Issue 113 Item 11 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