Long-Term Insulin Independence in Type 1 Diabetes Mellitus Using a Simplified Autologous Stem Cell Transplant

Context: Efforts to find a cure for type 1 diabetes have focused on the removal of the autoimmune pathophysiologic substrate, with the use of immunosuppressive regimens including autologous hematopoietic stem cell transplantation (AHSCT). Objective: The main objective of determining long-term insulin independence as well as changes in glycated hemoglobin (HbA1c). Secondary outcomes were procedure morbidity and the need for hospital management. Design: We enrolled patients with type 1 diabetes between 2012 and 2014. Median follow-up was 34 months (range, 25–56 mo). Setting: Ambulatory care. Interventions: We decided to carry out an AHSCT protocol using a less toxic and affordable simplified method based on fludarabine in an outpatient setting. Patients: Patients were of both sexes, age 8–25 years, with positive levels of anti-GAD antibodies, a C-peptide level >1.0 ng/mL, and