Type 1 diabetes

Donor shortage changes ICT holy grail


A shortage of islet donor cells means insulin independence may not be a reality for most patients who have received islet cell transplants, the conference has heard.

Traditionally the goal of islet cell transplants was for patients to achieve insulin independence but Jane Holmes-Walker from Westmead Hospital in Sydney told delegates that the islet transplant community were now probably split 50/50 on the goals and objective of islet cell transplants.

“I think there’s a realisation that insulin independence isn’t the “be all and end all” in this group who are referred with severe hypoglycaemia,” she told delegates.

“A functioning transplant almost abolishes their severe hypoglycaemia and the reality is with a limited supply that just needs allograft function,” she said

“Patients always want the holy grail of insulin dependence and some clinicians want that too but I think the reality is that with availability if we want to use the resource wisely the goal is really just to prevent hypoglycaemia.”

If a more steady supply of islet cells could be obtained it was possible islet cell transplantations could be an option for a wider group of people with diabetes.

Speaking from the audience Simon Heller from the University of Sheffield said that in the UK people were not referred because there was a perception that ICTs were only for the few.

“But one wonders if there was a belief that you could do it in a lot more,  we’d overwhelm our waiting lists,” he said.

“I don’t think we’ve overwhelmed our waiting lists yet so if you have appropriate patients then definitely refer to Melbourne, Adelaide or Sydney and there are appropriate pathways that are easily accessed,” Holmes-Walker told delegates.

Professor Holmes-Walker was presenting the findings of her research comparing islet cell transplantation with medical therapy for the management of severe hypoglycaemia in people with type 1 diabetes.

Results showed that following ICT all 21 were patients were C-peptide positive. At one year 8 of the patients were insulin independent and at six months and one year follow up there was a significant reduction in all parameters: HbA1c, mean glucose, sd glucose, HYPOscore, CGM% time in hypoglycaemia and CONGA of optimal medical therapy prior to ICT.

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