P.106: Prolonged Islet Allograft Function in Patients With Type 1 Diabetes After Islet Transplantation Is Associated With Female Sex of Donors and Recipients

Clinical islet transplantation was first realized over four decades ago at the University of Minnesota. Autologous islet transplantation is now widely recognized as a treatment to prevent diabetes in patients after pancreas excision and is offered at major transplant centers throughout the United States and the world. Type 1 diabetes represents a much larger demographic in which islet transplantation may benefit patients. Allogeneic islet transplantation can now offer similar outcomes to pancreas transplantation in a subset of patients with labile type 1 diabetes with less risk than whole organ transplantation. It is recognized as a standard of care in nations around the world but not in the United States, despite the important developmental role US scientists and physicians have played. Early reports of islet transplantation focused on insulin independence that proved to diminish over time. However, regardless of insulin status, islet transplantation provides benefits ranging from improved quality of life to reduction in diabetic complications. A National Institutes of Health sponsored multi-center Phase 3 Clinical Trial (CIT-07) demonstrated safety and efficacy, although the Food and Drug Administration chose to consider islets as a biologic that requires licensure, which makes offering the procedure in the clinic very challenging. Until regulations can be brought into communion with international standards, allogeneic islet transplantation in the United States is unlikely to match international levels of success and once promising programs are left to wither on the vine. Food and Drug Administration approval would open the door for third party medical reimbursement and allow many patients the opportunity to enjoy better health and quality of life. Establishment of clinical islet transplantation for type 1 diabetes would lead to optimizations in procedures making it more efficacious and cost effective while offering support for ongoing islet xenotransplantation studies that could bring islet transplantation to even more patients.

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Towards the fabrication of a 3D printed vascularized islet transplantation device for the treatment of type 1 diabetes

Frontiers in Bioengineering and Biotechnology ◽

10.3389/conf.fbioe.2016.01.01021 ◽

2016 ◽

Vol 4 ◽

Cited By ~ 1

Author(s):

Fernandez Stephanie ◽

Dussault Marc-Andr� ◽

B�gin-Drolet Andr� ◽

Ruel Jean ◽

Leask Richard ◽

...

Keyword(s):

Type 1 Diabetes ◽

Islet Transplantation ◽

3D Printed

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Mortality in People With Type 1 Diabetes, Severe Hypoglycemia, and Impaired Awareness of Hypoglycemia Referred for Islet Transplantation

Transplantation Direct ◽

10.1097/txd.0000000000000841 ◽

2018 ◽

Vol 4 (11) ◽

pp. e401 ◽

Cited By ~ 4

Author(s):

Melissa H. Lee ◽

Glenn M. Ward ◽

Richard J. MacIsaac ◽

Kathy Howe ◽

D. Jane Holmes-Walker ◽

...

Keyword(s):

Type 1 Diabetes ◽

Islet Transplantation ◽

Severe Hypoglycemia ◽

Impaired Awareness

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Clinical islet transplantation in type 1 diabetes mellitus: results of Australia's first trial

The Medical Journal of Australia ◽

10.5694/j.1326-5377.2006.tb00206.x ◽

2006 ◽

Vol 184 (5) ◽

pp. 221-225 ◽

Cited By ~ 52

Author(s):

Philip J O’Connell ◽

Wayne J Hawthorne ◽

Brian J Nankivell ◽

Anita T Patel ◽

Stacey N Walters ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Type 1 Diabetes Mellitus ◽

Islet Transplantation ◽

Clinical Islet Transplantation

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Multimorbidity Among Adult Outpatients With Type 1 Diabetes in Germany

Journal of Diabetes Science and Technology ◽

10.1177/1932296820965261 ◽

2020 ◽

pp. 193229682096526

Author(s):

Louisa van den Boom ◽

Gebhard Buchal ◽

Marcel Kaiser ◽

Karel Kostev

Keyword(s):

Type 1 Diabetes ◽

Psychiatric Disorders ◽

Insulin Pump ◽

Insulin Pump Therapy ◽

Deficiency Anemia ◽

Pump Therapy ◽

Cross Sectional ◽

Logistic Regression Models ◽

Female Sex

Aim: The aim of this cross-sectional retrospective study was to estimate the prevalence of different physical and psychiatric disorders as well as multimorbidity in outpatients with type 1 diabetes (T1D) in Germany. Methods: A total of 6967 adult patients with T1D from 958 general or diabetologist practices in Germany between January 2015 and December 2019 from the Disease Analyzer database (IQVIA) were included. The main outcome of the study was the prevalence of different diabetes-related and nondiabetes-related disorders within 12 months prior to the last outpatient visit. Multivariate logistic regression models were fitted with multimorbidity differently defined as >2, >3, >4, and >5 different disorders as a dependent variable and age, sex, glycated hemoglobin (HbA1c) values, and insulin pump therapy as impact variables. Results: Mean age (SD) was 45.3 (16.7) years; 42.9% were women, the mean HbA1c was 7.9% (SD: 1.4%). The most frequent disorder was arterial hypertension (31.2%), followed by dyslipidemia (26.4%), dorsalgia (20.4%), diabetic neuropathy (17.3%), and depression (14.6%). The proportion of thyroid gland disorders, retinopathy, urethritis, iron deficiency anemia, and psychiatric disorders was higher in women than in men. Hypertension and mental and behavioral disorders due to the use of tobacco were higher in men. On average, each patient was diagnosed with 3.1 different disorders. Age had the strongest association with multimorbidity, followed by HbA1c value and female sex. Conclusion: In summary, patients with T1D are often multimorbid, and the multimorbidity is associated with higher gender, female sex, and high HbA1c values. Understanding all of these factors can help practitioners create a risk profile for every patient.

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THERAPY OF ENDOCRINE DISEASE: Islet transplantation for type 1 diabetes: so close and yet so far away

Acta Endocrinologica ◽

10.1530/eje-15-0094 ◽

2015 ◽

Vol 173 (5) ◽

pp. R165-R183 ◽

Cited By ~ 21

Author(s):

Mohsen Khosravi-Maharlooei ◽

Ensiyeh Hajizadeh-Saffar ◽

Yaser Tahamtani ◽

Mohsen Basiri ◽

Leila Montazeri ◽

...

Keyword(s):

Type 1 Diabetes ◽

Islet Transplantation ◽

Diabetic Patients ◽

Immune Rejection ◽

Pancreatic Islet Transplantation ◽

Insulin Independence ◽

Endocrine Disease ◽

The Past ◽

Source Limitation

Over the past decades, tremendous efforts have been made to establish pancreatic islet transplantation as a standard therapy for type 1 diabetes. Recent advances in islet transplantation have resulted in steady improvements in the 5-year insulin independence rates for diabetic patients. Here we review the key challenges encountered in the islet transplantation field which include islet source limitation, sub-optimal engraftment of islets, lack of oxygen and blood supply for transplanted islets, and immune rejection of islets. Additionally, we discuss possible solutions for these challenges.

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