A long-term cell transplant programme has led to blood sugar level “stability” in those with difficult-to-control type 1 diabetes, latest data shows.

Researchers have hailed the “meaningful” impact of islet transplant treatment on those who face dangerously low or high blood sugars and the risk of long-term complications.

Islets are groups of cells which produce insulin, a hormone that helps to control the flow of energy from food. In people with type 1 diabetes, the immune system destroys the cells within islets, so those with the condition must inject themselves with insulin.

Latest data from a 20-year programme of islet transplant treatment in Canada has reported on survival rates, insulin independence and defence against life-threatening low blood sugars. Over the duration of the programme, 255 people were given a total of 700 islet transplants at the University of Alberta Hospital.

The findings have led the team behind the programme to say the process is an “effective therapy” that is “transformational”.

Dr James Shapiro, professor of surgery at the University of Alberta and Canada Research Chair in regenerative medicine and transplant surgery, led the team that developed the programme.
He said: “We’ve shown very clearly that islet transplantation is an effective therapy for patients with difficult-to-control type 1 diabetes. This long-term safety data gives us confidence that we are doing the right thing.”

Dr Peter Senior, Charles A. Allard Chair in Diabetes Research and director of the Alberta Diabetes Institute at the university, added: “This data shows really strong proof that cell-based therapies can deliver a meaningful and transformative impact for people with diabetes.

“We are delivering something which all other treatments for diabetes don’t deliver – there’s a comfort, a predictability, a stability to blood sugar levels that don’t exist with anything else.”

The data shows that 61% of islet infusion recipients were still on insulin a year after starting the programme; this reduced to 32% at five years and 8% after 20 years. Although most of the participants had to re-start their insulin injections, their condition was better controlled and their dosage much smaller.

Dr Shapiro said: “Being completely free of insulin is not the main goal. It’s a big bonus, obviously, but the biggest goal for the patient – when their life has been incapacitated by wild, inadequate control of blood sugar and dangerous lows and highs – is being able to stabilise. It is transformational.”

He went on to say: “Islet transplant as it exists today isn’t suitable for everybody, but it shows very clear proof of concept that if we can fix the supply problem and minimise or eliminate the anti-rejection drugs, we will be able to move this treatment forward and make it far more available for children and adults with type 1 and type 2 diabetes in the future.”

The study has been published in The Lancet Diabetes & Endocrinology.

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