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Cell transplantation helps difficult type 1 diabetes



By Serena Gordon

HealthDay Reporter

FRIDAY, March 30, 2018 (HealthDay News) – New research shows that for people with type 1 diabetes who can no longer feel if their blood sugar levels are too deep fall, An islet cell transplant can dramatically improve their lives.

Some people with type 1 diabetes develop hypoglycaemic unconsciousness, which means that they no longer feel any symptoms when their blood sugar levels drop dangerously. This can lead to severe low blood sugar levels (hypoglycemia), which can cause seizures and coma.

"It's hard to understand what impact this can have on everyday life and lifestyle and self-esteem," said study co-author Dr Nancy Bridges. She is the Director of Transplantation at the US National Institute of Allergy and Infectious Diseases.

"These are people who need to stop driving, people who may not be able to look after their own children Jobs that can not do their job, people who have to live with the idea Any decision you make can lead to an uncontrollable hypoglycemic event. "" Can I go with the dog, or will I wake up two blocks? "" The impact on her life is enormous, "explains Bridges.

Because the impact on their lives is so significant, people who repeatedly suffer from these severe hypoglycemic events are eligible for islet cell transplantation.

Islet cells are cells in the pancreas that produce the hormone insulin. Insulin helps to introduce the sugar from the food into the body cells in order to be used as fuel. In type 1

diabetes, the immune system attacks and destroys islet cells, mistakenly viewing them as foreign invaders.

This leaves people with type 1 diabetes insufficient insulin. You must replace the lost insulin with several daily injections or with an insulin pump. However, the correct dosage of insulin can be a difficult balancing act and too much insulin causes hypoglycemia.

Bridges said most people with Type 1 diabetes can cope with insulin treatment rather well and not experience these severe low blood sugar episodes. But for those who have this problem, an islet cell transplant can help.

Continued

However, the procedure is not without its own risks, and it is still under investigation in the United States. Because it is a transplant of foreign substances into the body, people have to take immunosuppressive drugs for the rest of their lives. These medicines are known to increase the risk of infection and cancer. But for people with diabetes, one of the biggest concerns, according to Bridges, is the effect these drugs can have on their kidneys.

"This is something that is discussed among diabetologists.Why should we ask for a treatment that carries the burden of immunosuppression, when insulin works well for most people? But given what we know about the physical and emotional stress Knowing hypoglycemia ignorance, we thought that patients would find this a good compromise, "said Bridges

A phase 3 clinical study included 48 patients with type 1 diabetes who were hypoglycaemic unconscious. They were between 26 and 65 years old, with an average age of 48 years. The average duration of her diabetes was 28 years. All received transplants of islet cells.

The participants also performed four quality of life examinations before and after the transplant.

Nearly 90 percent of participants stopped for at least one year with severe hypoglycemic events. They were also able to reach normal blood sugar levels, some without the need for insulin injections.

Both groups – those who were insulin-free and those who needed it – reported similar improvements in quality of life. [19659004] "There have been dramatic improvements in quality of life, and your fear of hypoglycaemia is gone," said Bridges. And even people with only a few functioning islets could become aware of hypoglycaemia again to prevent these severe episodes.

Dr. Andrew Stewart, Director of Diabetes, Obesity and Metabolic Institute at the Icahn School of Medicine at Mount Sinai in New York City, reviewed the findings.

"This is an interesting study that shows these significant and very realistic concerns and fears reduced in the first year after islet transplantation in the pancreas," he said.

Continued

"In addition, it underlines the point that it is not necessary to become insulin-free to achieve this quality of life improvement," Stewart added.

He said the study leaves some questions unanswered, such as: Is the reduction in hypoglycemia ignorance caused by the islet cell transplants or by the immunosuppressive drugs?

The study was recently published online in the journal Diabetes Care . Funding for the study was provided by the US National Institute of Allergy and Infectious Diseases and the US National Institute of Diabetes and Digestive and Kidney Diseases.

WebMD News from HealthDay

Sources

SOURCES: Nancy Bridges, MD, Head, Transplant, US National Institute of Allergy and Infectious Diseases; Andrew Stewart, MD, Director, Diabetes, Obesity and Metabolic Institute, Icahn School of Medicine at Mount Sinai, New York City; March 21, 2018, Diabetes Care online



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