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Treating diabetes with islet transplantation: lessons from the past decade in Lille.

Abstract：

:Type 1 diabetes (T1D) is due to the loss of both beta-cell insulin secretion and glucose sensing, leading to glucose variability and a lack of predictability, a daily issue for patients. Guidelines for the treatment of T1D have become stricter as results from the Diabetes Control and Complications Trial (DCCT) demonstrated the close relationship between microangiopathy and HbA1c levels. In this regard, glucometers, ambulatory continuous glucose monitoring, and subcutaneous and intraperitoneal pumps have been major developments in the management of glucose imbalance. Besides this technological approach, islet transplantation (IT) has emerged as an acceptable safe procedure with results that continue to improve. Research in the last decade of the 20th century focused on the feasibility of islet isolation and transplantation and, since 2000, the success and reproducibility of the Edmonton protocol have been proven, and the mid-term (5-year) benefit-risk ratio evaluated. Currently, a 5-year 50% rate of insulin independence can be expected, with stabilization of microangiopathy and macroangiopathy, but the possible side-effects of immunosuppressants, limited availability of islets and still limited duration of insulin independence restrict the procedure to cases of brittle diabetes in patients who are not overweight or have no associated insulin resistance. However, various prognostic factors have been identified that may extend islet graft survival and reduce the number of islet injections required; these include graft quality, autoimmunity, immunosuppressant regimen and non-specific inflammatory reactions. Finally, alternative injection sites and unlimited sources of islets are likely to make IT a routine procedure in the future.

journal_name

Diabetes Metab

journal_title

Diabetes & metabolism

authors

Vantyghem MC,Defrance F,Quintin D,Leroy C,Raverdi V,Prévost G,Caiazzo R,Kerr-Conte J,Glowacki F,Hazzan M,Noel C,Pattou F,Diamenord AS,Bresson R,Bourdelle-Hego MF,Cazaubiel M,Cordonnier M,Delefosse D,Dorey F,Fayard A

doi

10.1016/j.diabet.2013.10.003

subject

Has Abstract

pub_date

2014-04-01 00:00:00

pages

108-19

issue

eissn

1262-3636

issn

1878-1780

pii

S1262-3636(13)00199-7

journal_volume

pub_type

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Treating diabetes with islet transplantation: lessons from the past decade in Lille.