scholarly journals Islet Transplantation in Type 1 Diabetes Mellitus With Hypoglycaemic Unawareness

2020 ◽  
Vol 1 (4) ◽  
Author(s):  
Gaurav Agarwal ◽  
Sarah Cross
Keyword(s):  
New Technologies ◽  
Graft Loss ◽  
Islet Isolation ◽  
Newly Diagnosed ◽  
Insulin Independence ◽  
Invasive Treatment ◽  
Hypoglycaemia Unawareness ◽  
Islet Transplants

The primary indications for ICT in T1DM are glycaemic lability and hypoglycaemia unawareness.   ICT is an effective, minimally invasive treatment for stabilising glycaemic control, correcting hypoglycaemia unawareness and improving quality of life even when exogenous insulin-independence is not fully achieved. However, the majority of patients require two islet transplants.   The need for lifelong immunosuppression, in combination with the limited availability of donor pancreases, currently limits the wider application of ICT, particularly in the treatment of children newly diagnosed with T1DM.   New technologies, including macro- and micro-encapsulation, xenotransplantation and stem cell-derived b cells offer hope for the future of b cell replacement. Yet, until then, a continued focus on optimising donor pancreases, improving the islet isolation procedure, use of novel immunosuppression, and understanding the mechanisms behind graft loss is required.

Bone Turnover Biomarkers Are Useful In Monitoring Myeloma Bone Disease and As Early Predictor Biomarkers For Relapse Disease In Multiple Myeloma

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1869-1869
Author(s):  
Kay Reen Ting ◽  
Abdul Hameed ◽  
Jennifer Brady ◽  
Paul Dowling ◽  
Colin Clarke ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Bone Turnover ◽  
Bone Disease ◽  
Newly Diagnosed ◽  
Serum Free ◽  
Myeloma Bone Disease ◽  
And Control ◽  
Early Predictor

Abstract Background Multiple myeloma is a plasma cell disorder characterised by bone marrow infiltration with clonal plasma cells that secrete monoclonal immunoglobulin which is detected in serum or urine samples. Bone disease is a well-known devastating complication. It has a significant impact to the quality of life and morbidity in multiple myeloma. The uncoupling effect of osteoblast and osteoclast activity is the major element in development of myeloma bone disease (MBD). Imaging techniques are used as the current standard method for detection of bony lesions. They have limitations as they cannot provide a real-time assessment of bone turnover. Early detection of relapse disease is crucial to allow preventative therapeutic intervention as it could significantly impact on quality of life. Aims Bone biomarkers such as C-terminal telopeptide of type 1 collagen (CTX-1) and procollagen type 1 N-propeptide (P1NP) can be used as an early predictor marker for MBD relapses and a monitor for MBD at different stages of the disease. Methods CTX-1 and P1NP were measured by chemiluminescent immunoassay on fasting plasma samples from 111 patients including newly diagnosed multiple myeloma (n=28), remission (n=34), relapses (n=22) and control (n=27). These were measured at regular intervals over a 30 month study period. Relapse disease was identified by conventional biomarkers like paraprotein and serum free light chains, and confirmed by imaging and bone marrow biopsy. In a subset of patients with disease relapse, the Mann-Whitney test was used to compare bone markers pre-relapse and at relapse. Results CTX-1 levels were significantly higher in newly diagnosed multiple myeloma compared to remission and control groups (p < 0.0001). In relapse group, CTX-1 rose significantly at the time of pre-relapse to relapse state (p=0.0001). A rise of ≥ 2.0 fold rise in the level of CTX-1 from remission to relapse disease was noted. The median time between the pre-relapse sample and relapse disease was 3 months (range 1-14 months). Most of them had new bone lesions at relapse. This proves that it has potential as an early predictor of relapse or progressive bone disease. A case showed CTX-1 level was the only biochemical parameter to rise significantly prior to relapse as compared to the other conventional biomarkers (ie. paraprotein and serum free light chain). As for P1NP, the rise in P1NP from pre-relapse to relapse was not significant (p=0.0810). Conclusion Osteoclast biomarker serum CTX-1 correlates accurately with the disease burden in newly diagnosed multiple myeloma patients as compared to the rest of the groups. It is a more sensitive early predictor of relapse/progressive disease than established biomarkers. It is a more robust marker than P1NP. The rise in P1NP goes against the theory that there is an uncoupling of bone turnover in MBD and requires further study. CTX-1 is more cost effective and accessible than imaging and should be used routinely when monitoring bone disease activity in multiple myeloma patients, facilitating early intervention when relapse occurs. Disclosures: No relevant conflicts of interest to declare.

Islet of Langerhans Transplantation for the Treatment of Type 1 Diabetes

Swiss Surgery ◽  
2003 ◽  
Vol 9 (5) ◽  
pp. 242-246 ◽  
Author(s):  
Bucher ◽  
Mathe ◽  
Bosco ◽  
Andres ◽  
Bühler ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Islet Transplantation ◽  
Enzymatic Digestion ◽  
Pancreatic Tissue ◽  
Islet Of Langerhans ◽  
Insulin Independence ◽  
Islet Mass ◽  
Clinical Islet Transplantation ◽  
Islet Transplants

Islet of Langerhans transplantation is gaining recognition as a therapy for type 1 diabetes. The procedure involves enzymatic digestion of the pancreatic tissue, purification of the islets from the exocrine tissue, infusion of the islets into the portal vein and implantation in the liver. Until 1999, an overall rate of insulin independence of 14% at one year was reported in the International Islet Transplant Registry. The results of the "Edmonton protocol" since 2000 were a breakthrough in the field, with reports of 80% insulin independence at 1-year after solitary islet transplantation in non uremic patients with brittle type 1 diabetes. A rapamycin-based, steroid-free, islet-sparing immunosuppressive regimen was designed and the problem of the insufficient islet mass was tackled by sequential infusions of islets isolated from at least two pancreata. The University of Geneva has been involved in clinical islet transplantation since 1992, and has performed 51 allogeneic and 17 autologous. Twenty-one patients have been transplanted in Geneva since 2002. They were five solitary islet transplants, 14 islet after kidney transplants and two simultaneous islet-kidney (SIK) recipients. Insulin independence was achieved in 67%.

First report on the nationwide prevalence of paediatric type 1 diabetes in Serbia and temporal trends of diabetes ketoacidosis at diagnosis—a multicentre study

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Sandra Stankovic ◽  
Rade Vukovic ◽  
Ivana Vorgucin ◽  
Vera Zdravkovic ◽  
Nevena Folic ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Temporal Trends ◽  
Percentage Increase ◽  
Newly Diagnosed ◽  
First Report ◽  
High Prevalence ◽  
First Time

AbstractWe aimed to collect data on all paediatric patients who were diagnosed with type 1 diabetes mellitus (T1DM) between the years 2000 and 2019 in Serbia and estimate for the first time its prevalence. Also, the trends of diabetes ketoacidosis (DKA) occurrence at the time of diagnosis are monitored. We collected and retrospectively analysed the data of patients <19 years with newly diagnosed T1DM. T1DM was diagnosed in 3134 patients (53.2% male). Total number of youth <19 years with T1DM was 1735 with prevalence of 135.25/100000 at the end of study period. T1DM was diagnosed most frequently between the ages of 5 and 11 years (42.1%). At the time of diagnosis, 35.7% presented in DKA. The incidence and severity of DKA were more significant at the youngest age (p<0.001). There were significant annual percentage increase (2.2%) in the number of new cases of DKA (p=0.007). Conclusion: This first report of nationwide prevalence of T1DM in youth shows that Serbia is among countries with high prevalence of T1DM in youth. System changes are needed in order to provide better quality of health care to these patients.

scholarly journals Health-Related Quality of Life in Patients With Newly Diagnosed Type 1 Diabetes

Diabetes Care ◽  
2003 ◽  
Vol 26 (4) ◽  
pp. 1319-1320 ◽  
Author(s):  
H. E. Hart ◽  
W. K. Redekop ◽  
J. H. Assink ◽  
B. Meyboom - de Jong ◽  
H. J.G. Bilo
Keyword(s):  
Quality Of Life ◽  
Type 1 Diabetes ◽  
Newly Diagnosed ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related

scholarly journals Progress of Islet Transplantation over the Last 15 Years

2015 ◽  
Vol 11 (02) ◽  
pp. 70
Author(s):  
Mohammed Almehthel ◽  
Breay W Paty ◽  
David M Thompson ◽  
◽  
◽  
...  
Keyword(s):  
Quality Of Life ◽  
Glycemic Control ◽  
Islet Transplantation ◽  
Severe Hypoglycemia ◽  
Insulin Independence ◽  
Autoimmune Destruction ◽  
Acceptable Method ◽  
Selection Of

Diabetes mellitus prevalence is increasing worldwide. Type 1 diabetes (T1DM), which is caused mainly by autoimmune destruction of beta cells, accounts for approximately 5–10 % of all diabetes. Intensive glycemic control has been shown to reduce complications of T1DM. However, this has been difficult to achieve and is usually associated with frequent hypoglycemia. Islet transplantation (IT) has emerged as an acceptable method for the treatment of patients with T1DM who suffer for frequent severe hypoglycemia and/or glycemic lability. Although initial success was limited, improvement in IT has been observed over the last 15 years. The 5-year insulin independence rate approaches 30–50 % in some experienced centers. Even without achieving insulin independence, IT has significant benefits including prevention of hypoglycemia, stabilization of glycemic control, reduction in some complications of diabetes, and improvement in quality of life. Here, we provide a brief review on IT including its history, selection of IT candidates, description, and complications of the procedure and outcomes.

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