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Transplantation makes life better for difficult-to-use type 1 diabetes



FRIDAY, March 30, 2018 (HealthDay News) – New research shows that for people with type 1 diabetes who can no longer feel their blood sugar levels drop too low, an islet cell transplantation 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 level drops 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, lifestyle and self-esteem," said 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 may have to give up driving, people who may not be able to look after their own children Jobs that can not do their jobs, 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.

Da the effects on their lives are so significant, people who repeatedly experience these severe hypoglycemic episodes are eligible for islet cell transplantation.

Islet cells are cells in the pancreas that produce the hormone insulin, which helps insulate the sugar from food In type 1

diabetes, the immune system attacks and destroys islet cells, wrong Usually, they see them as foreign invaders.

This leaves people with type 1 diabetes without enough 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 could 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.

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 among people with diabetes, one of the biggest concerns is the effects of these drugs on the kidneys, according to Bridges.

"This is something that is discussed among diabetologists, why should we enforce treatment with the burden of immunosuppression when insulin works well for most people, but given what we have learned about the physical and emotional burden of hypoglycaemia? Ignorance, patient patients would find that a good compromise, "Bridges said.

The study, which was a phase 3 clinical trial, included 48 patients with type 1 diabetes who were unaware of hypoglycaemia. 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.

Participants also performed four quality of life surveys before and after the transplant.

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

Both groups – those who were insulin-free and those who needed it – reported similar improvements in quality of life.

"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 that these significant and very realistic concerns and fears are reduced during the first year after pancreatic islet transplantation," he said.

"In addition, it underlines the point that it is not necessary to become insulin-free in order to achieve these quality improvements," added Stewart.

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

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

Learn More

Learn about pancreatic islet cell transplantation from the US National Institute of Diabetes and Digestive and Kidney Diseases.

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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