For the majority of patients with
type 1 diabetes intensive
insulin therapy is effective and safe for maintaining glycemia and minimizing diabetes-associated complications. However, a rare number of patients show highly labile metabolic control and experience repeated and unpredictable
hypoglycemic episodes. Such condition is often caused by defective counterregulatory mechanisms and autonomous neuropathy. Patients are at high risk for severe acute and chronic complications, and quality of life is considerably impaired. For this small subset of patients, restoration of endogenous insulin secretion can substantially improve metabolic control and quality of life. In our experience, this is irrespective of
insulin independency. Here, we report on our 5 years' experience with implementing
islet transplantation as a potential treatment option for
type 1 diabetes. All patients were treated by long-term
insulin pump
therapy prior to enrolment. The main indication was severely unstable diabetes and repeated
hypoglycemia. From 2008 to 2013, 10 patients have been transplanted with single islet infusion; mean follow-up time was 35 months. All patients show persistent graft function, stable
glycemic control with a reduction in HbA1c in the absence of
hypoglycemia. All patients are kept on minimal exogenous
insulin. In conclusion,
islet transplantation can be an excellent
therapy for selected patients. Key prerequisite for success is a strict indication. The primary goal for
islet transplantation should be stabile glycemia and prevention of
hypoglycemia rather than
insulin independence. In fact, maintaining minimal exogenous
insulin may protect the islet graft from metabolic stress and even prolong islet graft function.