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Lancet. 2019 Oct 5;394(10205):1274-1285. doi: 10.1016/S0140-6736(19)31334-0. Epub 2019 Sep 15.

Advances in β-cell replacement therapy for the treatment of type 1 diabetes.

Author information

1
University of Lille, European Genomic Institute for Diabetes, Lille, France; Department of Endocrinology, Diabetology and Metabolism, Centre Hospitalier Universitaire de Lille, Lille, France; Inserm, Translational Research for Diabetes, Lille, France. Electronic address: mc-vantyghem@chru-lille.fr.
2
Department of Medicine, Leiden University Medical Center, Leiden, Netherlands; Hubrecht Institute of the Royal Netherlands Academy of Arts and Sciences and University Medical Center Utrecht, Utrecht, Netherlands.
3
University of Lille, European Genomic Institute for Diabetes, Lille, France; Department of General and Endocrine Surgery Centre, Centre Hospitalier Universitaire de Lille, Lille, France; Inserm, Translational Research for Diabetes, Lille, France.
4
Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; Institute for Diabetes, Obesity and Metabolism, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.

Abstract

The main goal of treatment for type 1 diabetes is to control glycaemia with insulin therapy to reduce disease complications. For some patients, technological approaches to insulin delivery are inadequate, and allogeneic islet transplantation is a safe alternative for those patients who have had severe hypoglycaemia complicated by impaired hypoglycaemia awareness or glycaemic lability, or who already receive immunosuppressive drugs for a kidney transplant. Since 2000, intrahepatic islet transplantation has proven efficacious in alleviating the burden of labile diabetes and preventing complications related to diabetes, whether or not a previous kidney transplant is present. Age, body-mass index, renal status, and cardiopulmonary status affect the choice between pancreas or islet transplantation. Access to transplantation is limited by the number of deceased donors and the necessity of immunosuppression. Future approaches might include alternative sources of islets (eg, xenogeneic tissue or human stem cells), extrahepatic sites of implantation (eg, omental, subcutaneous, or intramuscular), and induction of immune tolerance or encapsulation of islets.

PMID:
31533905
DOI:
10.1016/S0140-6736(19)31334-0
[Indexed for MEDLINE]

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