Prevalence of Type 1 Diabetes Worldwide
This paper deals with the intervention strategy of type 1 diabetes. It is a critical review paper that considers three articles that have primary research. In this paper, the comparison of the papers and their results have been reviewed to get the best and most authentic findings. It can help to get an overview of the islet cell replacement procedure and the issues of this treatment for type 1 diabetes. This review aims to identify the effectiveness of islet cell transplantation in the treatment of type 1 diabetes.
Type 1 diabetes increases dramatically in different countries. Almost 9.5% people of the total population in the world have type 1 diabetes. In the UK, about 8% of people of the total population have type 1 diabetes. 1 in 300 people has type 1 diabetes in the US. Among the overall population of Brazil 6-13% of people have this health issue. However, each country has a huge number of type 1 diabetes cases. For the treatment of type 1 diabetes, there is a need to focus on two things one is to inhibit the immune system to destroy those cells which make insulin and another thing is to replace the cells which are destroyed. Beta cells are only specialised to make insulin which is found in islets of Langerhans in the pancreas. In type 1 diabetes the immune system intends to destroy the beta cells.
In the treatment of type 1 diabetes, the major issue is too controlling blood glucose levels to slow the development of complications linked with diabetes. Transplantation of islets helps to get the body a healthy islet that can make insulin. Transplantation of islet cells is meant to be the transfer of cells from the donor of the organ into the body of another person. A person can’t get insulin therapy or injection for their entire life. This transplantation can give them rest from the insulin injection process. Moreover, it plays a vital role in the prevention of dangerous side effects of hypoglycemia. It also improves the control of glucose in the body in type 1 diabetes. However, some issues can occur during islet cell transplantation. These are the reason to critically review the islet cell transplantation procedure in the cure of type 1 diabetes.
According to Carlsson et al., (2018), the transplantation of pancreatic islets is an efficient treatment for patients who have type 1 diabetes with unstable glucose control. This paper aims to show the application of BetaAir devices containing allogeneic islet cells of the pancreas into patients who have type 1 diabetes. In maximum cases, the drugs are not in favour of performing transplantation. It is stated by Carlsson et al., (2018), transplantation of islet cells can offer the benefit to perform as minimal procedure of invasive in that islets can be percutaneously into the liver. For this reason, this paper has focused on the development of the novel means for controlling the system of immune to making the clinical implication. In this article, it has been shown that encapsulation can make a barrier that can prevent the immune cells to destroy the beta cells. Microencapsulation devices can recover the stem cell extracted cells (Carlsson et al., 2018). This study aims to evaluate the efficiency and safety of implementation of the Beta Air device consisting of the allogeneic pancreatic islets into patients who have type 1 diabetes.
Controlling Blood Glucose Levels in Type 1 Diabetes
In this study, the patients have maintained the inclusion criteria where the patients have type 1 diabetes between the age of 5 to 18 years. The patients who have any experience with organ transplantation are rejected. Pregnant or having any infectious disease including hepatitis C, HIV or renal failure had been rejected in this paper (Carlsson et al., 2018). Four patients have been chosen who have been transplanted with the 1-2 BetaAir devices in which each contains 155000-180000 islets. They have been monitored for three to six months to analyze the effectiveness of the recovery of devices.
This article has given the outcome that the implementation of the BetaAir device is effectively preventing immunization and rejection of the transplantation of tissues. This result section contains the evolution of safety surrounding the wound in recent days after islet cell transplantation. The patients who have carried the devices had some complaints about the device and reported stress of remembering and conducting oxygen refilling. The wounds of surgery have been healed as per they have expectations in all patients (Carlsson et al., 2018). It has the efficacy evolution in the result section where the efficiency of the BetaAir devices has been measured. It has been noted that the amount of insulin secreted from the different devices was equal to the individual slabs of the islet.
This study concluded that the implementation of the BetaAir device is fully safe and can support the survival of allogenic islets for a few months. However, the overall function of islet cell transplantation was limited. The Betaair devices can maintain the viability of transplanted beta cells for a few months. This approach can be used to guide for further development of initial trials of the clinic.
This article has aim to show the transplantation of islet cells to cure type 1 diabetes. It has also presented the complications of immunosuppression in the transplantation of islet cells. Transplantation of the islets is presently an experimental technique that is the minimally invasive process for the patients who have hypoglycemia unawareness that can provide an effective cure for type 1 diabetes. As per Luu et al., (2018), his transplantation can remove HU with the regeneration of a normal level of glycemic control. This paper has given evidence that this transplantation procedure of islet cell is a clinical treatment for patients of type 1 diabetes with HU. It is stated by Luu et al., (2018), transplantation of islets will gain FDA approval. In this study mainly the fear, concerns and hopes of the type 1 diabetes patients have been assessed before the transplantation of islets. It also examined the causes to choose the islet transplantation treatment. The patients have given the responses of the questionnaire that they have dissatisfaction because of loss of control and they have a desire for over control of their life. The patients in the interview have described their feeling about the hypoglycemia fear and panic for explaining the stress level to manage diabetes. Even some patients have expressed the fear of death or incapacity.
The Procedure of Islet Cell Transplantation
According to the responses of the participants, the HU make the barrier to doing daily activities of their life. People have more concerned about the complication of hyper and hypoglycemia in type 1 diabetes as it can develop visual impairment, a decline of cognitive level and heart diseases. After transplantation of islet patients have expressed their hope to get relief from the fear of side effects of hypoglycemia (Luu et al., 2018). They have expressed that they are living life without any anxiety or fear. The most important thing is that the patients have tight control on their blood sugar level which can enable patients to live a longer and healthier life. Posttransplantation they have improved their psychological status and boosted their energy to do daily routine works. Although major of the patients have a concern about the side effects of immunosuppressive therapy after transplantation.
In this paper, the interview has been done in which the sample size is 23. Of 23 participants 19 are female patients and the remaining four people are male patients. This article has been sued for the semi-structured interview. These participants are in the pre-transplantation state. In this interview, four questions have been set up which are open-ended structure-wise about the islet transplantation.
The findings of this paper indicated a lack of control because of the effect of diabetes. There are mainly four themes generated by evaluating the responses of the interview. Diabetes-related issues, expectations of the transplantation, outcomes of the transplant and fear about the hypoglycemia. In this finding of the paper, the patients have expressed concern about the long term issues or complications after the transplantation (Luu et al., 2018). These patients have been assumed to improve the management of diabetes through transplantation of islet in this interview. On the other hand, some patients have expressed their frustration regarding the inability of performing daily activities of their life due to the effect of hypoglycemia unawareness.
This study successfully concluded that the patients have viewed the transplantation of islet as the gain of autonomy and they have found that they have control over their lives. These patients also desired to reduce anxiety associated with the HU and other side effects of immunosuppressive. These results need confirmation although they can help in improving the education for the patient and provide communication to the patients.
This article has shown the potential cure of islet cell transplantation for type 1 diabetes. It has aim to investigate the link between the serum cytokines, adipokines and chemokines with the effective clinical outcome of the islet transplantation. In this study, it has been assessed that therapy of beta cells has been decreased the level of HbA1c and lowered the risk of long time issues or complications. It is criticized by van der Torren et al., (2016), that islet transplantation has the limitation that it could not maintain the insulin for a long time. It can be because of loss of independence insulin secretion over time. In this case, insufficient size of graft or the quality may impair the function of the initial graft may direct to the exhaustion of beta cells over time. The immunosuppressive drugs can affect the engraftment and the function of beta cells or cause the resistance of insulin. The key focus of this paper is on the particular adaptive immune responses of islets. It has shown that the transplantation of islets affects the serum marker stages. Even the immunosuppression after the transplantation affects the levels of serum marker.
The Effectiveness and Safety of BetaAir Device Implantation
In this article, almost thirteen patients have experienced islet transplantation based on the good graft type function. Thirteen patients who have type 1 diabetes and who have islet transplantation have been selected for this paper (van der Torren et al., 2016). These patients have the characteristics of c-peptide negative and fasted glycaemia. These patients have been used for the graft recipients where the patients reach insulin independence that is divided in the continued and versus transient who have insulin independence.
As a result of this paper, ninety protein serums have been identified in the concentrations which vary among the patients at time point. Even after transplantation thirteen markers have been changed and another seven number markers have been modified in the clinical subpopulation. All the other markers mainly remained without effect after the transplantation for the formation of immunosuppression. In this finding, the patients have experienced improved HbA1c with good engraftment. Two patients have insufficient engraftment (van der Torren et al., 2016). 16 markers have shown that over 20% of the values are out of the range of measurement, these amounts of values can be substituted as explained in the method section. This paper has investigated the level of serum markers before the transplantation in different patients with better engraftment which is different among the patients. The serum levels have been analyzed after one year of islet transplantation. Those patients who have continued the independence of insulin ad lower level of S100A12 than the patients with transient independence of insulin after the initial function of good graft.
In the conclusion of this paper, distinct type cytokine markers have been recognized in serum that predicts the outcomes of the clinic (van der Torren et al., 2016). These markers of serum may support the selection of patients and in choice of the immunotherapy. It has been shown that the few serum markers can give insights into the relation of the allografts of islets. The level of markers can be investigated to give validate these types of markers and the possible role in the prediction of long time graft survival.
According to Anteby et al., (2021), transplantation of the pancreas or islet is the only curative treatment for the disease of type 1 diabetes. However, their ability to restore the long time independence is low through allogenic rejection and the autoimmunity of islets. Even it has low autoimmune in combination. Autoimmune type 1 diabetes recurrence refers to the cause of loss of islet graft. In the allotransplantation of the islet, the former is not applicable and later it is not possible to gain. It is known that islets autoantibodies have a prolonged significance in the management of type 1 diabetes. There is increasing interest in the markers after transplantation of islets. In previous studies, it has been notified that the autoantibody of islets has a link with the long term function of islets. On the other hand, some studies stated they have not found any link between the autoantibody in post-transplantation and clinical results. However, the usage of autoantibodies of islets is a potential biomarker for type 1 diabetes (Anteby et al., 2021). In this paper, it is interpreted that the prognostic value of the autoantibody of islets for prediction of graft failure in the recipients of islet transplant with type 1 diabetes. In this study, the inflammatory reaction of instant blood mediated is the main cause of tissue loss by following the islet administration
Outcome of the BetaAir Device Implementation
In this article, the correlation between the titers of the islet autoantibodies and the transplanted islets have been found. It has evaluated the prognostic utilization of monitoring the autoantibodies of islets in the type 1 diabetes patient.
This study has conducted a survey where twelve patients have been considered and observed with type 1 diabetes. These patients also have severe hypoglycemia and face different health issues related to it.
This paper has conveyed the result that IA-ZA and ZnT8A antibody stages would not be detected before or after transplantation of islets (ITx). Almost 67% of the patients with the GADA+ seroconversion has been peaked within the months of 3 after the decline of islet transplantation.
This study has concluded that there is no link between the serum trends of GADA and the outcomes of ITX. It has been supported by other articles which have been stated the same statement before.
After analyzing the articles it can be said that in one article it has been shown that the islet cell transplantation can reduce the anxiety of hypoglycemia. The patients can get the energy to do normal activities of everyday life. It is criticized by Carlsson et al., (2018), the BetaAir devices can help the patients who have wound of transplantation of islet cell can heal quickly. On the other hand, another article has stated that there is no relation between the GADA level in the transplantation of islets and the results of the islet transplantation. In this article it has been found among twelve patients GADA levels have no link with the transplantation of pancreatic islet. The levels of the islet autoantibodies can target the ZnT8 and IA-2 who were not detectable in all patients before and after the transplantation and do not correlate with the outcome of transplantation. Further research of multi-institutional with the larger number of patient cohorts, different types of immunosuppressive and longer follow up are needed for testing the findings. It is argued by van der Torren et al., (2016), all the possible number of biomarkers of the survival from islet graft. Several markers have been measured in this paper that has been explained as the predictors of the transplantation of islet cell results in the vitro culture of the islets or after the stimulation of the immune cells. After kidney transplantation and islet transplantation, the IL-10 has gotten lower in the patients losing the graft function. However, all these articles have the same objective to analyze the strength or weakness of the islet transplantation procedure. This comparison has stated that the authors of different articles have shown the different applications of islet cell transplantation to reduce the number of cases of type 1 diabetes. There are many advantages and limitations are present of islet cell transplantation although it has a vital role in the treatment of type 1 diabetes. In simple words, islet cell transplantation can reduce the issues of hypoglycemia whereas it is difficult to continue for the long term. It means that it is a contradictory treatment for type 1 diabetes. Medical technology is involving new devices such as beta air devices continuously improves the medical treatment of type 1 diabetes.
Conclusion
It can be concluded that this critical review paper has successfully evaluated the strengths and weaknesses of all articles. It has been described the subject of the papers and critically analyzed the interpretation of the articles. This critique paper has shown that people are facing issues of hypoglycemia during type 1 diabetes and getting anxiety. The islet transplantation can help them to get energy for doing daily activities and can remove the risks of anxiety or fear of hypoglycemia. In recent years stem cell transplantation is getting more popular than islet cell transplantation as it has different challenges to implement and it is not for the long term. People with type 1 diabetes could not receive the islet cell transplantation for the long term this is the reason the doctors and medical sector has been switched to stem cell transplantation. These articles have given evidence and authenticity as these have the data of real-life experiences. These articles contain interviews and surveys where the patients have shared their experiences about islet cell transplantation and stem cell transplantation. It has conveyed that islet cell transplantation has the risk of immunosuppressing. Although there are some devices are available in the market that can help to recover the immunosuppress and healing of the wound. Researchers have tried to get a more effective way to implement this transplantation process of islet cells for type 1 diabetes. In future, there is a need to investigate more effective ways to recover the side effects of islet cell transplantation for type 1 diabetes patients.
References
Anteby, R., Lucander, A., Bachul, P. J., Pyda, J., Grybowski, D., Basto, L., … & Witkowski, P. (2021). Evaluating the Prognostic Value of Islet Autoantibody Monitoring in Islet Transplant Recipients with Long-Standing Type 1 Diabetes Mellitus. Journal of Clinical Medicine, 10(12), 2708. https://doi.org/10.3390/jcm10122708
Carlsson, P. O., Espes, D., Sedigh, A., Rotem, A., Zimerman, B., Grinberg, H., … & Korsgren, O. (2018). Transplantation of microencapsulated human islets within the bioartificial pancreas βAir to patients with type 1 diabetes mellitus. American Journal of Transplantation, 18(7), 1735-1744. https://doi.org/10.1111/ajt.14642
Luu, Q. F., Villareal, C. J., Fritschi, C., Monson, R. S., Oberholzer, J., & Danielson, K. K. (2018). Concerns and hopes of patients with type 1 diabetes prior to islet cell transplantation: A content analysis. Journal of Diabetes and its Complications, 32(7), 677-681. https://doi.org/10.1016/j.jdiacomp.2018.04.002
van der Torren, C. R., Verrijn Stuart, A. A., Lee, D., Meerding, J., van de Velde, U., Pipeleers, D., … & Roep, B. O. (2016). Serum cytokines as biomarkers in islet cell transplantation for type 1 diabetes. PloS one, 11(1), e0146649. https://doi.org/10.1371/journal.pone.0146649
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