Pancreas transplantation in type 1 diabetes: hope vs reality

Pancreas transplantation can improve quality of life for patients with type 1 diabetes by eliminating hypoglycemic and hyperglycemic episodes, the need for insulin injections, frequent self-monitoring of blood glucose levels, and dietary restrictions. Increasing evidence suggests that it may slow the progression of long-term diabetic complications. On the other hand, patients risk the adverse effects of lifelong immunosuppression.     

有氧运动和1型糖尿病

目的：探讨运动和1型糖尿病的关系，对运动预防和治疗1型糖尿病的作用进行总结。 资料来源：网上检索Medline 1980-01／2005-12与运动和1型糖尿病关系相关的文献，检索词“type 1 diabetes，Exercise”，限定语言种类为“English”。 资料选择：出现了90条检索结果，经过初选，选择与运动和1型糖尿病密切关联的文章，排除观察对象为动物的文章，结果共42篇。 资料提炼：对42篇文章查找全文，经过分析，剔出重复及与主题关联度小的文章，总共选取其中23篇作为参考文献，其中14篇与胰岛素敏感性及血糖水平有关，9篇与心血管功能和体脂有关。 资料综合：运动是控制l型糖尿病的主要手段。有氧运动对1型糖尿病患者有多种作用，可以控制其血糖水平，但是否完全有效还不能确定。运动影响糖尿病的作用机制包括，有氧运动能够增加胰岛素敏感性，降低血压，改进脂质水平，降低体脂，改善心血管功能。长时间有氧运动可能会产生低血糖等风险，运动时应加以注意。 结论：有氧运动对预防和治疗1型糖尿病可以起一定的作用，但运动时应注意出现低血糖等风险。     

有氧运动和1型糖尿病

目的:探讨运动和1型糖尿病的关系,对运动预防和治疗1型糖尿病的作用进行总结。资料来源:网上检索Medline1980-01/2005-12与运动和1型糖尿病关系相关的文献,检索词“type1diabetes,Exercise”,限定语言种类为“English”。资料选择:出现了90条检索结果,经过初选,选择与运动和1型糖尿病密切关联的文章,排除观察对象为动物的文章,结果共42篇。资料提炼:对42篇文章查找全文,经过分析,剔出重复及与主题关联度小的文章,总共选取其中23篇作为参考文献,其中14篇与胰岛素敏感性及血糖水平有关,9篇与心血管功能和体脂有关。资料综合:运动是控制1型糖尿病的主要手段。有氧运动对1型糖尿病患者有多种作用,可以控制其血糖水平,但是否完全有效还不能确定。运动影响糖尿病的作用机制包括,有氧运动能够增加胰岛素敏感性,降低血压,改进脂质水平,降低体脂,改善心血管功能。长时间有氧运动可能会产生低血糖等风险,运动时应加以注意。结论:有氧运动对预防和治疗1型糖尿病可以起一定的作用,但运动时应注意出现低血糖等风险。     

Immunotherapies in diabetes mellitus type 1

Type 1 diabetes is an autoimmune disease that gradually destructs insulin-producing beta cells. Over the years, clinicians' knowledge regarding the immunopathogenesis of this disease has greatly increased. Immunotherapies that can change the course of immune-mediated destruction and preserve and possibly regenerate the pancreatic beta cells seem to be promising in preclinical trials but so far have been unsuccessful in human studies. This article reviews the important immune interventions for type 1 diabetes that have been tried so far targeting the different stages of disease development and provides an insight into what the future might hold.     

Pancreatic exocrine insufficiency and type 1 diabetes mellitus

Studies in adults suggest that some patients with type 1 diabetes mellitus have pancreatic exocrine insufficiency (PEI). The primary aim of this study was to explore the association between pancreatic exocrine function and type 1 diabetes in young people under 17 years. The secondary aim was to evaluate the relationship between PEI in patients with diabetes, their clinical symptoms and blood glucose control. The importance of providing a highly trained multidisciplinary support network are also discussed.     

Preventing type 2 diabetes

The rapid and often relentless progression of type 2 diabetes suggests that high-risk patients should be provided with an equally aggressive strategy to protect their remaining beta-cell function and endogenous insulin secretion. Management of patients with prediabetes should incorporate both lifestyle and pharmacologic intervention. Although no specific recommendations are published for the management of prediabetes, one can assume that preservation of pancreatic beta-cell function, improvement in peripheral insulin resistance and pancreatic insulin secretion, reducing pancreatic alpha-cell secretion of glucagon, preventing long- and short-term diabetes-related complications, and assisting patients to loose weight are beneficial. Aggressive, timely, and physiologic management of prediabetes should be advocated.     

Enteroviruses and type 1 diabetes mellitus

Despite decades of research, the etiology of type 1 diabetes mellitus (DM) is unknown. Several risk factors have been associated with type 1 DM, including viral infections, genetic predisposition, nutritional factors, and chemicals. Several investigators hypothesize that the etiologies of type 1 DM result from a complex interaction of genetic and environmental factors. In this paper we review the epidemiologic data linking enteroviruses to type 1 DM and discuss potential mechanisms of pathogenesis.     

Immune intervention for type 1 diabetes mellitus

The major form of type 1 diabetes (T1D) is characterised by immune-mediated pancreatic islet β-cell destruction, and has also been called type 1A diabetes to distinguish it from idiopathic forms of islet β-cell loss. Since the first demonstration of islet cell antibodies in 1974, the concept has been that this form of diabetes is autoimmune in nature. The commonly accepted concept is that antibodies (representing the humoral arm of the immune system) do not mediate the β-cell destruction but rather serve as markers of that destruction, while the cellular arm of the immune system, specifically T-lymphocytes, mediate the β-cell destruction. Yet, the T-lymphocytes do not act alone. They receive help in initiating the response from antigen-presenting cells such as dendritic cells and macrophages, and appear to receive help also from B-lymphocytes. In addition, the initial immune response engenders secondary and tertiary responses - involving the whole immunological army - which collectively result in impairment of β-cell function, progressive destruction of β-cells, and consequent development of type 1A diabetes. The process is insidious and may evolve over many years, with the overt expression of clinical symptoms becoming apparent only when most β-cells have been destroyed. Yet, the process clearly evolves at different speeds - much more rapidly in young children, much more slowly in older individuals. And, although it has been thought that ultimately there is complete β-cell destruction, several studies have now demonstrated some degree of persistent β-cell function or existence (at autopsy) in long-standing T1D. A major focus of investigation in T1D is the preservation of β-cell function (and, it is hoped, of β-cells themselves), in the expectation that continuing endogenous insulin secretion will contribute towards better glycaemic control, reduce episodes of severe hypoglycaemia, and slow the development of complications such as retinopathy and nephropathy. Thus, there have been many studies designed to interdict the T1D disease process, mostly by altering the immune system, both during the stage of evolution of the disease and at the time of disease onset. This chapter of the Yearbook of Advanced Technology and Treatments in Diabetes reviews the key papers that have appeared in this field between July 2009 and June 2010. Articles selected were confined to studies in human beings. All immune intervention studies reported in this time frame were included. In addition, the author selected other relevant articles dealing with mechanisms, markers, triggers, and pathology of human type 1 diabetes.     

Latest overview of type 1 diabetes mellitus

Type 1 diabetes mellitus (T1DM) was defined as a heterogeneous disorder characterized by severe beta-cell loss. The subtype 1A is characterized by abnormal autoimmue-mediated response and 1B is idiopathic etiology, and most of patients with T1DM are classified in 1A. There are three subtypes characterized by onset, fulminant, acute onset and slowly progressive in T1DM. Among these three subtypes, there are differences in genetic etiology, pathogenesis and prevalence of autoantibodies. Glutamic acid decarboxylase-65 (GAD65), insulinoma-associated antigen-2 (IA-2) and insulin are major autoantigens in T1DM and autoantibodies for former two are frequently used for clinical diagnosis. Also novel autoantibodies for T1DM have been found and clinical characteristics of the patients with each antibody will be made clearer. There have been eager efforts to develop immunotherapies to prevent islet destruction and to cure the disorder with islet transplantation, and new treatment with inhaled insulin regimen. Continuous glucose monitoring system(CGMS) has been established to make clearer the daily profile of blood glucose of the patients and to improve the metabolic control. Most efficient treatment for T1DM is a still insulin injection. However, the development of new medical devices and novel treatment rather than insulin injection has been done and the progression will promise improved prognosis of vascular complications.     

Cell therapies for type 1 diabetes mellitus

Type 1 diabetes is caused by autoimmune destruction of pancreatic beta-cells and is characterised by absolute insulin insufficiency. The monocellular nature of this disease and endocrine action of insulin make this disease an excellent candidate for cellular therapy. Furthermore, precedent for cellular therapies has been set by successful cadaveric whole pancreas and islet transplantation. In order to expand the supply of cells to meet current and future needs, several novel cell sources have been proposed, including human beta-cells or islets expanded in culture, islet xenografts and pancreatic ductal progenitor cells. Surrogate beta-cells derived from hepatocytes, intestinal K cells or non-endodermal cell types have also been suggested. Stem cells found in bone marrow and umbilical cord blood have been used extensively to repopulate the haematopoietic system and offer the possibility of autologous transplantation. Recent studies have suggested that these stem cells may also have a broader capacity to differentiate, possibly into beta-cells. Stem cells from embryonic sources, such as human embryonic stem and embryonic germ cells, have the ability to proliferate extensively in culture and have an inherent developmental plasticity that may make them a potentially unlimited source of cells that can sense glucose and produce mature insulin. The wide range of proposed cell sources and our increasingly clear picture of pancreatic development suggest that novel cellular therapies might one day compete with non-cellular glucose sensing and insulin delivery devices.     

Modern insulin therapy for type 1 diabetes mellitus

Modern insulin therapy for Type 1 diabetes is part of a comprehensive treatment program designed to achieve and maintain blood glucose levels as close to normal as possible. The insulin regimens most likely to be successful approximate physiologic insulin delivery by combining basal and meal doses. Several options are available, including constant infusion by external pump and multiple daily injection therapy. Modern therapy affords major health benefits through improved blood glucose control, as well as lifestyle benefits associated with increased flexibility and spontaneity.