More than half of the most seriously affected Type 1 diabetes patients achieved years of insulin independence after they received a new method of islet cell transplantation, according to a paper published in Diabetes Care on the long-term outcomes of two phase three clinical trials. In addition to finding that many patients didn’t need insulin to maintain their blood sugar for up to eight years, the authors, co-led by Michael Rickels, the Willard and Rhoda Ware Professor in Diabetes and Metabolic Diseases in the Perelman School of Medicine, also reported that the new approach required fewer transplants than typical and was exceedingly safe.
“These data are important in showing that, in the long run, islet transplantation has efficacy, including among those who have had kidney transplants,” says Rickels. “Yes, most Type 1 diabetes patients are improved tremendously with current insulin delivery systems. But for those having the most difficulty controlling their blood sugar, and those whose diabetes has already been complicated by needing a kidney transplant, the outcomes we saw in this study are what we’ve been hoping to achieve for more than 20 years.”
Two cohorts of patients were analyzed: Those who received just islet transplantation and those who received islets after kidney transplantation. Of those observed all the way through to what was defined as the “long-term” endpoint, more than half had surviving islet grafts. Additionally, of the 75% who initially were able to come off insulin therapy, more than half maintained total insulin independence, meaning they needed no additional insulin injections throughout the years of follow-up.
Islet cells are located in the pancreas and are critical to keeping blood sugar in check by producing the hormone insulin. But the islets of those with Type 1 diabetes are destroyed by the immune system and don’t make insulin. A form of cell replacement therapy—which exists elsewhere in the world but is still considered experimental in the United States—is islet cell transplantation, which takes normal-functioning cells from the pancreas of deceased donors and introduces them via a small catheter to patients whose own islets no longer work.
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