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Can We Cure Diabetes?

Islet cell transplantation has come a long way but has further to go.

For children with type 1 diabetes, early data indicate that pancreatic islet cell transplantation holds promise of a cure. In a multisite international trial, 36 adults (age range, 23 to 59) with very poorly controlled type 1 diabetes (severe recurrent hypoglycemia, severe glycemic lability, or progressive complications) underwent islet transplantation. Each patient could receive up to three islet infusions to achieve insulin independence.

Eleven of the 36 patients required a single infusion, 9 required two infusions, and 16 required three infusions. At 1 year posttransplant, 44% of the patients were insulin-independent, 28% had partial function, and 28% had complete graft loss. Within 2 years of transplant, 76% of those who had achieved insulin independence at some point during the trial had become insulin-dependent.

Comment: What is the relevance of this article for pediatricians? Many of us care for children with type 1 diabetes and must advise parents about the possibility of a "cure." These data suggest that if a cure using islet transplantation is possible, it is in the distant future. Given the availability of new types of insulin that improve glycemic control, and data indicating that tight metabolic control significantly reduces complications of diabetes, two editorialists suggest that islet transplantation should be available only to highly selected patients.

— Howard Bauchner, MD

Published in Journal Watch Pediatrics and Adolescent Medicine November 8, 2006

Citation(s):

Shapiro AM et al. International trial of the Edmonton protocol for islet transplantation. N Engl J Med 2006 Sep 28; 355:1318-30.

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• Medline abstract (Free)

Bromberg JS and LeRoith D. Diabetes cure — Is the glass half full? N Engl J Med 2006 Sep 28; 355:1372-4.

• Original article (Subscription may be required)
• Medline abstract (Free)