Recent advances in the management of diabetes
Pancreas Transplantation
In Type 1 diabetes, the pancreas does not produce insulin. The only alternative so far was to provide insulin from outside by injections. A new approach is to transplant a pancreas, obtained from a dead body or part of the pancreas obtained from a living donor. The old pancreas is not removed from the body. It continues to function and manufacture digestive enzymes. The extra pancreas is usually transplanted in the pelvis. Diabetic patients who are undergoing kidney transplantation are the candidates for pancreas transplantation. Major problems/ drawbacks with pancreas transplant are:
• It is only being done in advanced stage of the disease, i.e. in patients who have end stage renal disease
• There is shortage of availability of pancreas for transplantation
• Patient has to take immunosuppressive drugs lifelong
Islet Cell Transplantation
A solution to overcome some of the drawbacks of pancreas transplantation is to perform islet cells transplants. Islet cells sense blood glucose levels and release the insulin accordingly. Islet cell transplantation is a relatively easy procedure. The islet cells are collected in a syringe and injected into the testes or outer capsule of the kidney where they get implanted. Being a simple procedure it can be repeated again if required. Problems associated with islet cell transplantation are – rejection of the transplanted cells and the shortage of human pancreas as a source of islet cells.
Gene Therapy
Some special types of cells (fibroblast) are removed from the body of the patient. These cells are maintained in a culture medium. The gene responsible for production of insulin is introduced into the cells. The gene induces the production of insulin by the cells. Once the cells start producing insulin, they are reintroduced into the body of the patient. The main advantage is that immunosupperessive drugs are not required as the injected cells are the patient’s own. Moreover donors are not required. The therapy is still in the experimental stage.