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Treatment of diabetes (Type I) through transplantation 

Treatment of diabetes (Type I) through transplantation
Chapter:
Treatment of diabetes (Type I) through transplantation
Author(s):

Parthi Srinivasan

DOI:
10.1093/med/9780199235292.003.1597
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date: 11 December 2019

Type 1 diabetes mellitus (T1DM) is an autoimmune disease associated with selected genetic HLA alleles, which results in the permanent destruction of beta cells of the pancreatic islets of Langerhans, with subsequent insulinopenia and hyperglycaemia (1). Meta-analysis indicates that high birth weight and increased early weight gain may be risk factors for type 1 diabetes (2). The clinical state leads to significant increase in premature mortality and morbidity, including through accelerated atherosclerosis, cardiac autonomic neuropathy, and possibly intrinsic cardiomyopathy (3). Intensive exogenous insulin therapy can be effective in preventing the progression of such morbidity, but carries with it a three- to six- fold increase in risk of life threatening hypoglycaemia (see Chapter 13.4.8). Clinicians seeking an alternative therapy or even potential cure of T1DM through replacement of the destroyed pancreatic beta cells conducted the first whole organ pancreas transplant (PT) in Minneapolis in 1966. Although now accepted as effective treatment for T1DM, PT involves major surgery, with its attendant complications. Recognition of this led, in the early nineties, to trials of islet allograft transplantation (IT), as this limits the transplant procedure to the islets. Representing only 2% of the whole organ, they are the only part of it that is abnormal in T1DM. Shapiro’s report in 2000 of consistent insulin independence without major surgery led to a worldwide increase in clinical IT (4). We herein discuss the two options in brief, pose our opinions and conclude with some thought to a few future novel therapies for the disease.

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