In The News
The final phase of clinical human trials for human islet transplantation in type1 diabetics are underway at the Schulze Diabetes Institute - University of Minnesota Medical School. Insulin producing islet cells are harvested from 2 to 4 human pancreases, cleaned and injected into an abdominal portal vein that connects to the liver. Once in the liver, the islet cells attach and begin to produce insulin. Studies show that insulin independence has been achieved for up to five years following this procedure. There are still two hurdles that SDI is presently addressing. First, there is a limited supply of human pancreas for islet cell harvesting and for that reason SDI is presently studying two alternate sources of islet cells. Specially bred pigs with major similarities to humans represent one potential new source. The other are human skin stem cells modified to function like islet cells. The second hurdle is the extensive use of immunosuppressive drugs that can cause major negative side effects. These compounds are required to prevent islet cell rejection when the immune system sees them as foreign to the body.
A Boston University/Massachusetts General Hospital research team has developed the equivalent of a bionic pancreas and expects to have it packaged into a single automated unit within three years. The system as it now exists consists of three independent components tied to a smart phone app as a controller. The three units include a Dexcom CGM and two Tandem pumps one with insulin to reduce sugar levels, the other containing glucagon to raise blood glucose. An algorithm was developed to link these components into a working system to mimic the actual way the pancreas controls sugar levels within the body. Results of a short trial clearly suggest that this combined system improved blood sugar significantly better than standard monitors and pumps presently in use. At present this system requires the type 1 diabetic to insert three needles into one’s abdomen. Several companies are presently working to incorporate this combined hormonal system into a single automated system which would serve to simplify the life of a type 1 diabetic. One of the interesting outcomes – participants needed to recalibrate their CGM sensor only twice a day reducing the number of finger pricks from ten to two. Additional info can be found at the following sites:
Father Devises A 'Bionic Pancreas' To Help Son With Diabetes
Bionic Pancreas Shows Promise for Type 1 Diabetes
Outpatient Glycemic Control with a Bionic Pancreas in Type 1 Diabetes
Researchers at Boston Children’s hospital discovered a chemical pathway at the molecular level, dubbed ATP/P2X7R, that induces T cells, part of the body’s immune system , to attack the islet cells of the pancreas thereby halting insulin production. This is an essential first step towards finding an eventual cure for T1D an autoimmune disease. Animal research is still underway but it will be several years before human trials would begin.
Islet Cell Transplantation
Feb 2014 - A type1 reversal in genetically bred mice modified to mimic type 1 diabetes in humans was recently accomplished by research scientists at the Gladstone Institute in San Francisco. They were successful in taking skin cells, reprogramming them through a series of steps to stem cells that function like pancreatic beta cells that are able to produce insulin. One week after transplanting these modified stem cells into mice with high blood sugar levels, glucose levels dropped to near normal. Eight weeks following transplantation fully functioning beta cells were found in these experimental animals. These findings were reported in the guardian on Feb 6. The Guardian
Couple these findings with a newly discovered simple, inexpensive and fast way to take mature cells and turn them into embryonic-like stem cells could seriously reduce the time needed to create a cure for type 1 diabetes or at least alleviate the instability experienced by brittle diabetics. CNN.COM
Potential Cure for Type 1 Diabetes
It has long been held that individuals with Type1 Diabetes (T1D) would eventually stop producing insulin altogether. The pancreatic beta cells would cease to function and C-peptide analysis, an indicator of insulin production, would prove negative (reflective of zero insulin production).
With the advent of a new micro-analytical procedure for C-peptide, extremely low levels of C-peptide were identified in 73% of those patients with T1D for >5 years, and in 68% of those with T1D for >30 years. This indicates that not all beta cells succumb to the autoimmune attack characteristic of Type 1 diabetes. An alternate possibility is that some beta cells that survive this attack may be undergoing regeneration.
The ability to identify low levels of C-peptide after having a meal suggests that viable beta cells are acting as insulin micro-secretors. It may be possible to culture and use one’s own cells in beta cell transplantation which in turn would serve to eliminate or reduce the use of immunosuppressive agents presently required to prevent rejection.
Ref. Source reference: Oram RA, et al "The majority of patients with long-duration type 1 diabetes are insulin microsecretors and have functioning beta cells" Diabetologia 2013; DOI: 10.1007/s00125-013-3067-x.
T1D Insulin Producing Beta Cells Don't All Die
PYSCHOLOGICAL CAUSES OF BRITTLENESS DEBUNKED - 2016
New Diagnostic Criteria is being proposed to help physicians distinguish Brittle Type 1 Diabetes ( BT1D) patients from those considered to be stable T1D’s. This criteria is to be published in scientific journals by doctor’s Lablanche and Benhamou from Grenoble France within the next six months.
The diagnostic criteria employed have been copied and pasted with their permission from a NIH clinical trial NCT 02854696 presently recruiting participants.
“A patient will be considered as experiencing a brittle type 1 diabetes if at least two criteria are present among: persistence of severe hypoglycemia, occurrence of ketoacidosis events without obvious etiology, diagnosis of unaware hypoglycemic episodes < 3 mmol/l based on CGM or self-monitoring blood glucose data, a mean blood glucose standard deviation>50%, MAGE index (Mean amplitude of glucose excursions)>60 mg/dl, LBGI index (low blood glucose index)>5, Clarke score≥4 or HYPOSCORE>800.”
A research paper just released compared 42 brittle patients to 42 stable T1D’s and found “no differences in terms of global severity of psychopathological distress and specific symptoms of axis I DSM-IV-TR psychiatric diagnosis between these two groups. Axis I represent acute symptoms that need treatment such as depression, schizophrenia and panic attacks. Some variations in personality traits appear to exist between the two groups but not psychiatric issues. Hopefully physicians will now turn their attention to resolving the physiological causes of BT1D. Diagnose the cause, treat the cause and eliminate brittleness allowing the individual to live their lives with a more stable form of T1D.search paper just released compared 42 brittle patients to 42 stable T1D’s and found “no differences in terms of global severity of psychopathological distress and specific symptoms of axis I DSM-IV-TR psychiatric diagnosis between these two groups. Axis I represent acute symptoms that need treatment such as depression, schizophrenia and panic attacks. Some variations in personality traits appear to exist between the two groups but not psychiatric issues. Hopefully physicians will now turn their attention to resolving the physiological causes of BT1D. Diagnose the cause, treat the cause and eliminate brittleness allowing the individual to live their lives with a more stable form of T1D.