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- November 20, 2008 |
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Welcome to the #1 online source of information for Diabetes Specialists! An international online community of more than 10,000 Diabetes Specialists.
CME on Diabetes is a website built to transmit top-level CME conferences given by international experts in endocrinology, insulin resistance, prediabetes, metabolic syndrome and type 2 diabetes. More than 2.6 million slides have been viewed since the website launch. Thank you for your continued support and commitment!
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"The Edmonton protocol - Where to from now?"Dr. Philip O'Connell (biography)
English - 2007-11-17 - 43 minutes
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Summary :
In patients with type 1 diabetes, increasing hypoglycaemia with improving glycaemic control is a problem in patients on intensive insulin treatment. Although the DCCT study showed intensive insulin treatment to result in less complications, the accompanying risk of severe hypoglycaemia makes it harder to maintain long-term.
Islet transplantation aims to achieve normal HbA1c using insulin secreting cells. The Edmonton protocol showed that glucose control could be achieved with islet transplantation in patients with type 1 diabetes and a history of severe hypoglycemia and metabolic instability (1). A five-year follow-up study was published in Diabetes, concluding that “islet transplantation can relieve glucose instability and problems with hypoglycemia. C-peptide secretion was maintained in the majority of subjects for up to 5 years, although most reverted to using some insulin. The results, though promising, still point to the need for further progress in the availability of transplantable islets, improving islet engraftment, preserving islet function, and reducing toxic immunosuppression.” (2). Findings from the International Trial of the Edmonton Protocol for Islet Transplantation were recently published, showing a centre effect (3).
Islet transplantation can be a successful treatment for the metabolic instability associated with hypoglycaemia unawareness, however the procedure remains experimental. Strategies to reduce immunosuppressive complications and protect islet graft mass are needed.
Copyright © 2008 E-MedHosting.com Inc.
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- The rationale of the Edmonton protocol for islet transplantation
- Results from the Edmonton group and the International Multicenter Trial of Islet Transplantation Using the Edmonton Protocol in Patients with Type 1 Diabetes
- Benefits of and problems with the Edmonton protocol
- Future directions for research
Bibliographic references :
A.M. James Shapiro, M.B., B.S., Jonathan R.T. Lakey, Ph.D., Edmond A. Ryan, M.D., Gregory S. Korbutt, Ph.D., Ellen Toth, M.D., Garth L. Warnock, M.D., Norman M. Kneteman, M.D., and Ray V. Rajotte, Ph.D.Islet Transplantation in Seven Patients with Type 1 Diabetes Mellitus Using a Glucocorticoid-Free Immunosuppressive Regimen N Engl J Med. 2000 Jul 27;343(4):230-8.
2.Ryan EA, Paty BW, Senior PA, Bigam D, Alfadhli E, Kneteman NM, Lakey JR, Shapiro AM. Five-Year Follow-Up After Clinical Islet Transplantation Diabetes 54:2060-2069, 2005.
3. A.M. James Shapiro, M.D., Ph.D., Camillo Ricordi, M.D., Bernhard J. Hering, M.D., Hugh Auchincloss, M.D., Robert Lindblad, M.D., R. Paul Robertson, M.D., Antonio Secchi, M.D., Mathias D. Brendel, M.D., Thierry Berney, M.D., Daniel C. Brennan, M.D., Enrico Cagliero, M.D., Rodolfo Alejandro, M.D., Edmond A. Ryan, M.D., Barbara DiMercurio, R.N., Philippe Morel, M.D., Kenneth S. Polonsky, M.D., Jo-Anna Reems, Ph.D., Reinhard G. Bretzel, M.D., Federico Bertuzzi, M.D., Tatiana Froud, M.D., Raja Kandaswamy, M.D., David E.R. Sutherland, M.D., Ph.D., George Eisenbarth, M.D., Ph.D., Miriam Segal, Ph.D., Jutta Preiksaitis, M.D., Gregory S. Korbutt, Ph.D., Franca B. Barton, M.S., Lisa Viviano, R.N., Vicki Seyfert-Margolis, Ph.D., Jeffrey Bluestone, Ph.D., and Jonathan R.T. Lakey, Ph.D.International Trial of the Edmonton Protocol for Islet Transplantation N Engl J Med. 2006 Sep 28;355(13):1318-30.
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