|
Link to this page
Your search term(s) "islet cell transplantation" returned 24 results.
Displaying all search results.
Islet Cell Transplantation: How Effective Is It?. IN: LeRoith, D.; Vinik, A., eds. Controversies in Treating Diabetes: Clinical and Research Aspects. Totowa, NJ: Humana Press. 2008. pp 11-32.
This chapter about the effectiveness of islet transplantation is from a book that addresses diabetes controversies, specifically in the etiology and management of the disease. The authors of this chapter note that islet transplantation as a treatment for diabetes has shown great promise but has significant limitations. The chapter covers a brief history of islet transplantation, islet isolation, limits of the procedure, clinical islet transplantation, immunosuppression, the Edmonton advance, islet transplantation outcome follow-up, benefits, risk and limitations, new methods of beta-cell replacement and encapsulation, and endogenous beta-cell regeneration. Although islet transplantation can restore insulin independence to the patient with type 1 diabetes, nearly all patients must return to insulin therapy by 5 years after procedure due to loss of islet function. Other problems include the need for immunosuppression, an inadequate islet supply, risks associated with the portal vein cannulation, host sensitization against the donor islets, allogeneic islet effects on the surrounding host liver tissue, and great expense. The authors conclude by encouraging ongoing research in this area. 102 references.
Full Record Printer Friendly Version
Adverse Events. IN: Collaborative Islet Transplant Registry Annual Report. Bethesda, MD: National Diabetes Information Clearinghouse. pp. 125-145.
The number of transplant centers performing clinical islet cell transplantation continues to increase, as does the number of centers participating in and reporting to the Collaborative Islet Transplant Registry (CITR). The CITR was founded in September 2001 to provide support for logistics, data capture, quality control monitoring, statistical design and analysis, and other Registry activities. This chapter from the second Annual Report of the CITR summarizes the adverse events the islet transplant programs experienced. The authors note that one center did not report any adverse event, so the data included may underrepresent true occurrences. The chapter includes the overall adverse event rate; the serious adverse event rate for islet-alone transplant recipients, 1 year post-infusion; a summary of adverse events by time periods following the first infusion procedure; events that were life-threatening or required hospitalization; and duration of hospitalization. Overall, 77 serious adverse events were reported to the Registry, with 22 percent of them classified as life-threatening and 58 percent requiring inpatient hospitalization. Almost 69 percent of the serious adverse events were classified as unrelated to the islet infusion procedure and 38 percent unrelated to the immunosuppression therapy. Ninety-five percent of the serious adverse events resolved with no residual effects. The chapter includes one page of text and 17 pages of figures and tables, graphically representing the information presented. Readers are referred to the Registry’s website, www.citregistry.org, for more information. 6 figures. 19 tables.
Full Record Printer Friendly Version
Collaborative Islet Transplant Registry Annual Report. Bethesda, MD: National Diabetes Information Clearinghouse. 2005. 214 p.
The number of transplant centers performing clinical islet cell transplantation continues to increase, as does the number of centers participating in and reporting to the Collaborative Islet Transplant Registry (CITR). The CITR was founded in September 2001 to provide support for logistics, data capture, quality control monitoring, statistical design and analysis, and other Registry activities. This second Annual Report of the CITR describes the progress in islet or beta cell transplantation. The information is drawn from 19 North American islet transplant programs, representing 138 transplant recipients. The information is presented in four sections: a summary of Registry data; islet-transplant-alone recipient, donor, and outcome information; islet-after-kidney recipient, donor, and outcome information; and Registry data quality. The Report describes patient care, surgical experiences, follow-up care, complications, hypoglycemia, insulin independence, and immunosuppression in these patients. The Report provides data on the recipients, pancreas donors, pancreas preservation, islet processing, islet infusions, recipient treatment, post-transplant islet function, and adverse events. The Report is designed to provide information that can form the basis necessary for the development of islet transplantation as a curative therapy for type 1 diabetes. Readers are referred to the Registry’s website, www.citregistry.org, for more information. 210 figures.
Full Record Printer Friendly Version
Towards a Cure for Type 1 Diabetes (And Other Autoimmune Diseases?). Infocus. 12(4): 1. December 2004.
This article, from the newsletter of the nonprofit association American Autoimmune Related Diseases Association, considers current research on type 1 diabetes and its potential cure. The article reports on the work of Denise Faustman and colleagues at Massachusetts General Hospital (MGH). The MGH team's approach identifies and selectively eliminates only the faulty cells of the immune system that mistakenly destroy healthy insulin-producing beta cells. Although the research was conducted on mice, the Federal Drug Administration and the MGH have approved plans for a clinical trial to correlate the mouse model findings to type 1 diabetes in humans. The article describes the animal research in detail, then describes how those findings may be tested in humans. The author concludes that the concept of islet regeneration without the need for islet cell transplantation or embryonic stem cells opens up a way to look for better treatments for type 1 diabetes.
Full Record Printer Friendly Version
Islet Transplantation. In: Sperling, M.A. Type 1 Diabetes: Etiology and Treatment. Totowa, NJ: Humana Press Inc. 2003. p. 529-552.
A renewal of interest for the transplantation of islets of Langerhans as a means to cure diabetes is currently being observed, as clinical studies are undertaken at an expanding number of transplant centers throughout the world. This chapter on islet cell transplantation is from a book in which well-recognized physicians and researchers review the latest thinking about the causes of type 1 diabetes and the best approaches to treating both its acute and chronic complications. Topics include islet isolation and purification, islet transplantation, and new strategies toward tolerance induction. The author notes that islet cell transplantation can be performed as a percutaneous minimally invasive procedure, in which islets are infused into the liver via the portal vein. In addition, the islet transplantation modality could circumvent the organ shortage that prevents most patients with diabetes who are eligible from pancreas transplantation from actually receiving a graft. Further, islet transplantation offers the possibility of maintaining the graft without chronic immunosuppression when the induction of donor-specific tolerance or immunoisolation emerge as clinical strategies. 2 figures. 204 references.
Full Record Printer Friendly Version
Collaborative Islet Transplant Registry Annual Report. Bethesda, MD: National Diabetes Information Clearinghouse. 2005. (CD-ROM)
The number of transplant centers performing clinical islet cell transplantation continues to increase, as does the number of centers participating in and reporting to the Collaborative Islet Transplant Registry (CITR). The CITR was founded in September 2001 to provide support for logistics, data capture, quality control monitoring, statistical design and analysis, and other Registry activities. This CD-ROM provides the second Annual Report of the CITR, supporting the mission of supporting progress and promoting safety in islet or beta cell transplantation. The disk contains the Annual Report in PDF format, March 2005 Case Report Forms in PDF format, and the figures and tables from the Annual Report in 210 PowerPoint slides. The information is drawn from 19 North American islet transplant programs, representing 138 transplant recipients. The Report describes patient care, surgical experiences, follow-up care, complications, hypoglycemia, insulin independence, and immunosuppression in these patients. The Report provides data on the recipients, pancreas donors, pancreas preservation, islet processing, islet infusions, recipient treatment, post-transplant islet function, and adverse events. The Report is designed to provide information that can form the basis necessary for the development of islet transplantation as a curative therapy for type 1 diabetes. Readers are referred to the Registry’s website, www.citregistry.org, for more information. 210 figures.
Full Record Printer Friendly Version
Executive Summary. IN: Collaborative Islet Transplant Registry Annual Report. Bethesda, MD: National Diabetes Information Clearinghouse. pp. 1-3.
The number of transplant centers performing clinical islet cell transplantation continues to increase, as does the number of centers participating in and reporting to the Collaborative Islet Transplant Registry (CITR). The CITR was founded in September 2001 to provide support for logistics, data capture, quality control monitoring, statistical design and analysis, and other Registry activities. This introductory chapter from the second Annual Report of the CITR describes the progress in islet or beta cell transplantation. This chapter briefly summarizes the annual information that was drawn from 19 North American islet transplant programs, representing 138 transplant recipients. The information focuses on islet-transplant-alone recipients (n = 118), donor, and outcome information. The summary briefly describes patient care, surgical experiences, follow-up care, complications, hypoglycemia, insulin independence, and immunosuppression in these patients. The median age of islet-transplant-alone recipients was 41.6 years and duration of diabetes was 29 years. More than 66 percent of the recipients were female, and all had type 1 diabetes. The median age of the deceased donor for these recipients was 44 years (range 8 to 65 years); 53 percent of the donors were male, and approximately 66 percent were white. At the time of this report, follow-up evaluations had been completed for 112 out of 118 patients. Of these 112 patients, 55 (49.1 percent) are insulin independent, while 39 (34.8 percent) are insulin dependent. Fifteen patients (13.4 percent) have experienced graft failure, while three participants have an unknown insulin status. There is a striking decrease in the occurrence of severe hypoglycemic events subsequent to the first infusion. The majority of the recipients received daclizumab for induction and sirolimus combined with tacrolimus for maintenance immunosuppression. Information about adverse events, received from 18 of the 19 transplant centers, show that almost 74 percent of the recipients experienced at least one adverse event in year 1, while 36 percent experienced one or more serious adverse events in the first year post-transplant. Overall, 77 serious adverse events were reported to the Registry, with 22 percent (n = 17) of them classified as life-threatening and 58 percent (n = 45) requiring an inpatient hospitalization. Ninety-five percent of these adverse events were resolved without residual effects. Readers are referred to the Registry’s website, www.citregistry.org, for more information.
Full Record Printer Friendly Version
Graft Function. IN: Collaborative Islet Transplant Registry Annual Report. Bethesda, MD: National Diabetes Information Clearinghouse. pp. 77-111.
The number of transplant centers performing clinical islet cell transplantation continues to increase, as does the number of centers participating in and reporting to the Collaborative Islet Transplant Registry (CITR). The CITR was founded in September 2001 to provide support for logistics, data capture, quality control monitoring, statistical design and analysis, and other Registry activities. This chapter from the second Annual Report of the CITR provides information about the analysis of graft function for the 188 patients who received islet transplant alone. It also provides information about insulin independence, initiation of insulin therapy, changes in insulin dosing, severe hypoglycemic events, metabolic measures, islet graft dysfunction, and diabetes-related secondary complications. The chapter includes four pages of text and 28 pages of figures and tables, graphically representing the information presented. Readers are referred to the Registry’s website, www.citregistry.org, for more information. 31 figures. 17 tables.
Full Record Printer Friendly Version
Insulin Therapy. In: Edelman, S.V. and Henry, R.R. Diagnosis and Management of Type 2 Diabetes. Caddo, OK: Professional Communications, Inc. 2002. p. 121-148.
This chapter on the use of insulin therapy is from a handbook for primary care providers that offers a concise overview of the diagnosis and management of type 2 diabetes. Insulin therapy most commonly is reserved for patients who have failed an adequate trial of diet, exercise, and oral antidiabetes agents. However, institution of insulin therapy is commonly delayed inappropriately in patients failing oral antidiabetes agents. The authors encourage early use of insulin soon after it is evident that oral antidiabetes agents are failing. The authors focus on the different insulin regimens commonly used to normalize glucose levels and glycosylated hemoglobin (HbA1c, a measure of blood glucose levels over time) in patients with type 2 diabetes mellitus. Topics include selecting an insulin preparation, the application of intensive insulin therapy, combination therapy, multiple injection regimens, insulin pump therapy, alternative insulin delivery systems, complications of insulin therapy, and the use of islet cell transplantation. 2 figures. 5 tables. 5 references.
Full Record Printer Friendly Version
Immunosuppressive and Other Medications. IN: Collaborative Islet Transplant Registry Annual Report. Bethesda, MD: National Diabetes Information Clearinghouse. pp. 63-76.
The number of transplant centers performing clinical islet cell transplantation continues to increase, as does the number of centers participating in and reporting to the Collaborative Islet Transplant Registry (CITR). The CITR was founded in September 2001 to provide support for logistics, data capture, quality control monitoring, statistical design and analysis, and other Registry activities. This chapter from the second Annual Report of the CITR summarizes the data reported to the Registry on immunosuppressive and other medications, such as anti-hypertensive and lipid lowering medications and adjunctive therapies. The chapter includes one page of text and 12 pages of figures and tables, graphically representing the information presented. The majority of islet-alone recipients at time of first infusion were on a daclizumab, sirolimus, and tacrolimus immunosuppression regimen. Tables show the other immunosuppression regimens that have been used, dosing for these medications, and T-cell antibodies used for induction at the first infusion, as well as maintenance therapy regimens and dosing information. Prior to the first infusion, 32 percent of the recipients were on at least one anti-hypertensive medication, and 16 percent were on a lipid-lowering medication. For adjunctive therapies, at the time of their first infusion, more than 91 percent of recipients used an antibiotic, 81 percent used heparin, 81 percent used vitamin supplements, and 80 percent used antivirals. Readers are referred to the Registry’s website, www.citregistry.org, for more information. 4 figures. 9 tables.
Full Record Printer Friendly Version
Islet After Kidney Transplant Information Summary. IN: Collaborative Islet Transplant Registry Annual Report. Bethesda, MD: National Diabetes Information Clearinghouse. pp. 147-203.
The number of transplant centers performing clinical islet cell transplantation continues to increase, as does the number of centers participating in and reporting to the Collaborative Islet Transplant Registry (CITR). The CITR was founded in September 2001 to provide support for logistics, data capture, quality control monitoring, statistical design and analysis, and other Registry activities. This chapter from the second Annual Report of the CITR provides information about islet-after-kidney-transplant recipients (n = 19 recipients, from three islet transplant programs). The median age of the islet-after-kidney-transplant recipient was 47.7 years, and the median duration of diabetes was 31 years. Compared with islet-alone recipients, islet-after-kidney recipients are older, weigh less, and have a lower body mass index (BMI). Almost 90 percent of the recipients were either on an insulin pump or were taking three or more insulin injections per day. The chapter also provides information about islet infusion, donors, pancreas procurement and islet processing, immunosuppression medications, graft function, severe hypoglycemic events, laboratory tests, and adverse events. The chapter includes four pages of text and 50 pages of figures and tables, graphically representing the information presented. Readers are referred to the Registry’s website, www.citregistry.org, for more information. 35 figures. 45 tables.
Full Record Printer Friendly Version
Methods Summary. IN: Collaborative Islet Transplant Registry Annual Report. Bethesda, MD: National Diabetes Information Clearinghouse. pp. 5-8.
The number of transplant centers performing clinical islet cell transplantation continues to increase, as does the number of centers participating in and reporting to the Collaborative Islet Transplant Registry (CITR). The CITR was founded in September 2001 to provide support for logistics, data capture, quality control monitoring, statistical design and analysis, and other Registry activities. This introductory chapter from the second Annual Report of the CITR describes the progress in islet or beta cell transplantation. This introductory chapter briefly summarizes the methods used to gather annual information from the 19 North American islet transplant programs, representing 138 transplant recipients. The chapter describes how CITR uses a set of web-based forms to capture pertinent information that help characterize and follow trends in safety and efficacy of islet transplantation, paying particular attention to islet processing, transplant techniques, and treatment protocols. This chapter also defines several key terms used by CITR that are used in the Annual Report figures and tables. Abbreviations and other symbols used in the Annual Report are also defined in this chapter. Readers are referred to the Registry’s website, www.citregistry.org, for more information and can request a copy of the data collection forms from the CITR Coordinating Center (citr@emmes.com).
Full Record Printer Friendly Version
Pancreas Procurement and Islet Processing. IN: Collaborative Islet Transplant Registry Annual Report. Bethesda, MD: National Diabetes Information Clearinghouse. pp. 47-63.
The number of transplant centers performing clinical islet cell transplantation continues to increase, as does the number of centers participating in and reporting to the Collaborative Islet Transplant Registry (CITR). The CITR was founded in September 2001 to provide support for logistics, data capture, quality control monitoring, statistical design and analysis, and other Registry activities. This chapter from the second Annual Report of the CITR summarizes the pancreas procurement and islet processing data reported to the Registry. The chapter includes one page of text and 15 pages of figures and tables, graphically representing the information presented. In more than 60 percent of the procedures, the pancreas procurement team was not affiliated with the processing and transplant team, while 81 percent of the processing procedures took place at the same institution as the islet transplant center. The median duration of cold ischemia was 7 hours. All of the processing facilities use a density gradient for islet purification, while 45.5 percent of the islet products processed used islet cell culture. The tables include an islet product characterization summary, a comparison of donor body mass index with islet equivalents, recovery time measures, pancreas viability, and other body weight considerations. Readers are referred to the Registry’s website, www.citregistry.org, for more information. 4 figures. 10 tables.
Full Record Printer Friendly Version
Recipient and Donor Characteristics. IN: Collaborative Islet Transplant Registry Annual Report. Bethesda, MD: National Diabetes Information Clearinghouse. pp. 23-46.
The number of transplant centers performing clinical islet cell transplantation continues to increase, as does the number of centers participating in and reporting to the Collaborative Islet Transplant Registry (CITR). The CITR was founded in September 2001 to provide support for logistics, data capture, quality control monitoring, statistical design and analysis, and other Registry activities. This chapter from the second Annual Report of the CITR summarizes the recipient and donor characteristics of 138 transplant recipients; as of December 2004, information was submitted by the 19 transplant centers. The chapter includes two pages of text and 21 pages of figures and tables, graphically representing the information presented. Information provided includes recipient demographic information, islet infusion information, and details about the donors. The median age of islet-transplant-alone recipients was 41.6 years and duration of diabetes was 29 years. More than 66 percent of the recipients were female, and all had type 1 diabetes. The mean number of islet equivalents infused was similar for each type of infusion (islet transplant alone or islet-after-kidney transplant). The median age of the deceased donor for these recipients was 44 years (range 8 to 65 years); 53 percent of the donors were male, and approximately 66 percent were white. Readers are referred to the Registry’s website, www.citregistry.org, for more information. 13 figures. 18 tables.
Full Record Printer Friendly Version
Recipients Laboratory Data. IN: Collaborative Islet Transplant Registry Annual Report. Bethesda, MD: National Diabetes Information Clearinghouse. pp. 113-124.
The number of transplant centers performing clinical islet cell transplantation continues to increase, as does the number of centers participating in and reporting to the Collaborative Islet Transplant Registry (CITR). The CITR was founded in September 2001 to provide support for logistics, data capture, quality control monitoring, statistical design and analysis, and other Registry activities. This chapter from the second Annual Report of the CITR provides a summary of reported abnormal laboratory liver function tests, abnormal lipid tests, and the percent of islet cell recipients with a marked increase in serum creatinine from baseline. Reports at the two-times-or-greater than the upper limit of normal at any time since the time of the recipient’s first infusion were minimal for Alanine Aminotransferase (ALT) (3.7 percent), Asparate Aminotransferase (AST) (4.5 percent), alkaline phosphatase (4.2 percent), and total bilirubin (0.9 percent). There were no reports at this level for total cholesterol and only 2 reports (1.8 percent) for triglycerides. In addition, there were only 5 reports (4.7 percent) of recipients with an increase in their serum creatinine of 0.5 milligrams per deciliter or greater than their baseline level. The chapter includes one page of text and eight pages of figures and tables, graphically representing the information presented. Readers are referred to the Registry’s website, www.citregistry.org, for more information. 12 figures. 3 tables.
Full Record Printer Friendly Version
Registry Data Quality Review. IN: Collaborative Islet Transplant Registry Annual Report. Bethesda, MD: National Diabetes Information Clearinghouse. pp. 205-211.
The number of transplant centers performing clinical islet cell transplantation continues to increase, as does the number of centers participating in and reporting to the Collaborative Islet Transplant Registry (CITR). The CITR was founded in September 2001 to provide support for logistics, data capture, quality control monitoring, statistical design and analysis, and other Registry activities. This chapter from the second Annual Report of the CITR provides a quality review summary of Registry data. The chapter describes the quality review process, then summarizes the data collected and reported on for the Annual Report. The authors note that, within the past year, six CITR islet transplant centers have had an onsite data audit; data queries from these audits is also provided. The chapter includes one page of text and three pages of tables, graphically representing the information presented. Readers are referred to the Registry’s website, www.citregistry.org, for more information. 4 tables.
Full Record Printer Friendly Version
Registry Summary. IN: Collaborative Islet Transplant Registry Annual Report. Bethesda, MD: National Diabetes Information Clearinghouse. pp. 9-19.
The number of transplant centers performing clinical islet cell transplantation continues to increase, as does the number of centers participating in and reporting to the Collaborative Islet Transplant Registry (CITR). The CITR was founded in September 2001 to provide support for logistics, data capture, quality control monitoring, statistical design and analysis, and other Registry activities. This chapter from the second Annual Report of the CITR summarizes the activities of the 19 North American islet transplant programs, representing 138 transplant recipients. The chapter includes one page of text and eight pages of figures and tables, graphically representing the information presented. Information provided includes the names and locations of the centers participating in the CITR, a summary of the number of infusions entered in the Registry by year the islet infusion was performed, the number of islet infusions patients received, the different types of islet transplantations (islet transplant alone or islet-after-kidney recipients), and information about the donors. Readers are referred to the Registry’s website, www.citregistry.org, for more information. 10 figures.
Full Record Printer Friendly Version
Mayo Clinic on Managing Diabetes. Rochester, MN: Mayo Clinic. 2001. 194 p.
This book provides practical and easy to understand information on controlling diabetes and preventing complications of the disease. Part one provides facts about diabetes. Topics include types of diabetes, the signs and symptoms of diabetes, the risk factors for diabetes, and the criteria and tests for diagnosing diabetes. In addition, the issue of diabetic complications is addressed, focusing on hypoglycemia, diabetic hyperosmolar syndrome, diabetic ketoacidosis, neuropathy, nephropathy, retinopathy, heart and blood vessel disease, and increased risk of infection. Part two deals with the components involved in controlling the disease. Chapters discuss monitoring blood glucose, eating a healthy diet, getting daily exercise, and maintaining a healthy weight. Part three examines medical therapies for managing diabetes. Chapters provide information on the use of insulin to manage type 1 and type 2 diabetes; the use of sulfonylureas, meglinitides, biguanides, alpha glucosidase inhibitors, thiazolidinediones, and drug combinations to manage type 2 diabetes; and pancreas and islet cell transplantation as possible cures for diabetes. Part four addresses issues related to living well with diabetes. One chapter focuses on important tests every person who has diabetes should be getting, including the glycosylated hemoglobin test, lipid tests, the serum creatinine test, and the urine microalbumin test. Another chapter discusses self care issues, including having annual physical examinations, visiting a dentist regularly, caring for feet, avoiding smoking, monitoring blood pressure, and managing stress. A third chapter explores sexual health issues for both men and women. Topics include the affect of the menstrual cycle and menopause on blood glucose, hormone replacement therapy, pregnancy, and impotence. Each chapter concludes with a question and answer section. The book also includes a list of additional resources. 17 figures. 1 table.
Full Record Printer Friendly Version
Pancreas and Islet Transplantation: An Unfinished Journey. Transplantation Proceedings. 33(7-8): 3485-3488. November-December 2001.
This article reviews the history and current activities in the areas of pancreas and islet cell transplantation. The authors note that in the 35 years since the first vascularized (with blood vessels) pancreas transplant was performed in Minneapolis, Minnesota to prevent recurrent nephropathy (kidney disease) in a concomitant renal (kidney) transplant, an estimated 12,000 procedures have been performed in the United States. While this represents a major achievement, it is nevertheless insignificant compared to the estimated one million patients with type 1 diabetes in this country. However, the initially slow journey has recently gathered momentum with the introduction of more flexible immunosuppression protocols, the ability to individualize surgical options to patient needs, and the dramatic improvement of isolated islet transplantation results. The authors discuss pancreas transplant options, surgical techniques, the donor pancreas, surgical complications, immunosuppression, the benefits of pancreas transplantation, and islet cell transplantation. 25 references.
Full Record Printer Friendly Version
Beta Cell Replacement and Islet Transplantation. Diabetes Self-Management. 17(1): 52, 54, 56. January-February 2000.
This article, the first in a series on diabetes research, reports on advancements in the areas of beta cell replacement and islet transplantation. In type 1 diabetes, the body destroys its own insulin producing beta cells. Replacing these cells via transplantation has been the subject of research for many years. Transplantation of beta cell containing islets is a less invasive approach than transplanting a whole pancreas. Progress on whole pancreas and beta cell transplantation has been hampered by the lack of available organs and the question of immunosuppression. The Center for Islet Cell Transplantation is a project with the goal of successful transplantation of beta cells without immunosuppression. Approaches to islet transplantation under investigation include mixed bone marrow chimerism and co-stimulatory blockade. Another approach to islet transplantation that has been pursued for many years with different levels of success is the approach of shielding the islet from the immune system by a physical barrier while still allowing them to receive the nutrients they need to survive and the insulin generating signals they need to produce the necessary insulin, then getting them through the barrier to the bloodstream. Techniques for accomplishing this include microencapsulation and a bioartificial pancreas. Other aspects of transplantation that investigators are concerned about include alloreactivity and autoreactivity. In addition, the issue of who might benefit most from transplantation needs to be addressed.
Full Record Printer Friendly Version
Innovations in the Research and Treatment of Diabetes. Today's Dietitian. 2(11): 34-35. November 2000.
This article reports on new advances in the treatment and prevention of diabetes. In the future, people who have diabetes can expect to administer insulin by inhaling it. Both a powdered and liquid form of insulin are now in human trials, and researchers continue to obtain good results with regard to effectiveness and safety. An oral medication combining metformin and glyburide, called Glucovance, is being reviewed by the Food and Drug Administration. In clinical trials, the drug improved both fasting blood glucose and postprandial sugars. The GlucoWatch will allow users to check blood glucose levels every 20 minutes without drawing blood. The device uses electrical currents to measure blood glucose levels in the skin. A four minute glycosylated hemoglobin test will allow patients and their doctors to receive immediate feedback about glucose levels over the past 3 months. Measurement of fructosamine levels provides information on blood glucose levels over the past 2 to 3 weeks. In addition, researchers have discovered a possible genetic marker for type 2 diabetes, and they are investigating the role of glucagon receptors in blood glucose control and the importance of regular patient provider contact in improving diabetes control. The hope for a cure for type 1 diabetes rests on islet cell transplantation.
Full Record Printer Friendly Version
Churchill's Pocketbook of Diabetes. New York, NY: Harcourt Health Sciences. 2000. 316 p.
This book serves as a resource for health care workers who are not diabetes specialists but who are in regular contact with people who have diabetes. The book offers guidance on the daily management of these patients. The book begins with a chapter on the key biochemical defects of diabetes and recent changes in classification. Chapter two focuses on the diagnosis and initial management of diabetes. Topics include the clinical presentation of diabetes, the diagnostic criteria for diabetes, the history and physical examination, the influence of comorbidity, the psychological impact of diabetes, the aims of treatment, the relationship between glycemic control and complications, the assessment of glycemic control, the principles of education in diabetes, and the organization and economics of diabetes care. The next chapter discusses the management of diabetes, focusing on nutrition therapy, smoking cessation or reduction, physical exercise, oral antidiabetic agent therapy, insulin therapy, and pancreatic and islet cell transplantation. The focus of the fourth chapter is on the acute metabolic complications of diabetes, including hypoglycemia, diabetic ketoacidosis, diabetic hyperosmolar nonketotic syndrome, and lactic acidosis. The fifth chapter describes the complications of diabetes, including ocular, kidney, nerve, foot, macrovascular, cutaneous, musculoskeletal, and connective tissue problems; hypertension; diabetic dyslipidemia; and infection. The final chapter addresses special topics, including diabetes in children, adolescents, the elderly, and pregnant women; intercurrent illness; surgery and other invasive procedures; and social and legal aspects. The book also presents evidence based boxes providing the rationale underlying treatment decisions. 19 figures. 16 plates. Numerous tables. 74 references.
Full Record Printer Friendly Version
Promise of Islet Cells. Diabetes Forecast. 53(3): 54-60. March 2000.
This article discusses the promise of islet cell transplantation for people who have type 1 diabetes. Although theoretically transplantation of live islet cells would cure diabetes, theory has yet to become reality. The reason this cure has remained elusive is that the beta cells themselves are extremely fragile. Only about half of the cells probably survive the trip from the scene of their removal to the transplant site, and half of those survivors probably die before being injected. It is likely that only 25 percent of those transplanted cells engraft in the recipient's body. Then the recipient's immune system attacks the transplanted cells. The drugs used to prevent rejection, particularly cyclosporine and prednisone, compound the problem by impairing the ability of the new islets to respond to glucose and produce insulin and by the severe side effects they cause. Although pancreas transplants are becoming more successful, most patients, given a choice, would prefer a less invasive islet procedure, if it worked, to the trauma of major surgery. Pancreas transplants are very expensive, but they are often covered by medical insurance whereas islet cells transplants, which are also expensive, are not covered by medical insurance. The article reviews animal and human research on islet cell transplantation and highlights promising projects being conducted in Minnesota, North Carolina, Miami, and Boston.
Full Record Printer Friendly Version
T Cell Mutiny. JDF International Countdown. 21(1): 34-36, 38-39. Winter 2000.
This article reviews scientific efforts aimed at intervening in the process by which the immune system attacks and destroys insulin producing beta cells of the pancreas. The mechanism by which the immune system attacks and destroys these cells involves certain white blood cells called T lymphocytes. These cells infiltrate the pancreatic islets and secrete cytokines that set about destroying the beta cells. A current hypothesis is that autoimmune diseases such as diabetes result when the balance of power between autoreactive T cells and autoregulatory T cells shifts in favor of the autoreactive T cells. Although the cause of this shift is unknown, it is known that people who develop type 1 diabetes have a genetic predisposition to the disease. However, many investigators believe that something must happen in the environment to trigger it. Possible triggers include an invading virus and the loss of oral tolerance. The realization that type 1 diabetes is an autoimmune disease led scientists to test whether immunosuppressive agents could preserve functioning of remaining beta cells in people who still had some functioning beta cells. Studies revealed limited success, so scientists shifted their efforts toward earlier intervention. One promising effort is the use of low dose insulin injections before the onset of type 1 diabetes. Another approach has been to give insulin orally to produce oral tolerance. Both strategies have evolved into a large multicenter clinical trial known as the Diabetes Prevention Trial-Type 1. Another relatively benign approach to intervention involves using high doses of the B vitamin nicotinamide. Other research efforts are focusing on the beta cell protein glutamic acid decarboxylase (GAD). Findings from a study of GAD suggest that the immune response to GAD might completely block diabetes in prediabetic people as well as people who have type 1 diabetes who receive islet cell transplants. Emerging strategies for preventing autoimmune recurrence in islet cell transplantation include bone marrow chimerism, antibodies that block the function of T cells, and gene therapy.
Full Record Printer Friendly Version
Displaying all search results.
Start a new search.
|
