Transplant
May Help Some Type 1 Diabetics
Benefits
of islet transplantation appear to be long lasting, greater than 2
years sofar.
Researchers
following diabetics who have undergone a treatment called islet
transplantation report that more than half of the patients still don't
require insulin injections more than 2 years after treatment,
according to a report in the July issue of the journal Diabetes.
Dr.
Edmond A. Ryan of the University of Alberta in Edmonton, Alberta,
Canada said that, "The islet transplant procedure is continuing
to give very good results." The treatment does cause
complications, but he said that these side effects are "no more
than would be expected" from the use of powerful
immune-suppressing drugs that keep the body from rejecting the
transplanted cells.
"I
said to one of my patients recently, 'There is no free lunch,' and he
said he thought the price he paid in terms of adverse events was well
worth it for the benefits obtained," Ryan said.
One
experimental approach to treating type 1 diabetes is to transplant
islets, which are clusters of cells in the pancreas that contain beta
cells. Though islet transplantation has the potential to free
diabetics from daily insulin injections, the treatment is risky, and
immune-suppressing drugs can cause serious side effects.
Ryan
and his colleagues now report the outcome of 17 patients who have
completed the islet transplantation procedure and have been followed
for an average of about 20 months. Of the 15 patients who have been
followed for at least a year, 9 (60%) no longer need to take insulin.
Of those who had been followed for at least two years, 4 out of 6
(67%) were off insulin, according to the report.
Even
though several patients had to resume taking insulin, half are using a
50% lower dose of insulin than before the transplant.
Despite
the benefits of the transplant, there is definitely room for
improvement, Ryan and his colleagues point out. The treatment was
associated with a variety of side effects, including blood clots,
bleeding, elevated cholesterol levels and a rise in creatinine, which
is a marker for kidney disease.
Right
now, islet transplantation is suitable only for a small percentage of
people with type 1 diabetes, according to Ryan. The group most likely
to benefit is a subset of type 1 patients who have great difficulty
controlling their blood sugar, or glucose, levels despite the best
treatment, he said. This group accounts for 5% to 10% of people with
type 1 diabetes, he said.
"In
time, as the procedure becomes safer and if other sources of islets
can be found, it could apply to many more," he said. SOURCE:
Diabetes 2002;51:2148-2157
