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• W3134108844 abstract "Type 1 diabetes is a chronic autoimmune disease characterized by the destruction of pancreatic beta cells which leads to an insulin deficiency. The onset of type 1 diabetes mostly occurs before 25 years of age, but can also occur later in life. In 2015, 3.4 million Canadians were living with diabetes, of which an estimated 9% of adult patients and most pediatric patients are classified as type 1. Of this cohort, 0.3% of patients suffer from labile diabetes (also referred to as brittle or unstable diabetes and meaning hard to control) and may experience frequent episodes of hyperglycemia and hypoglycemia, diabetic ketoacidosis, and hypoglycemic unawareness. The lability of these patients’ blood glucose levels leads to a decreased quality of life and may reduce life expectancy.Type 1 diabetes is generally treated with insulin replacement therapy in the form of multiple daily injections. However, one alternative to insulin therapy, which may be beneficial to patients with labile diabetes, involves restoring endogenous insulin production via islet cell transplantation. Islet cell transplantation involves the infusion of purified islet cells from a deceased donor pancreas into the liver through the portal vein. As such, islet cell transplantation recipients require life-long treatment with immunosuppressive agents. With the introduction of ever improving, steroid free immunosuppression regimens (the first of which was the Edmonton Protocol in the year 2000), islet cell transplantation has become an increasingly feasible treatment option for patients with labile diabetes.In patients with type 1 diabetes, islet cell transplantation may result in glucose stability (i.e., a reduction or elimination of hypoglycemia), improvement in glycated hemoglobin A1c (HbA1c), insulin independence, and may stabilize or improve microvascular complications (retinopathy and neuropathy) of diabetes. However, as a result of the small number of specialized transplantation centers and donor pancreases, the availability of treatment with islet cell transplantations for patients with type 1 diabetes has been limited.A CADTH report published in 2014 reviewed the clinical effectiveness, cost-effectiveness, and evidence-based guidelines regarding islet cell transplantation in patients with unstable diabetes. The report concluded that there was limited evidence to suggest that islet transplantation was effective in improving clinical outcomes in patients with unstable type 1 diabetes. Another CADTH report, which examined islet cell transplantation relative to different interventions, was published in March 2020 and provided a reference list of studies and evidence-based guidelines published since the end of the aforementioned report’s literature search. This report aims to provide a summary and critical appraisal of the evidence regarding the clinical effectiveness, cost-effectiveness, and evidence-based guidelines regarding the use of islet cell transplantation in patients with unstable type I diabetes mellitus which was identified in the previous CADTH Reference List report." @default.
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• W3134108844 date "2020-04-29" @default.
• W3134108844 modified "2023-09-27" @default.
• W3134108844 title "Islet Cell Transplantation for Patients with Unstable or Uncontrollable Diabetes Mellitus: A Review of Clinical Effectiveness, Cost-Effectiveness and Guidelines [Internet]" @default.
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