Persistent insulin secretion, assessed by plasma C-peptide estimation in long-term juvenile diabetics with a low insulin requirement

Eff, Ch.; Faber, O. K.; Deckert, T.

doi:10.1007/bf00421234

Cited by 63 publications

(27 citation statements)

References 15 publications

(22 reference statements)

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“…Digon et al, unpublished results). Similar percentages of patients with persistent C-peptide secretion have been documented in the literature (9)(10)(11), contrasted by a smaller number of individuals (11%) reported in the Diabetes Control and Complications Trial (12). Further, old (13) as well as more recent sporadic case reports (14) and other small studies (15) have suggested that diabetes can sometimes resolve and/or that pancreatic insulin production can at least be promoted in patients with longstanding T1DM.…”

supporting

confidence: 58%

Challenges facing islet transplantation for the treatment of type 1 diabetes mellitus

Rother

Harlan²

2004

J. Clin. Invest.

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Islet transplantation represents a most impressive recent advance in the search for a type 1 diabetes mellitus cure. While several hundred patients have achieved at least temporary insulin independence after receiving the islet "mini-organs" (containing insulin-producing β cells), very few patients remain insulin independent beyond 4 years after transplantation. In this review, we describe historic as well as technical details about the procedure and provide insight into clinical and basic research efforts to overcome existing hurdles for this promising therapy.Worldwide, more than 750 individuals with type 1 diabetes mellitus (T1DM) have received allogeneic islet transplants since 1974, in an effort to cure their chronic condition. Though this is still a small number (especially when compared with the estimated 1 million afflicted with T1DM and an additional 17 million with type 2 diabetes in the US, not to mention the estimated 140 million with diabetes worldwide), much has been learned, especially since the promising results of the Edmonton group were published in 2000 (1, 2). This report described 7 consecutive patients with T1DM who became insulin independent after receiving islet allografts, which reflects a success rate never previously achieved. The initial enthusiasm over the observation that islet transplantation can restore insulin-independent euglycemia to patients with long-standing T1DM has been dampened by complications associated with the procedure itself and the immunosuppression necessary to prevent rejection of the transplanted islets, as well as by the gradual loss of islet function and other problems arising from the placement of allogeneic islets in the liver (3, 4).At the same time, our understanding about the natural history of T1DM has changed. Epidemiological data indicate that the prognosis for survival among patients with T1DM is good and improving (5-7). Additional evidence strongly suggests that a significant minority with even long-standing T1DM continue to display islet function (8). For instance, we found that at least 40% of individuals with chronic T1DM (mean duration of 23 years) screened for our islet transplantation protocol had measurable circulating C-peptide levels, an equimolar by-product of endogenous insulin production (B.J. Digon et al., unpublished results). Similar percentages of patients with persistent C-peptide secretion have been documented in the literature (9-11), contrasted by a smaller number of individuals (11%) reported in the Diabetes Control and Complications Trial (12). Further, old (13) as well as more recent sporadic case reports (14) and other small studies (15) have suggested that diabetes can sometimes resolve and/or that pancreatic insulin production can at least be promoted in patients with longstanding T1DM. These studies have raised heretofore underexplored avenues for clinical investigation, which we will return to. Brief historyIn 1924, after approximately 40 years of unsuccessful attempts by various investigators to control diabetes using pa...

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supporting

confidence: 58%

Challenges facing islet transplantation for the treatment of type 1 diabetes mellitus

Rother

Harlan²

2004

J. Clin. Invest.

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“…In long-standing IDDM patients, the persisting residual B cell function is associated with a decreased incidence of proliferative retinopathy (Eff et al, 1978) or proteinuria (Sjoberg et al, 1987). In the present study, however, the prevalence of retinopathy which needed photocoagulation therapy and neuropathy was not increased in NIDDM patients with poor residual B cell function compared with those with good residual B cell function and the diabetic complications could develop even though the pancreatic B cell function was well preserved .…”

Section: Discussioncontrasting

confidence: 68%

“…Furthermore, since it was reported that the persisting residual B cell function would be associated with a decreased incidence of diabetic complications in longstanding IDDM (Eff et al, 1978;Sjoberg et al, 1987), we also examined the relationship between the residual B cell function and the chronic diabetic complications. Fig.…”

mentioning

confidence: 99%

Residual B Cell Function in Patients with Long-Standing NIDDM and its Relation to Metabolic Control and Diabetic Complications.

et al. 1988

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“…Patients with residual beta-cell function have fewer diabetic complications. [106][107][108][109][110] An early autopsy study showed persistence of insulin positivity in 37% of patients with T1DM of more than 21 years duration. 111 Similarly, beta cells have been identified in 88% of patients with T1DM 67 years duration.…”

Section: Novel Concepts To Explain Altered Insulin Requirements In Lamentioning

confidence: 99%

Factors determining insulin requirements in women with type 1 diabetes mellitus during pregnancy: a review

2014

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Most women with type 1 diabetes mellitus (T1DM) have increased insulin requirements during pregnancy. However, a minority of women have a fall in insulin requirements. When this occurs in late gestation, it often provokes concern regarding possible compromise of the feto-placental unit. In some centres, this is considered as an indication for delivery, including premature delivery. There are, however, many other factors that affect insulin requirements in pregnancy in women with type 1 diabetes mellitus and the decline in insulin requirements may represent a variant of normal pregnancy. If there is no underlying pathological process, expedited delivery in these women is not warranted and confers increased risks to the newborn. We will explore the factors affecting insulin requirements in gestation in this review. We will also discuss some novel concepts regarding beta-cell function in pregnancy.

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Persistent insulin secretion, assessed by plasma C-peptide estimation in long-term juvenile diabetics with a low insulin requirement

Cited by 63 publications

References 15 publications

Challenges facing islet transplantation for the treatment of type 1 diabetes mellitus

Challenges facing islet transplantation for the treatment of type 1 diabetes mellitus

Residual B Cell Function in Patients with Long-Standing NIDDM and its Relation to Metabolic Control and Diabetic Complications.

Factors determining insulin requirements in women with type 1 diabetes mellitus during pregnancy: a review

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