Type 1 diabetes; Insulin-dependent diabetes; Juvenile diabetes
Major advances in islet-cell transplantation are allowing more patients to come off insulin or reduce their use of it.
Major clinical trials are now using an investigational specific islet-cell (also called beta-cell) transplantation procedure called the Edmonton protocol, which usually involves the following steps:
This procedure is still investigational but has helped some patients with severe type 1 diabetes to become free of insulin injections. However, many of these insulin-independent patients needed to resume insulin injections within 2 years. Researchers are continuing to work on refining the Edmonton protocol so that its benefits can be more sustainable and long lasting.
A major obstacle for the islet cell transplantation is the need for two or more donor pancreases to supply sufficient islet cells. Unfortunately, there are not enough pancreases available to make this procedure feasible for even 1% of patients. Researchers are looking for alternative approaches including the use of umbilical cord cells, embryonic or adult stem cells, bone marrow transplantation, and other types of cellular therapies. These studies are still in very early stages, but researchers predict that there will be major advances in these fields in the coming years.
Whole pancreas transplants and double transplants of pancreases and kidneys are proving to have a good long-term success rate for some patients with type 1 diabetes. The operations help to prevent further kidney damage, and long-term studies indicate that they may even eventually reverse some existing damage. There is some evidence that heart disease and diabetic neuropathy improve after pancreas transplantation (although not retinopathy). However, this procedure has significant surgical and postsurgical complications in patients with diabetes. One 10-year study reported that survival rate at 10 years was 76%, and two-thirds of the patients had both pancreas and kidney function. Immunosuppressive drugs are needed lifelong with this procedure. Doctors generally recommend transplants in cases of end-stage kidney failure or when diabetes poses more of a threat to the patient's life than the transplant itself.
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