title: Treating diabetes with islet transplantation: lessons from the past decade in Lille.
abstract: Type 1 diabetes (T1D) is due to the loss of both beta-cell insulin secretion and glucose sensing, leading to glucose variability and a lack of predictability, a daily issue for patients. Guidelines for the treatment of T1D have become stricter as results from the Diabetes Control and Complications Trial (DCCT) demonstrated the close relationship between microangiopathy and HbA1c levels. In this regard, glucometers, ambulatory continuous glucose monitoring, and subcutaneous and intraperitoneal pumps have been major developments in the management of glucose imbalance. Besides this technological approach, islet transplantation (IT) has emerged as an acceptable safe procedure with results that continue to improve. Research in the last decade of the 20th century focused on the feasibility of islet isolation and transplantation and, since 2000, the success and reproducibility of the Edmonton protocol have been proven, and the mid-term (5-year) benefit-risk ratio evaluated. Currently, a 5-year 50% rate of insulin independence can be expected, with stabilization of microangiopathy and macroangiopathy, but the possible side-effects of immunosuppressants, limited availability of islets and still limited duration of insulin independence restrict the procedure to cases of brittle diabetes in patients who are not overweight or have no associated insulin resistance. However, various prognostic factors have been identified that may extend islet graft survival and reduce the number of islet injections required; these include graft quality, autoimmunity, immunosuppressant regimen and non-specific inflammatory reactions. Finally, alternative injection sites and unlimited sources of islets are likely to make IT a routine procedure in the future.
authors: Endocrinology and Metabolism Department, Inserm U599, Lille University Hospital, C.-Huriez Hospital, 1, rue Polonovski, 59037 Lille cedex, France; Diabetes Biotherapy, Inserm U859, Lille University Hospital, Lille, France. Electronic address: mc-vantyghem@chru-lille.fr.
authors: M-C
authors: MC
authors: Vantyghem
authors: Endocrinology and Metabolism Department, Inserm U599, Lille University Hospital, C.-Huriez Hospital, 1, rue Polonovski, 59037 Lille cedex, France.
authors: F
authors: F
authors: Defrance
authors: Endocrinology and Metabolism Department, Inserm U599, Lille University Hospital, C.-Huriez Hospital, 1, rue Polonovski, 59037 Lille cedex, France.
authors: D
authors: D
authors: Quintin
authors: Endocrinology and Metabolism Department, Inserm U599, Lille University Hospital, C.-Huriez Hospital, 1, rue Polonovski, 59037 Lille cedex, France.
authors: C
authors: C
authors: Leroy
authors: Endocrine Surgery Department, Lille University Hospital, Lille, France.
authors: V
authors: V
authors: Raverdi
authors: Endocrinology Department, Rouen University Hospital, Rouen, France.
authors: G
authors: G
authors: Prévost
authors: Endocrine Surgery Department, Lille University Hospital, Lille, France.
authors: R
authors: R
authors: Caiazzo
authors: Diabetes Biotherapy, Inserm U859, Lille University Hospital, Lille, France.
authors: J
authors: J
authors: Kerr-Conte
authors: Nephrology Department, Lille University Hospital, Lille, France.
authors: F
authors: F
authors: Glowacki
authors: Nephrology Department, Lille University Hospital, Lille, France.
authors: M
authors: M
authors: Hazzan
authors: Nephrology Department, Lille University Hospital, Lille, France.
authors: C
authors: C
authors: Noel
authors: Diabetes Biotherapy, Inserm U859, Lille University Hospital, Lille, France; Endocrine Surgery Department, Lille University Hospital, Lille, France.
authors: F
authors: F
authors: Pattou
authors: A S Balavoine
authors: AS
authors: Diamenord
authors: R
authors: R
authors: Bresson
authors: M F
authors: MF
authors: Bourdelle-Hego
authors: M
authors: M
authors: Cazaubiel
authors: M
authors: M
authors: Cordonnier
authors: D
authors: D
authors: Delefosse
authors: F
authors: F
authors: Dorey
authors: A
authors: A
authors: Fayard
authors: C
authors: C
authors: Fermon
authors: P
authors: P
authors: Fontaine
authors: C
authors: C
authors: Gillot
authors: S
authors: S
authors: Haye
authors: A C
authors: AC
authors: Le Guillou
authors: W
authors: W
authors: Karrouz
authors: C
authors: C
authors: Lemaire
authors: M
authors: M
authors: Lepeut
authors: R
authors: R
authors: Leroy
authors: B
authors: B
authors: Mycinski
authors: E
authors: E
authors: Parent
authors: C
authors: C
authors: Siame
authors: A
authors: A
authors: Sterkers
authors: F
authors: F
authors: Torres
authors: O
authors: O
authors: Verier-Mine
authors: E
authors: E
authors: Verlet
authors: R
authors: R
authors: Desailloud
authors: A
authors: A
authors: Dürrbach
authors: M
authors: M
authors: Godin
authors: J D
authors: JD
authors: Lalau
authors: C
authors: C
authors: Lukas-Croisier
authors: E
authors: E
authors: Thervet
authors: O
authors: O
authors: Toupance
authors: Y
authors: Y
authors: Reznik
authors: P F
authors: PF
authors: Westeel
mesh_terms: D001786:Blood Glucose / Q000378:metabolism*; D002097:C-Reactive Protein / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000276:immunology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D050417:Insulin-Secreting Cells / Q000276:immunology / Q000378:metabolism*; D016381:Islets of Langerhans Transplantation / Q000009:adverse effects / Q000379:methods; D008297:Male; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011379:Prognosis; D011788:Quality of Life; D015203:Reproducibility of Results; D018570:Risk Assessment; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D002097:C-Reactive Protein; D006442:Glycated Hemoglobin; D007166:Immunosuppressive Agents; C517652:hemoglobin A1c protein, human
keywords: Beta score; Brittle diabetes; Diabetes cell therapy; Islet transplantation; Type 1 diabetes