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Mark Molitch Part 3, Hyperglycemia After Transplantation

In part 3 of this Exclusive Interview, Dr. Mark Molitch talks with Diabetes in Control Publisher Steve Freed during the ADA meeting in San Diego, California about his ADA presentation on resulting diabetes diagnoses or hyperglycemia following islet pancreatic transplant surgery.

Dr. Mark Molitch is the Martha Leland Sherwin Professor of Medicine at Northwestern in the
Division of Endocrinology, Metabolism and Molecular Medicine. He has been active in clinical research in diabetes, focusing on diabetic nephropathy, and other areas of endocrinology.

Transcript of this video segment:

Steve Freed: You’re presenting at a symposium. It’s called Primer on Transplantation with a Clinician: Addressing Hyperglycemia After Transplantation from Post-Transplant Diabetes to Reoccurrence of Hypoglycemia After Islet Pancreas Transplant. Can you explain that?

Mark Molitch: Really, there’s a couple different aspects to this. One is just looking at patients who had solid organ transplants such as liver or kidney, lung and heart, and the hyperglycemia that occurs after surgery in these patients. So, for some of these people, it’s just diabetes that they had before that is now a little worse with the stress of surgery. For some of those patients it’s diabetes that had not been discovered prior to surgery but it was clearly there, it just hadn’t been diagnosed and yet to some where you just have hyperglycemia related to the stress of the surgery. And finally some people recover from the stress of the surgery. but then develop diabetes months to a few years later related to some of the immunosuppressant drugs that they get for the transplant management. There are several different sub-categories there that need to be addressed and in my discussion, I covered all that information.

Steve Freed: When you think of transplantation …in Canada where they started this whole thing wishing that people go back to diabetes that they require insulin after a transplant. From your experience, would you call that a success, transplantation, and more diabetics type 1 should consider it if we had the beta…

Mark Molitch: You’re referring now to the islet cell transplant, which is a little bit different from what I was talking about, although I did address that in my discussion. So, the islet of transplants, when they’re done now, they’re done primarily for people who have hypoglycemic unawareness after long-standing diabetes; they can’t control their diabetes because of repeated episodes of hypoglycemia. One of the issues is that they don’t like to have patients going for islet cell transplant who have any degree of kidney disease because of the potential kidney toxicity of drugs. So, it’s been relatively successful. You know most patients, probably 80% of people are insulin free at the end of one year, but then that starts to go down pretty dramatically at 3 years and 5 years. At about 5 years, we’re down to well less than 50% that are still not insulin requiring. So it’s a temporizing type of thing. On the other hand, even at 4 or 5 years, even if they require some insulin, they are still much better than they were before, much less hypoglycemia, better controlled, even though they’re not completely insulin independent. But you’re right; you raise a question is this truly a viable type of treatment. It is very, very limited. It requires two or three sets of islets from two to three donors for a single recipient, which makes it fairly difficult to apply this on a widescale basis.

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