Much has been learned in terms of the effectiveness of diabetes education on improving knowledge. However, other topic areas and outcomes need further exploration.

In Brief Recent concern about the optimum management of hyperglycemia for hospital patients has heightened awareness of necessary standards of care. Publications have confirmed that diabetes is not diagnosed or treated when detected in acute care settings, and opportunities for education are missed. Hospitalization presents an opportunity to address patients' unique urgent learning needs. In centers where quality diabetes management is a priority, education is readily available, roles are clear, and quality is monitored, evidence supports the notion that inpatient education is related to earlier discharge and improved outcomes following discharge.

Global community members who experience similar health problems gravitate to each other for information and support. Peers may be more approachable and can relate to the particular living circumstances one experiences. In well-resourced countries, people have opportunities for learning diabetes self-management; however, empathy may be more helpful when practical barriers arise. Little is published in medical literature about how to foster diabetes peer support and what is published is often limited to English language. Among those programs available, commonalities are readily seen. There is significant evidence that well-informed people cope better with adapting their lifestyle to medical regimens. Professionally delivered diabetes education has been well defined, but there may be additional benefit from learning from those who are living the experience everyday regarding how to navigate health care systems, handle finances, deal with natural emotions or family relations. Diabetes is epidemic and worldwide. There will never be sufficient traditional health care services to meet all future patients needs. While we persist in training health care professionals to deliver better diabetes care, we can explore how to mobilize willing volunteers to provide additional ongoing support to people with diabetes, where they live and work. While the characteristics of a peer educator have been defined slightly differently by several programs, there is agreement across programs that they need to be able to communicate clearly, they need to be willing to learn, they need to have confidence and they need to be flexible and dependable.

A randomized study Placebo Low dose High dose n 6 6 6 Fasting plasma glucose (mmol/l) 8.2 Ϯ 0.2 8.8 Ϯ 0.4 8.3 Ϯ 0.6 8.4 Ϯ 0.3 8.4 Ϯ 1.1 7.2 Ϯ 0.4* Fasting plasma insulin (pmol/l) 8.7 Ϯ 1.7 8.3 Ϯ 1.6 13.4 Ϯ 2.5 8.7 Ϯ 1.2 9.0 Ϯ 1.8 13.2 Ϯ 2.5 Total cholesterol (mmol/l) 5.69 Ϯ 0.23 6.05 Ϯ 0.31 4.97 Ϯ 0.21 5.66 Ϯ 0.31 5.68 Ϯ 0.34 4.45 Ϯ 0.18* LDL cholesterol (mmol/l) 3.72 Ϯ 0.23 4.11 Ϯ 0.28 3.12 Ϯ 0.16 3.78 Ϯ 0.41 3.80 Ϯ 0.28 2.72 Ϯ 0.16* HDL cholesterol (mmol/l) 1.40 Ϯ 0.10 1.27 Ϯ 0.10 1.16 Ϯ 0.05 1.42 Ϯ 0.16 1.16 Ϯ 0.10 1.11 Ϯ 0.05 Triglycerides (mmol/l) 1.26 Ϯ 0.15 1.45 Ϯ 0.35 1.52 Ϯ 0.19 1.37 Ϯ 0.30 1.61 Ϯ 0.30 1.33 Ϯ 0.13 HbA 1c (%) 7.0 Ϯ 0.3 7.3 Ϯ 0.4 7.1 Ϯ 0.3 7.0 Ϯ 0.2 7.3 Ϯ 0.4 6.8 Ϯ 0.3 Blood pressure (mmHg) 134 Ϯ 13

As of October 1, 2007, 25 North American medical institutions and one European islet transplant center reported detailed information to the Registry on 315 allograft recipients, of which 285 were islet alone (IA) and 30 were islet after kidney (IAK). Of the 114 IA recipients expected at 4 years after their last infusion, 12% were insulin independent, 16% were insulin dependent with detectable C-peptide, 40% had no detectable C-peptide, and 32% had missing C-peptide data or were lost to follow-up. Of the IA recipients, 72% achieved insulin independence at least once over 3 years and multiple infusions. Factors associated with achievement of insulin independence included islet size >1.0 expressed as IEQs per islet number [hazard ratio (HR) = 1.5, p = 0.06], additional infusions given (HR = 1.5, p = 0.01), lower pretransplant HbA(1c) (HR = 1.2 each %-age unit, p = 0.02), donor given insulin (HR = 2, p = 0.003), daclizumab given at any infusion (HR = 1.9, p = 0.06), and shorter cold storage time (HR = 1.04, p = 0.03), mutually adjusted in a multivariate model. Severe hypoglycemia prevalence was reduced from 78-83% preinfusion to less than 5% throughout the first year post-last infusion, and to 18% adjusted for missing data at 3 years post-last infusion. In Year 1 post-first infusion for IA recipients, 53% experienced a Grade 3-5 or serious adverse event (AE) and 35% experienced a severe AE related to either an infusion procedure or immunosuppression. In Year 1 post-first infusion, 33% of IA subjects and 35% of IAK subjects had an AE related to the infusion procedure, while 35% of IA subjects and only 27% of IAK subjects had an AE related to the immunosuppression therapy. Five deaths were reported, of which two were classified as probably related to the infusion procedure or immunosuppression, and 10 cases of neoplasm, of which two were classified as probably related to the procedure or immunosuppression. Islet transplantation continues to show short-term benefits of insulin independence, normal or near normal HbA(1C) levels, and sustained marked decrease in hypoglycemic episodes.