11-6: CONTINUOUS GLUCOSE MONITORING AND ASSESSMENT OF LONG-TERM ISLET FUNCTION IN AUTOLOGOUS ISLET TRANSPLANTATION AFTER TOTAL PANCREATECTOMY FOR PANCREATIC NEOPLASIA: PRELIMINARY DATA FROM THE VERONA COHORT

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Introduction: Total pancreatectomy with autologous islet transplantation (TPAIT) has been proposed as an alternative to high-risk pancreatic anastomosis after pacreaticoduodenectomy for prevention of surgical complications, while maintaining low risks to develop brittle pancreatogenic diabetes. However, few studies have investigated the relationship between continuous glucose monitoring (CGM) profiles and TPAIT outcomes. Methods: Between September 2023 and February 2025, 10 subjects with pancreatic neoplasia underwent TPAIT (males/females 5/5, age 60 [IQR 55-68] years, islet infusion 1912 [IQR 1724 – 3074] IEQ/kg) at the University Hospital of Verona. All of them underwent a glucometabolic monitoring program with visits at 1 (n=10), 3 (n=9), 6 (n=7) and 12 months (n=6) after TPAIT, including hematological exams and CGM-derived 3-month glucose profiles. Islet metabolic function at 12 months was assessed through the most recent modified Minnesota criteria, and optimal outcomes were compared to not-optimal ones. Results: Six subjects reached 12 months of follow-up: according to modified Minnesota criteria, their islet function was classified as optimal (n=3), good (n=2) and failure (n=1). All subjects with not-optimal islet function developed diabetes. Patients with optimal versus not-optimal outcomes displayed lower coefficients of variation at 3, 6 and 12 months (17.7% vs 27.9%, 20.4% vs 30.3%, 24.6% vs 29.4% respectively, all p<0.05), higher time in range (TIR) and tight range (TITR) and lower glycemia risk index (GRI) at 3 and 12 months (TIR: 99% vs 86%, 96% vs 84% respectively; TITR: 95% vs 60%, 85% vs 56% respectively; GRI: 2.4 vs 15.2, 4.8 vs 15.2, respectively; all p<0.05), and lower time above range at 12 months (3 vs 15%, p<0.05). Conclusions: According to our preliminary data, optimal islet function at 12 months after TPAIT was associated with lower glycemic variability and longer time spent in euglycemia, thereby suggesting that CGM metrics may be a good clinical indicator of long-term islet glucose competence.

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