Progress of Islet Transplantation over the Last 15 Years

Diabetes mellitus (DM) is a global epidemic. In 2013, there were 382 million people with DM, and this number is expected to rise to 592 million by 2035. Type 1 diabetes (T1DM), which is caused mainly by an autoimmunemediated destruction of beta cells within the islet of Langerhans, accounts for 5–10 % of the total cases of diabetes worldwide. Glycemic control is the cornerstone of diabetes care. The Diabetes Control and Complications Trial (DCCT) demonstrated that intensive glycemic control reduces the long-term complications of hyperglycemia in T1DM. However, diabetic complications continue to be a significant burden in persons with T1DM. Additionally, intensive blood glucose control often comes at the cost of increased rate of hypoglycemia. The improvement in glycemic control was associated with a twoto sixfold increase in severe hypoglycemia in the intensive treatment arm of the DCCT. However, it is often challenging to attain or sustain target hemoglobin A1c (HbA1c) of less than 7 %, especially in patients who are at risk for hypoglycemia. In the Epidemiology of Diabetes Intervention and Complication (EDIC) study, the difference in mean HbA1c between the two original DCCT treatment groups has become statistically indistinguishable (around 8 %) during the most recent years of follow-up. Analysis of the National Health and Nutrition Examination Survey (NHANES) data collected between 1999 and 2000 indicated that only 37.0 % of adults with diagnosed DM in the US achieved a HbA1c below 7 %.