islet transplantation

A group of researchers followed a woman with type 1 diabetes mellitus who underwent laparoscopic islet transplantation. Over the course of 12 months, the woman consistently maintained normal blood glucose levels and establish an independence from exogenous insulin administration.

 

Diabetes Mellitus Type 1 is a disorder characterized by increased levels of glucose in the body resulting from autoimmune destruction of the insulin-producing β cells of the pancreas. Lifetime administration of insulin and monitoring of blood glucose levels are required for the management of this condition. Current insulin preparations available on the market are usually administered subcutaneously. Surgical intervention via islet transplantation could also be done to maintain blood glucose levels in patients affected with type 1 diabetes mellitus.

In a recent correspondence published in The New England Journal of Medicine, a group of researchers led by David Baidal, M.D. followed a 43-year-old woman with type 1 diabetes mellitus who underwent islet transplantation. The patient received islet transplantation onto the omentum via laparoscopic route. Immunosuppressive therapy with mycophenolate sodium and tacrolimus was provided to prevent transplant rejection. Tacrolimus was replaced with sirolimus 8 months post-transplantation due to reported hair loss. The patient was also advised to exercise regularly and maintain a low-carbohydrate diet after transplantation. Capillary blood glucose levels, glycated hemoglobin levels, and beta and BETA-2 scores (measure of β cell function, with higher scores indicating better function) were monitored accordingly.

Follow-up assessments at 75 days, 6 months, and 12 months post-transplantation showed restoration of normal blood glucose levels and exogenous insulin independence. However, insulin secretion decreased and a functional islet decline was observed at 12 months. Researchers attributed this phenomenon to the change in immunosuppressant therapy from tacrolimus to sirolimus. The patient was able to maintain a normal blood glucose level despite the observed decline in function and did not have any episodes of hypoglycemia which required exogenous insulin administration.

In summary, laparoscopic islet transplantation is a promising method for the management of type 1 diabetes mellitus and may reduce dependence to exogenous insulin administration. However, further studies should be done to establish the safety and long-term outcomes of this procedure.

 

Written By: Karla Sevilla

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