Islet Transplantation

Abstract

The discovery of insulin dramatically changed the outcome for patients with type 1 diabetes and the acute lethal complications of diabetes like diabetic ketoacidosis could be effectively treated. However, the improved survival allowed the development of the secondary complications of diabetes. Typically the patient with type 1 diabetes develops retinopathy, nephropathy, neuropathy, or vascular disease over time. It was not until 1993 that definitive proof for the value of good glycemic control was established. Controlling glycemia with exogenous insulin remains a challenge. Given the nonphysiological subcutaneous route of insulin administration, its inherent delay in absorption, the variability of serum levels obtained, and the systemic versus portal venous delivery, it is perhaps remarkable how well the glucose levels are actually controlled. Many efforts have been made to generate a closed‐loop system for glucose control, including the Biostator® and insulin infusion pumps. The goal of any closed‐loop system is to have reliable glucose sensing linked to appropriate insulin delivery on a continuous basis. Mechanical closed‐loop systems may in the future achieve this but have been fraught with problems despite early promise. Transplantation of islets of Langerhans or of the whole pancreas can achieve a physiological closed‐loop system today.