Abstract

 The primary indications for ICT in T1DM are glycaemic lability and hypoglycaemia unawareness.
 
 
 
 ICT is an effective, minimally invasive treatment for stabilising glycaemic control, correcting hypoglycaemia unawareness and improving quality of life even when exogenous insulin-independence is not fully achieved. However, the majority of patients require two islet transplants.
 
 
 
 The need for lifelong immunosuppression, in combination with the limited availability of donor pancreases, currently limits the wider application of ICT, particularly in the treatment of children newly diagnosed with T1DM.
 
 
 
 New technologies, including macro- and micro-encapsulation, xenotransplantation and stem cell-derived b cells offer hope for the future of b cell replacement. Yet, until then, a continued focus on optimising donor pancreases, improving the islet isolation procedure, use of novel immunosuppression, and understanding the mechanisms behind graft loss is required.
Highlights
The need for lifelong immunosuppression, in combination with the limited availability of donor pancreases, currently limits the wider application of islet cell transplantation (ICT), in the treatment of children newly diagnosed with Type 1 Diabetes Mellitus (T1DM). 4
Case history Mrs X is a 62-year-old female. She was diagnosed with Type 1 Diabetes Mellitus (T1DM) at the age of 13, which she has managed with exogenous insulin
The first double-arm trial (TRIMECO) has been completed, in which T1DM patients with a history of severe hypoglycaemia were randomised to either ICT immediately or 6-month insulin therapy followed by ICT7
Summary
In contrast to previous retrospective analyses, The Clinical Islet Transplantation (CIT) Consortium reported a large phase 3 prospective study (CIT-07) to evaluate ICT in 48 T1DM patients with HU in 20166. Less than half of subjects remained insulin independent at follow-up (replicating the results of previous studies), the work shows that ICT can act in conjunction with insulin therapy to achieve target HbA1C control as well as reduce hypoglycaemia. The first double-arm trial (TRIMECO) has been completed, in which T1DM patients with a history of severe hypoglycaemia were randomised to either ICT immediately or 6-month insulin therapy followed by ICT7.
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