It is widely accepted that autoimmune mechanisms are involved in the pathogenesis of type I (insulin-dependent, IDDM) diabetes mellitus. (1)Islet cell antibodies (ICA) reacting with antigens in the cytoplasma, or on the surface of...
moreIt is widely accepted that autoimmune mechanisms are involved in the pathogenesis of type I (insulin-dependent, IDDM) diabetes mellitus. (1)Islet cell antibodies (ICA) reacting with antigens in the cytoplasma, or on the surface of islet-cells (ICSA), or against a 64 kD human islet-cell protein, as well as insulin autoantibodies (lAA) are present years before the onset of clinical diabetes. They probably serve as serologic markers of ongoing beta-cell destruction in predisposed individuals. In monozygotic twins initially discordant for type I diabetes, loss of beta-cell function has been shown to be temporarily associated with the presence of ICA (2). Several studies in discordant monozygotic twins or first-degree relatives of type I diabetics revealed that ICA-positive relatives are more likely to develop overt diabetes than are the ICA-negative (3). Moreover, the presence of both ICA and lAA in these individuals confers an even higher risk of progression to IDDM (1)
Fasting hyperglycemia in insulin-dependent diabetic patients (IDDM) treated according to the basal-bolus principle may be due to the fact that currently available neutral protamine Hagedorn (NPH) insulin preparations do not sufficiently...
moreFasting hyperglycemia in insulin-dependent diabetic patients (IDDM) treated according to the basal-bolus principle may be due to the fact that currently available neutral protamine Hagedorn (NPH) insulin preparations do not sufficiently meet the increased insulin need in the second part of the night. In the present study, it was investigated whether the amorphous zinc insulin Semilente can be used to control fasting hyperglycemia in IDDM patients. Ten type 1 diabetic patients with persistent fasting hyperglycemia (> 10 mmol/l) participated in the double-blind randomized cross-over trial with 2 10-day treatment periods. Night profiles of blood glucose and free insulin concentrations were determined at the end of each treatment period. Three doses of regular insulin were given before the meals and NPH insulin and Semilente at 10.00 p.m. Nighttime blood glucose and insulin profiles were different under the treatment with Semilente and NPH insulin. Injection of Semilente at bedtime resulted in higher insulin and lower blood glucose values during the second part of the night (p < 0.001 versus Semilente by ANOVA). Semilente injected at bedtime can prevent the early-morning rise in blood glucose in type I diabetic patients.
Magnesium deficiency has been associated with type 2 diabetes and may reduce insulin sensitivity and impair glucose tolerance. The etiology of magnesium depletion in diabetes is unclear. Animal studies suggest that diabetes may impair...
moreMagnesium deficiency has been associated with type 2 diabetes and may reduce insulin sensitivity and impair glucose tolerance. The etiology of magnesium depletion in diabetes is unclear. Animal studies suggest that diabetes may impair magnesium absorption; however, there are no published data on magnesium absorption in humans with diabetes. Magnesium absorption from a test meal and the excretion and retention of magnesium were compared between patients with type 2 diabetes and healthy control subjects. A meal labeled with 10 mg (26)Mg isotopic label was administered, and stool and urine samples were collected for 10 and 6 d, respectively. Apparent absorption was calculated as the difference between the oral dose of (26)Mg isotopic label and the total amount of the isotopic label excreted in the feces. Magnesium retention was calculated from the apparent absorption and urinary excretion of (26)Mg isotopic label in the 6 d after administration. Mean (+/- SD) values for fractional magn...
Für die Beschreibung physiologischer Regelkreise in der Endokrinologie werden traditionell einfache Mo-delle herangezogen, wie sie etwa Ingenieure verwen-den, um einfache Maschinen zu konstruieren, die eine bestimmte «Grösse» konstant...
moreFür die Beschreibung physiologischer Regelkreise in der Endokrinologie werden traditionell einfache Mo-delle herangezogen, wie sie etwa Ingenieure verwen-den, um einfache Maschinen zu konstruieren, die eine bestimmte «Grösse» konstant halten sollen. Im Falle des Blutzuckers agieren die Langerhans-Inseln im Pankreas als Regler, der mittels Ausschüttung von Insulin und Glukagon allfälligen Abweichungen vom Soll-Blutzucker kontinuierlich entgegenwirkt. Die Vision , den Typ-1-Diabetes mellitus mittels eines auto-matisiert funktionierenden Regelkreislaufs ersetzen zu können, wurde vor 40 Jahren mit der Entwicklung des «Biostator» k onkretisiert [ 1]. Über die l etzten Jahrzehnte hat es sich allerdings gezeigt, dass solche automatischen Systeme auf dem Papier zwar einfach zu konstruieren sind, die technische Umsetzung im klinischen Alltag jedoch mit erheblichen Schwierig-keiten verbunden ist. Bisher müssen die entscheidenden Reaktionen im Regelkreis noch durch den Patienten selbst ausgelö...
intakes of fat and antioxidant vitamins are predictors of
In obese children, subclinical inflammation is often present and is correlated with the metabolic syndrome. Dietary factors, such as fatty acids and antioxidants, potentially modulate the association between adiposity and subclinical...
moreIn obese children, subclinical inflammation is often present and is correlated with the metabolic syndrome. Dietary factors, such as fatty acids and antioxidants, potentially modulate the association between adiposity and subclinical inflammation, but few data are available in children. The aim of the study was to determine whether dietary fat or antioxidant intakes influence circulating tumor necrosis factor alpha (TNF-alpha), interleukin 6 (IL-6), C-reactive protein (CRP), and leptin concentrations in overweight children. In a cross-sectional study of 6-14-y-old normal-weight (n = 33), overweight (n = 19), and obese (n = 27) Swiss children, nutritional intakes were assessed from two 24-h dietary recalls and a 1-d dietary record. Percentage body fat from skinfold thicknesses, waist-hip ratio, and blood pressure were measured. Fasting blood samples were collected for the measurement of insulin, glucose, HDL-cholesterol, triacylglycerol, CRP, IL-6, TNF-alpha, and leptin concentration...
Background/Objectives: Insulin resistance (IR) and hypertension are common in overweight children, and the adipocyte-derived hormones resistin, adiponectin, and leptin may modulate IR and blood pressure (BP). Few data exist in children on...
moreBackground/Objectives: Insulin resistance (IR) and hypertension are common in overweight children, and the adipocyte-derived hormones resistin, adiponectin, and leptin may modulate IR and blood pressure (BP). Few data exist in children on dietary determinants of IR, BP, or leptin, and no data exist on dietary determinants of resistin and adiponectin. Therefore, the objective of this study was to investigate dietary determinants of IR, BP, resistin, adiponectin, and leptin concentrations, as well as the interrelationship among these variables, in normal and overweight children. Subjects/Methods: In 6- to 14-year-old Swiss children (n=79), nutritional intake was assessed using two 24-hour-recalls and a one-day dietary record. Body mass index (BMI), body fat percentage (BF%), waist/hip ratio (W/H ratio), BP, glucose, insulin, resistin, adiponectin, and leptin were determined. IR was calculated using the quantitative insulin sensitivity check index (QUICKI). Results: BMI, BF%, and W/H r...
We have developed an Internet-based, interactive computer model to determine the long-term health outcomes and economic consequences of implementing different treatment policies or interventions in type 1 and type 2 diabetes mellitus. The...
moreWe have developed an Internet-based, interactive computer model to determine the long-term health outcomes and economic consequences of implementing different treatment policies or interventions in type 1 and type 2 diabetes mellitus. The model projects outcomes for populations, taking into account baseline cohort characteristics and past history of complications, current and future diabetes management and concomitant medications, screening strategies and changes in physiological parameters over time. The development of complications, life expectancy, quality-adjusted life expectancy and total costs within populations can be calculated. The model is based on a series of sub-models that simulate important complications of diabetes (cardiovascular disease, eye disease, hypoglycaemia, nephropathy, neuropathy, foot ulcer, amputation, stroke, ketoacidosis, lactic acidosis and mortality). Each sub-model is a Markov model using Monte Carlo simulation incorporating time, state, time-in state, and diabetes type-dependent probabilities derived from published sources. Analyses can be performed on cohorts with type 1 or type 2 diabetes. Cohorts, defined in terms of age, gender, baseline risk factors and pre-existing complications, can be modified or new cohorts defined by the user. Economic and clinical data in the model can be edited, thus ensuring adaptability by allowing the inclusion of new data as they become available; creation of country- or provider-specific versions of the model; and allowing the investigation of new hypotheses. The CORE Diabetes Model allows the calculation of long-term outcomes, based on the best data currently available. Diabetes management strategies can be compared in different patient populations in a variety of realistic clinical settings, allowing the identification of efficient diabetes management strategies.
In pancreatic islets, nitric oxide (NO) produced on exposure to cytokines mediates β-cell injury leading to diabetes mellitus. On the other hand, l-arginine-derived NO may participate in the signal transduction pathway of physiological...
moreIn pancreatic islets, nitric oxide (NO) produced on exposure to cytokines mediates β-cell injury leading to diabetes mellitus. On the other hand, l-arginine-derived NO may participate in the signal transduction pathway of physiological insulin secretion. This review focuses on the dual role of NO as a mediator of physiological and pathophysiological processes in pancreatic islets.
The purpose of this study was to examine the possible links between type 2 diabetes, daytime sleepiness, sleep quality and caffeine consumption. In this case-control field study, comparing type 2 diabetic ( n=134) and non-type 2 diabetic...
moreThe purpose of this study was to examine the possible links between type 2 diabetes, daytime sleepiness, sleep quality and caffeine consumption. In this case-control field study, comparing type 2 diabetic ( n=134) and non-type 2 diabetic ( n=230) participants, subjects completed detailed and validated questionnaires to assess demographic status, health, daytime sleepiness, sleep quality and timing, diurnal preference, mistimed circadian rhythms and habitual caffeine intake. All participants gave saliva under standardised conditions for CYP1A2 genotyping and quantification of caffeine concentration. Hierarchical linear regression analyses examined whether type 2 diabetes status was associated with caffeine consumption. Type 2 diabetic participants reported greater daytime sleepiness ( p=0.001), a higher prevalence of sleep apnoea ( p=0.005) and napping ( p=0.008), and greater habitual caffeine intake ( p<0.001), derived from the consumption of an extra cup of coffee each day. This...
Although results from in vitro studies and clinical trials demonstrate strong associations between oxidative stress and cardiovascular risk, to date still no convincing data are available to suggest that treatment with antioxidants might...
moreAlthough results from in vitro studies and clinical trials demonstrate strong associations between oxidative stress and cardiovascular risk, to date still no convincing data are available to suggest that treatment with antioxidants might reduce vascular events. Oxidative modifications of low-density lipoproteins (LDL) represent an early stage of atherosclerosis, and small, dense LDL are more susceptible to oxidation than larger, more buoyant particles. Oxidized LDL are independent predictors of subclinical and clinical atherosclerosis. Recent studies suggested that novel therapeutic strategies may take into account the removal of such particles from circulation. Future research is required to explore the potential synergistic impact of markers of oxidative stress and atherogenic dyslipidemia, particularly small dense LDL, on cardiovascular risk.
Diabetes mellitus comprises a group of metabolic disturbances that are characterized by hyperglycemia. In 1997 the American Diabetes Association (ADA) proposed new criteria for the diagnosis and classification of diabetes mellitus, which...
moreDiabetes mellitus comprises a group of metabolic disturbances that are characterized by hyperglycemia. In 1997 the American Diabetes Association (ADA) proposed new criteria for the diagnosis and classification of diabetes mellitus, which was also adopted by WHO. Although the criteria is the same, the ADA puts emphasis on the use of the fasting plasma glucose (FPG) for screening and diagnosis, whereas WHO maintains the use of the OGTT and recommends the FPG only if an OGTT can not be performed. Different pathogenetic processes are involved in the development of diabetes ranging from autoimmune destruction of beta-cells resulting in an absolute insulin deficiency to insulin with a defect on insulin secretion. The new classification is based on the etiology of the disease. Diabetes is classified into one of four catagories: Type-1, type-2 Diabetes mellitus, specific forms of diabetes, and gestational diabetes. For screening and diagnosis FPG or the two hour value after the OGTT can be used. Glycosylated hemoglobin is not suitable for screening and diagnosis of diabetes despite some contradictory statements. For many decades clear evidence was missing that chronic hyperglycemia caused diabetic late complications; complications including dysfunction or failure of several organ systems, in particular eyes, kidneys, nerves, and the cardiovascular system. The results of two large prospective trials – the Diabetes Control and Complications Trial (DCCT; 1993) and the United Kingdom Prospective Study (UKPDS; 1998) – that were recently published provided the final proof that normoglycemia prevents or delays the progression of these late complications. Due to the insidious nature of these complications they are often not diagnosed and have to be looked for in each patients with diabetes and have to be controlled regularly. Based on the results of the UKPDS and other studies, evidence based therapeutic goals could be defined. Multifactorial interventions with increased physical activity, cessation of smoking, aspirin treatment, lowering of HbA1c, blood pressure, and lipids in patients with type 2 diabetes have been proven to drastically reduce the risk of developing diabetic nephropathy or cardiovascular complications drastically. We recommend the following treatment strategy for patients with type 2 diabetes in clinical practice: 1) Treatment should be individualized. 2) Treatment should be started step by step to document efficacy of treatment and compliance of patients. 3) Plasma glucose and blood pressure should be normalized in all patients with type 2 diabetes (up to an age of 70 years), since there are no threshold values for HbA1c and blood pressure. 4) Therapeutic goals should be checked every three to six months. 5) In the case that therapeutic goals can not be met, treatment should be intensified. Often a combination therapy with many different drugs is required. 6) A specialist for diabetes should be consulted, if the therapeutic goals can not be met over a period of six months.
Protein kinase Bα (PKBα)/AKT1 and PKBβ/AKT2 are required for normal peripheral insulin action but their role in pancreatic β cells remains enigmatic as indicated by the relatively mild islet phenotype of mice with deficiency for either...
moreProtein kinase Bα (PKBα)/AKT1 and PKBβ/AKT2 are required for normal peripheral insulin action but their role in pancreatic β cells remains enigmatic as indicated by the relatively mild islet phenotype of mice with deficiency for either one of these two isoforms. In this study we have analysed proliferation, apoptosis, β cell size and glucose-stimulated insulin secretion in human islets overexpressing either PKBα or PKBβ. Our results reveal redundant and specific functions. Overexpression of either isoform resulted in increased β cell size, but insulin production and secretion remained unchanged. Proliferation and apoptosis of β cells were only significantly stimulated and inhibited, respectively, by PKBα/AKT1. Importantly, overexpression of PKBα/AKT1 in dissociated islets increased the ratio of β cells to non-β cells. These results confirm our previous findings obtained with rodent islets and strongly indicate that PKBα/AKT1 can regulate β cell mass also in human islets.
Long-term data of patients with type 1 diabetes mellitus (T1D) after simultaneous islet-kidney (SIK) or islet-after-kidney transplantation (IAK) are rare and have never been compared to intensified insulin therapy (IIT). Twenty-two...
moreLong-term data of patients with type 1 diabetes mellitus (T1D) after simultaneous islet-kidney (SIK) or islet-after-kidney transplantation (IAK) are rare and have never been compared to intensified insulin therapy (IIT). Twenty-two patients with T1D and end-stage renal failure undergoing islet transplantation were compared to 70 patients matched for age and diabetes duration treated with IIT and to 13 patients with kidney transplantation alone or simultaneous pancreas-kidney after loss of pancreas function (waiting list for IAK [WLI]). Glycemic control, severe hypoglycemia, insulin requirement, and direct medical costs were analyzed. Glycated hemoglobin decreased significantly from 8.2 ± 1.5 to 6.7 ± 0.9% at the end of follow-up (mean 7.2 ± 2.5 years) in the SIK/IAK and remained constant in IIT (7.8 ± 1.0% and 7.6 ± 1.0) and WLI (7.8 ± 0.8 and 7.9 ± 1.0%). Daily insulin requirement decreased from 0.53 ± 0.15 to 0.29 ± 0.26 U/kg and remained constant in IIT (0.59 ± 0.19 and 0.58 ± 0....
Cardiovascular disease is by far the major cause of morbidity and mortality in subjects with diabetes mellitus type 2. The risk of cardiovascular disease in persons with type 2 diabetes is greater for any given risk factor, alone or in...
moreCardiovascular disease is by far the major cause of morbidity and mortality in subjects with diabetes mellitus type 2. The risk of cardiovascular disease in persons with type 2 diabetes is greater for any given risk factor, alone or in combination, than it is in persons without diabetes. Independent risk factors for cardiovascular disease in type 2 diabetes are hyperglycemia, hypertension, dyslipidemia and smoking. Subjects with diabetes mellitus type 2 benefit from cardiovascular risk factor modification, either as a primary or secondary intervention, as much as or more than those without diabetes. Risk factor modification includes behavioral modification to affect regular physical activity, healthy diet, weight loss, and smoking cessation. In addition, an optimal glycemic control with HbA1c < 7% is crucial and, aggressive management of hypertension (< 130/80 mmHg) and dyslipidemia are particularly important. Finally, aspirin (100 mg/d) is standard in secondary prophylaxis of...
In most patients with Type 2 Diabetes, the primary treatment goal is near-normoglycemia. If diet, physical activity, and oral hypoglycemic agents fail to achieve the individual treatment goal, insulin therapy must be considered. Insulin...
moreIn most patients with Type 2 Diabetes, the primary treatment goal is near-normoglycemia. If diet, physical activity, and oral hypoglycemic agents fail to achieve the individual treatment goal, insulin therapy must be considered. Insulin therapy in patients with Type 2 Diabetes is safe, highly efficient and should be initiated not too late. We recommend to perform the insulin therapy in Type 2 Diabetics individually upon the patients characteristics, no general recommendation can be given. Possible approaches to start an insulin therapy in general practice are discussed. Insulin therapy may be initiated as bedtime insulin (depot insulin at bedtime) in combination with oral agents. In patients who fail to achieve good glycemic control with this combination therapy, mealtime insulin (short-acting insulin before the meals) may be introduced instead of the oral agents (multiple injection regimen). Bedtime insulin may be discontinued when fasting glucose concentrations remain in the desir...
Different intervention strategies for the optimisation of disease management of diabetes exist and have been shown to increase the proportion of patients receiving screening and examinations and to improve risk factors such as HbA1c,...
moreDifferent intervention strategies for the optimisation of disease management of diabetes exist and have been shown to increase the proportion of patients receiving screening and examinations and to improve risk factors such as HbA1c, lipids, and blood pressure. Thus, in the long-term, a decrease in diabetic complications and the associated costs could be expected. To address this question, the current analysis used a published diabetes simulation model to analyse the long-term clinical and economic implications of implementing various interventions in the Swiss setting. Based on data from the literature, the short-term effects on clinical variables of multifactorial interventions, including screening for nephropathy and retinopathy, educational programmes and control of cardiovascular risk profile were assessed, and a cost-effectiveness analysis in comparison to standard care was performed. Life expectancy (LE) and total lifetime costs (TC) from the perspective of the health insuran...
In pancreatic islets, nitric oxide (NO) produced on exposure to cytokines mediates beta-cell injury leading to diabetes mellitus. On the other hand, L-arginine-derived NO may participate in the signal transduction pathway of physiological...
moreIn pancreatic islets, nitric oxide (NO) produced on exposure to cytokines mediates beta-cell injury leading to diabetes mellitus. On the other hand, L-arginine-derived NO may participate in the signal transduction pathway of physiological insulin secretion. This review focuses on the dual role of NO as a mediator of physiological and pathophysiological processes in pancreatic islets.
Thirty-six adult type 1 diabetics, whose metabolic control was unsatisfactory on conventional insulin treatment or on continuous subcutaneous insulin infusion, were treated for an average of 13 months by the basis-bolus insulin regimen...
moreThirty-six adult type 1 diabetics, whose metabolic control was unsatisfactory on conventional insulin treatment or on continuous subcutaneous insulin infusion, were treated for an average of 13 months by the basis-bolus insulin regimen using pen-like insulin injectors. HbAlc-values improved from 8.1% before to 6.7% at the end of the observation period, with the same daily injected amount of insulin (39 +/- 2 IU/d before, 38.7 +/- 2 IU/d after switching to the new regimen). The number of hypoglycemic events did not increase with the new insulin regimen. Acceptability was good. Flexibility as to the timing of meals and easy handling of the device were considered the main advantages of the new system. Some patients were bothered by the need for intensified self-monitoring of blood glucose. The insulin regimen according to the basis-bolus principle using pen-like injectors led to an improvement of both metabolic control of the patients and their quality of life. It is, however, mandator...
The aim of this health economic modelling study was to investigate the effect of irbesartan combined with conventional antihypertensive medications compared to conventional antihypertensive therapy alone on the progression of nephropathy...
moreThe aim of this health economic modelling study was to investigate the effect of irbesartan combined with conventional antihypertensive medications compared to conventional antihypertensive therapy alone on the progression of nephropathy in patients with hypertension, type 2 diabetes and microalbuminuria in a Swiss setting. In simulated patients with hypertension and type 2 diabetes, treatment of microalbuminuria with irbesartan 300 mg daily plus conventional antihypertensive medications was compared to a control regimen (conventional medications excluding angiotensin converting enzyme inhibitors, other angiotensin-2-receptor antagonist and dihydropyridine calcium channel blockers). Progression from microalbuminuria to nephropathy, doubling of serum creatinine, ESRD, and all-cause mortality was simulated over a 25-year time horizon using a published Markov model adapted to a Swiss setting. Transition probabilities were based on the Irbesartan in Reduction of Microalbuminuria-2 Study...
High amounts of dietary fructose may contribute to dyslipidemia in adults, but there are few data in children. Childhood adiposity is associated with smaller LDL particle size, but the dietary predictors of LDL size in overweight children...
moreHigh amounts of dietary fructose may contribute to dyslipidemia in adults, but there are few data in children. Childhood adiposity is associated with smaller LDL particle size, but the dietary predictors of LDL size in overweight children have not been studied. We aimed to determine whether LDL particle size is associated with dietary factors and specifically with fructose intake in normal-weight and overweight children. In a cross-sectional study of normal-weight and overweight 6-14 y-old Swiss children (n = 74), dietary intakes were assessed by using two 24-h-recalls and a 1-d dietary record. Body mass index (BMI) and waist-hip ratio (WHR) were measured, and plasma lipid profile and LDL particle size were determined. Compared with the normal-weight group, overweight children had significantly higher plasma triacylglycerol concentrations, lower HDL-cholesterol concentrations, and smaller LDL particle size (P < 0.05). LDL particle size was inversely correlated to BMI SD scores an...
It is estimated that in 2010 more than 220 million people will be affected by type 2 diabetes mellitus (T2DM). Early evidence indicates that specific markers for alpha and beta cells in pancreatic islets of Langerhans can be used for...
moreIt is estimated that in 2010 more than 220 million people will be affected by type 2 diabetes mellitus (T2DM). Early evidence indicates that specific markers for alpha and beta cells in pancreatic islets of Langerhans can be used for early T2DM diagnosis. Currently, the analysis of such histological tissues is manually performed by trained pathologists using a light microscope. To objectify classification results and to reduce the processing time of histological tissues, an automated computational pathology framework for segmentation of pancreatic islets from histopathological fluorescence images is proposed. Due to high variability in the staining intensities for alpha and beta cells, classical medical imaging approaches fail in this scenario. The main contribution of this paper consists of a novel graph-based segmentation approach based on cell nuclei detection with randomized tree ensembles. The algorithm is trained via a cross validation scheme on a ground truth set of islet ima...
Non-alcoholic fatty liver disease (NAFLD) is a major health problem and occurs frequently in the context of metabolic syndrome and type 2 diabetes mellitus. Hepatocyte-specific Pten-deficiency in mice was shown previously to result in...
moreNon-alcoholic fatty liver disease (NAFLD) is a major health problem and occurs frequently in the context of metabolic syndrome and type 2 diabetes mellitus. Hepatocyte-specific Pten-deficiency in mice was shown previously to result in hepatic steatosis due to hyperactivated AKT2. However, the role of peripheral insulin-sensitive tissues on PTEN- and AKT2-dependent accumulation of hepatic lipids has not been addressed. Effects of systemically perturbed PTEN/AKT2 signalling on hepatic lipid content were studied in Pten-haplodeficient (Pten(+/-) /Akt2(+/+) ) mice and Pten-haplodeficient mice lacking Akt2 (Pten(+/-) /Akt2(-/-) ). The liver and skeletal muscle were characterized by histology and/or analysis of insulin signalling. To assess the effects of AKT2 activity in skeletal muscle on hepatic lipid content, AKT2 mutants were expressed in skeletal muscle of Pten(+/+) /Akt2(+/+) and Pten(+/-) /Akt2(+/+) mice using adeno-associated virus 8. Pten(+/-) /Akt2(+/+) mice were found to have ...
Type 1 diabetes mellitus results from autoimmune destruction of the insulin-secreting cells in the pancreas. The dramatic breakthrough in 2000 with the "Edmonton protocol" for successful solitary islet transplantation has...
moreType 1 diabetes mellitus results from autoimmune destruction of the insulin-secreting cells in the pancreas. The dramatic breakthrough in 2000 with the "Edmonton protocol" for successful solitary islet transplantation has restored optimism for the application of islet transplantation as a treatment for type 1 diabetes. Due to the recent successes, islet transplantation has evolved from a theoretical concept to its current status as a therapeutic option for patients with type 1 diabetes. Islet transplantation has shown to normalize metabolic control in a way that has been virtually impossible to achieve with exogenous insulin. The less invasive procedure of islet transplantation as compared to whole pancreas transplantation in patients with type 1 diabetes mellitus would be expected to be safer and much less costly. However, this procedure also requires lifetime immunosuppression with drugs. The limited availability of donor organs and the necessity of transplantation of se...