New Hope for Type 1 Diabetes Patients

Sept. 27, 2006 — -- For more than 1½ million Americans diagnosed with Type 1 diabetes, every day can be a challenge.

Type 1 diabetes is believed to be caused by dysfunctional islet cells in the pancreas.

In some cases, it is believed that the body's immune cells actually attack the islet cells that control blood sugar, so the body cannot produce insulin.

Type 1 diabetics always need to monitor their blood-sugar levels and take insulin every day.

But a new report published in Thursday's New England Journal of Medicine suggests that a special surgery could free some patients from needing to take daily insulin.

Short-Term Success

This new study finds that transplanted healthy cells can replace the defective ones in the patient's body.

However, the transplanted cells will only work for a short time.

Islet cell transplantation takes pancreatic cells from a healthy donor and transplants them into a diabetic patient.

A group of Canadian researchers transplanted healthy islet cells into 36 patients with Type 1 diabetes using a method called the Edmonton Protocol.

The group and other scientists had been studying the Edmonton Protocol for many years.

One year after the surgery, almost half of those patients no longer needed daily insulin.

After two years, five of the patients could still go day to day without insulin, but the rest needed to take it again.

Some Lingering Benefits From Surgery

Even though most patients eventually still took daily insulin, the surgery had some lingering benefit.

Some patients found they were less affected by severe drops in their blood-sugar levels after the surgery, even though they still needed insulin.

Experts say that the finding is positive because it proves that this protocol can work in some patients.

"On a negative side, we now know that the initial positive result [insulin independence] is not lasting, and patients go back on small doses of insulin," said Dr. Enrico Cagliero of Boston's Massachusetts General Hospital Diabetes Center and one of the study's authors.

"Overall, patients are still better off [after the surgery]," Cagliero said. "For a small minority of Type 1 diabetic patients, islet cell transplants are a good option, but major steps are needed before it can be considered a standard procedure."

Other experts agree that the transplant surgery is a step forward for diabetes control.

But, they say, an islet cell transplant is only practical for a very small group of diabetes patients whose benefits would outweigh the risks of being on lifelong anti-rejection medications.

Any patient who undergoes transplant surgery has to take anti-rejection medications to protect the transplanted cells from being attacked by normal immune system cells that recognize the transplanted cells as being "foreign."

The bottom line?

Islet cell transplantation is a possible consideration for people with very serious diabetes, but it appears that it would be best for a small group of people and in very special cases.