Cohort Study to Refine the Positioning of Closed-loop Therapy Versus Islet Transplantation in the Management of Patients With Unstable Type 1 Diabetes

Prior treatment

• Kidney transplant patients

Other illness

• Patients with type 1 diabetes who do not meet the criteria for islet transplantation

Other

• Patients already fitted with a closed loop
• Persons covered by articles L1121-5 to L1121-8 of the CSP (corresponding to all protected persons)
• Persons opposed to participation in research

• Type 1 diabetic patients describing:
• Significant glycaemic variability defined by the presence of one of these 3 criteria: - Standard deviation \> 50% of the glycaemic mean or a MAGE index \> 60 mg/dL
• Coefficient of glycaemic variation \> 36%
• LBGI index \> 5 or HYPOSCORE \> 800
• This glycaemic variability must be persistent, i.e. persist for more than 12 months despite optimal diabetes management by a multi-professional team. Optimum management involves :
• Monitoring by a team with expertise in insulin pump and glucose sensor technologies
• Training patients in functional insulin therapy, intensive self-monitoring of blood glucose levels, and prevention and management of situations where there is a risk of hypoglycaemia
• Use of pump and glucose sensor therapy, with interruption before hypoglycaemia
• Reinforced multi-professional support and monitoring, possibly combined with support via telemedicine.
• This glycaemic variability must be considered as severe, i.e. causing unpredictable clinical and metabolic events that impair quality of life, such as severe, disabling and frequent hypoglycaemia (at least 2 Severe Hypoglycaemia with assistance from a third party in the last 12 months or at least 1 Severe Hypoglycaemia with life-threatening consequences in the last 12 months (coma, convulsions or trauma)) or ketosis ketoacidosis.