors for the patients’ response to AHSCT.
Methods: Factors examined include sex, age, presence of diabetic ketoacidosis (DKA) at diagnosis, glycated hemoglobin (A1c), and levels of antibodies. The primary measurements was length of time subjects were able to discontinue insulin (calculated as the length of time free from exogenous insulin divided by the total follow-up for that subject). . In addition, for subjects with longitudinal data, trends in C-peptide (a measure of endogenous insulin production) and levels of antibodies were analyzed to determine whether beta cell function was preserved and autoimmunity reversed.
Results: DKA at diagnosis was significantly associated with the following factors: age younger than 20 years (p=0.0314), a shorter time free from insulin post-treatment (
