title: Diabetes cell therapy: a decade later.
abstract: Type 1 diabetes is an intrinsically unstable condition because of the loss of both insulin secretion and glucose sensing. Guidelines to treat type 1 diabetes have become stricter since results from the Diabetes Control and Complications Trial (DCCT) demonstrated the close relationship between microangiopathy and HbA1c levels. Therapeutic strategies first require the treatment of underlying organic causes of the brittleness associated with the optimization of insulin therapy including continuous subcutaneous insulin infusion and glucose monitoring. Alternative approaches may still be needed for the most severely affected patients. During the last decade, islet transplantation has gone from an inconsistent 1-year rate of insulin independence of 10% to 80% and could reach 50% at 5 years, at the expense of non-negligible side effects. Among potential causes of islet transplantation success, sufficient islet mass and low levels of cellular autoimmunity are of critical importance. The main issues are currently the availability of an unlimited source of insulin-secreting cells, and the immunosuppressive drug side effects. Today, islet alone and islet after kidney transplantation are offered in a limited number of isolation centres, usually in clinical trials. Islet after kidney transplantation can be considered in type 1 diabetic patients with end-stage kidney disease that are ineligible for double kidney-pancreas transplantation. Islet transplantation alone is proposed to C-peptide negative adult diabetic patients with a body weight <80 kg or low daily insulin needs with creatinine clearance above 60 ml/min, albuminuria lower than 300mg/24H and without desire for pregnancy in women. Currently and until a more complete assessment of the 5- and probably 10-year overall benefit-risk ratio is available, islet transplantation remains a clinical research procedure.
authors: Unit of Endocrinology and Metabolism, Endocrine Surgery and Nephrology Department, Lille University Hospital, Lille, France. mc-vantyghem@chru-lille.fr
authors: M C
authors: MC
authors: Vantyghem
authors: A S
authors: AS
authors: Balavoine
authors: R
authors: R
authors: Caiazzo
authors: J
authors: J
authors: Kerr-Conte
authors: C
authors: C
authors: Noel
authors: F
authors: F
authors: Pattou
mesh_terms: D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002986:Clinical Trials as Topic; D003920:Diabetes Mellitus / Q000097:blood / Q000601:surgery*; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D050417:Insulin-Secreting Cells / Q000378:metabolism; D016381:Islets of Langerhans Transplantation / Q000009:adverse effects / Q000639:trends; D007668:Kidney / Q000503:physiopathology; D017410:Practice Guidelines as Topic; D011379:Prognosis; D011788:Quality of Life; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein; D006442:Glycated Hemoglobin; D007166:Immunosuppressive Agents