"It is our aim that, ultimately, all people with Type 1 diabetes [will] become eligible for islet transplantation and free from insulin dependence.

Islet cells are found in the pancreas and produce insulin. Type 1 diabetes often starts in childhood and has been considered irreversible. It occurs as a result of the islet cells being destroyed. Usually, the destruction of these cells is the result of an autoimmune process in which the body fails to recognize the cells as its own, resulting in total insulin deficiency.

Prior to the islet cell transplant breakthrough, the only treatment for Type 1 diabetes was insulin injections.

Earlier Success Reported in Canada

An islet cell transplant has never before been achieved in the United Kingdom, according to King's College Hospital. The patient, a 61-year old man, no longer needs insulin injections following three transplants of islet cells isolated from cadaveric donor pancreases.

Historically, islet transplants have been only partially successful. They have reduced the amount of insulin required, but the need for regular injections still remained. The first reports of insulin independence came recently from a program in Canada.

The King's program is the first to report a comparable result for the UK. This patient has proved that it is possible for islet transplants to lead to freedom from administered insulin and diabetes-treatment associated problems, says King's.

Life-Threatening Hypoglycemia

The patient suffered from Type 1 diabetes for over 30 years, experiencing increasing problems with his diabetes therapy. Prior to the islet transplant, he endured severe, potentially life-threatening hypoglycemic (low blood sugar) attacks, which profoundly affected his quality of life. Following the islet transplant, he is now producing his own insulin and is completely free from hypoglycemia.

The King's team, a collaboration between the Department of Diabetes and the Liver Unit's transplantation team, has transplanted three Type 1 diabetes patients with pancreatic islet cells to date. The first two patients achieved partial success, achieving relief of hypoglycemia problems, but still requiring small doses of insulin.

Islet cells are obtained from donor pancreases and are transplanted by injection into the liver of the recipient. Once in the liver, the cells develop their own blood supply and begin producing insulin. This procedure is minimally invasive and only takes around 45 minutes to complete.

Extremely Regimented Lives

There are around 250,000 people in the UK currently suffering from Type 1 diabetes. The patients live with the constant need to be aware of their blood glucose levels and the threat of long-term complications, such as blindness, renal failure, amputation and cardiovascular disease. Hypoglycemia is also an ever-present threat.

Hypoglycemia can vary from being mildly uncomfortable to life threatening. People with Type 1 diabetes often live extremely regimented lives, requiring self blood testing four times or more times per day, injecting insulin five times per day, and constantly being aware of the food they eat, level of exercise and levels of alcohol consumption.

"This breakthough is hugely exciting," says Professor Stephanie Amiel, Consultant in Diabetes. "The implications for the future are enormous. Eventually, this could mean the end of insulin dependence for all Type 1 diabetes sufferers," she predicts.

"In its current state of technology though, islet transplantation is not perfect," Professor Amiel notes. "We do not have enough organ donors; therefore, we cannot extract enough islets to help all Type 1 patients. More research needs to be done to perfect the islet isolation procedures and the drugs we use to prevent rejection of the islets and recurrence of the diabetes," she explains.

"At present, we can therefore only offer this treatment to patients in whom conventional treatments are failing in a major way. However, it is our aim that ultimately all people with Type 1 diabetes would become eligible for islet transplantation and free from insulin dependence," Professor Amiel concludes.

Far-Reaching Implications for Cell Research

"This breakthrough in islet transplantation is remarkable," adds Mr. Nigel Heaton, Consultant Liver Surgeon. "King's is the first center in the UK to achieve insulin independence in Type 1 patients. The research approach at King's is totally multidisciplinary, with experts across specialities in diabetes, liver transplantation, cell isolation and radiology all working together," he points out.

"The result of this work will have far-reaching implications, not only for Type 1 diabetes patients, but also in the wider area of cell research," says Mr. Heaton. "We have shown that cell transplantation, with both pancreatic islet cells and previously with hepatocyte cells, can offer patients a valuable alternative to conventional treatments."

The islet cell research was funded by King's College Hospital Charitable Trust and Dixons Charitable Foundation. The clinical costs are supported by Diabetes UK.

Information for Patients

The islet transplantation team at King's College Hospital has an active islet transplantation program. This is still an experimental procedure for people with Type 1 diabetes in which pancreatic islets from human donor organs are infused into the body to try and replace some of the islet function which the patient has lost. In order to prevent rejection of the islet graft and recurrence of the diabetes, the recipient is committed to taking drugs that suppress the body's immune system.

Islet transplantation is not yet a perfect procedure and cannot guarentee insulin independence. It can, however, stop recurrent severe hypoglycemia (low blood sugar) in insulin-treated patients, reduce their insulin requirements, and give much better glucose control, as long as the islets survive.

You may be suitable for islet transplantation IF:

• You have Type 1 (juvenile onset, insulin dependent) diabetes, and

• You are aged between 18 and 65, and

• You are using multiple daily insulin injection therapy (> 3 injections per day), and

• You are experiencing problems with SEVERE HYPOGLYCEMIA -- episodes of low blood glucose you cannot treat yourself, and

• You are requiring no more than 0.7 units of insulin per kg body weight to maintain a reasonably good average blood glucose, and

• You have good kidney function.

If you think you may be eligible, you should discuss your interest with your usual diabetes consultant. We are happy to accept referrals. A questionnaire will be sent to you and your diabetes consultant to complete, to make sure you have no contraindications and, if appropriate, we will then offer you an appointment.

Referrals can be made in writing to:

Professor Stephanie A. Amiel
Diabetes Department
King's College Hospital
Denmark Hill
London SE5 9RS

The questionnaires can be posted to you on receipt of your name, date of birth, date of diagnosis and current insulin regimen to:

Sophia.Coker@kcl.ac.uk