Islet transplantation can restore endogenous ␤-cell function to subjects with type 1 diabetes. Sixty-five patients received an islet transplant in Edmonton as of 1 November 2004. Their mean age was 42.9 ؎ 1.2 years, their mean duration of diabetes was 27.1 ؎ 1.3 years, and 57% were women. The main indication was problematic hypoglycemia. Forty-four patients completed the islet transplant as defined by insulin independence, and three further patients received >16,000 islet equivalents (IE)/kg but remained on insulin and are deemed complete. Those who became insulin independent received a total of 799,912 ؎ 30,220 IE (11,910 ؎ 469 IE/kg). Five subjects became insulin independent after one transplant. Fifty-two patients had two transplants, and 11 subjects had three transplants. In the completed patients, 5-year follow-up reveals that the majority S ustained C-peptide production and successful insulin independence after pancreatic islet transplantation in type 1 diabetic patients was reported over 4 years ago by the Edmonton group (1). This reality became possible with the use of newer, more potent immunosuppressive agents, the avoidance of corticosteroids, and high-quality islet preparations, although typically two islet infusions were necessary to attain insulin independence. Over this period, other centers have been able to replicate the initial success of the Edmonton Protocol with further refinements in technique (2-5), and islet transplantation is increasingly being used (6 -8).However, the need for ongoing immunosuppressive therapy and the scarcity of donor islets have precluded the widespread adoption of islet transplantation. The main indications for solitary islet transplantation have been frequent recurrent hypoglycemia or labile glucose values that have defied optimization of medical therapy. An additional hoped for, but unproven, benefit has been stabilization or improvement of diabetes complications with the achievement of stable good glycemic control. Now, 5 years after the first islet transplant was performed with the Edmonton Protocol, we have had the opportunity to review the outcomes in terms of C-peptide secretion, insulin independence, correction of hypoglycemia and lability, acute complications encountered, chronic problems related to immunsuppressive therapy, and some assessment of the effect on diabetes complications. RESEARCH DESIGN AND METHODSAs of 1 November 2004, 65 patients have received islet transplants at the University of Alberta. Four other subjects were transplanted as part of the Immune Tolerance Network trial of islet transplantation and will be reported independently. One further subject was transplanted with a preparation from a pediatric donor that had many trapped islets. This subject had primary nonfunction of the graft, and the data from this patient are not included in this report. At the time of the transplant, the mean age of the 65 patients was 42.9 Ϯ 1.2 years, their duration of diabetes was 27.1 Ϯ 1.3 years, and 57% were women. Their median weight was 68.5 kg (interq...

Gestational diabetes mellitus (GDM) is the most common medical complication of pregnancy. It is associated with maternal and neonatal adverse outcomes. Maintaining adequate blood glucose levels in GDM reduces morbidity for both mother and baby. There is a lack of uniform strategies for screening and diagnosing GDM globally. This review covers the latest update in the diagnosis and management of GDM. The initial treatment of GDM consists of diet and exercise. If these measures fail to achieve glycemic goals, insulin should be initiated. Insulin analogs are more physiological than human insulin, and are associated with less risk of hypoglycemia, and may provide better glycemic control. Insulin lispro, aspart, and detemir are approved to be used in pregnancy. Insulin glargine is not approved in pregnancy, but the existing studies did not show any contraindications. The use of oral hypoglycemic agents; glyburide and metformin seems to be safe and effective in pregnancy.

BACKGROUND AND OBJECTIVESThe prevalence of gestational diabetes (GDM) has increased recently worldwide, mainly due to adoption of the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria. The objectives of this study were to determine the prevalence of GDM in Saudi women and to assess risk factors and pregnancy outcomes using the IADPSG criteria.DESIGN AND SETTINGA prospective descriptive study of pregnant Saudi women presenting at the Maternity and Children Hospital, Medina, Saudi Arabia, between October 2011 and June 2014.METHODSFasting plasma glucose, glycated hemoglobin, and random plasma glucose concentrations were obtained for all participants at the first antenatal visit. In women with normal results, screening for GDM was performed at 24 to 28 weeks of gestation, with a 75-g oral glucose tolerance test (OGTT). Women who had GDM were treated with diet, exercise, and insulin as needed. Pregnancy outcomes were recorded after delivery. Multiple logistic regression was used to assess possible risk factors for GDM.RESULTSEarly screenings showed abnormal glucose in 211 of 954 women (22.1%). In 445 women, the OGTT showed GDM in 183 women (39.4%). GDM cases identified by OGTT and by early screening increased the rate of GDM to 51% (292 women). Older maternal age, higher body mass index, higher blood pressure, past GDM, history of delivering a malformed child, and family history of diabetes were the main risk factors for GDM. GDM increased the risk of neonatal hypoglycemia (OR 9.353), low Apgar score (OR 5.546), and induction of labor (OR 2.33). The newborns of GDM mothers had a higher birth weight: 3043 g vs. 2890 g in the non-GDM group (P=.004). Other maternal and neonatal outcomes were not significantly different between the two groups.CONCLUSIONThe prevalence of GDM is high among Saudi women. Timely and effective treatment reduces perinatal morbidity and improves outcomes.

BackgroundWomen with gestational diabetes mellitus (GDM) are required to control their blood glucose shortly after GDM diagnosis to minimize adverse pregnancy outcomes. A real time-continuous glucose monitoring system (RT-CGMS) provides the patient with continuous information about the alterations in levels of the blood glucose. This visibility may empower the patient to modify her lifestyle and engage in therapeutic management. The aim of this study was to determine whether a single application of RT-CGMS to pregnant women shortly after GDM diagnosis is useful as an educational and motivational tool.MethodsThis study was a prospective open label randomized controlled study conducted at Maternity and Children Hospital, Medina, Saudi Arabia. A total of 130 pregnant women with GDM were randomised to either blood glucose self-monitor alone (SMBG group) (n = 62) or in addition to SMBG, patients wore a Guardian® REAL-Time Continuous Glucose Monitoring System (Medtronic MiniMed) once for 3–7 days, within 2 weeks of GDM diagnosis (RT-CGMS group) (n = 68). The primary outcomes were maternal glycemic control and pregnancy outcomes. Secondary outcomes were the changes in parameters of glucose variability, which includes mean sensor readings, standard deviation (SD) of blood glucose, and area under the curve for hyper and hypoglycaemia at the end of the RT-CGMS application.ResultsHbA1c, mean fasting and postprandial glucose levels were similar in both groups at the end of the pregnancy. Pregnancy outcomes were comparable. However, there was significant improvement in the parameters of glucose variability on the last day of sensor application; both mean glucose and the SD of mean glycaemia were reduced significantly; P = 0.016 and P = 0.034, respectively. The area under the curve for hyper and hypoglycaemia were improved, however, the results were not statistically significant.ConclusionAlthough a single application of RT-CGMS shortly after GDM diagnosis is helpful as an educational tool, it was not associated with improvement in glycemic control or pregnancy outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s13098-016-0161-5) contains supplementary material, which is available to authorized users.

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