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Brittle type 1 diabetes mellitus.
- Source :
-
Current medicinal chemistry [Curr Med Chem] 2007; Vol. 14 (16), pp. 1739-44. - Publication Year :
- 2007
-
Abstract
- A small group of patients affected by type 1 diabetes mellitus is characterized by a severe instability of glycemic values with frequent and unpredictable hypoglycemic and/or ketoacidosis episodes which cannot be explained by errors of patients or diabetologists. The quality of life of these patients is dramatically compromised in particular because of the frequency of acute events, hospital recoveries and precocious appearance of chronic complications. This clinical condition has been defined as "brittle diabetes". A precise quantification of these patients is difficult because diagnostic criteria are still not well defined and it is often difficult to verify errors of patients in terms of inappropriate conduct with the pathology. Even more than the other kinds of diabetes, therapy is based on education, glycemic control, intensive therapy and strict interaction between physicians and patients. The introduction of insulin analogous, with either ultra-fast and ultra-slow action and the use of subcutaneous insulin pumps have significantly increased the possibility of treating the most of these cases. However, there is a minority of patients resistant to the therapy. In similar cases, pancreas or islet transplantation represents an effective therapeutic option entailing good expected outcomes. The main limiting factor of beta cell function replacement by transplantation is so far represented by the potentially severe side effects of the immunosuppression therapy necessary to avoid graft rejection and recurrence of autoimmunity.
- Subjects :
- Blood Glucose metabolism
Diabetic Ketoacidosis complications
Diagnosis, Differential
Graft Rejection
Humans
Immunosuppressive Agents pharmacology
Insulin metabolism
Insulin therapeutic use
Insulin Infusion Systems
Insulin-Secreting Cells metabolism
Islets of Langerhans Transplantation methods
Pancreas Transplantation methods
Treatment Outcome
Diabetes Mellitus, Type 1 diagnosis
Diabetes Mellitus, Type 1 pathology
Diabetes Mellitus, Type 1 therapy
Subjects
Details
- Language :
- English
- ISSN :
- 0929-8673
- Volume :
- 14
- Issue :
- 16
- Database :
- MEDLINE
- Journal :
- Current medicinal chemistry
- Publication Type :
- Academic Journal
- Accession number :
- 17627511
- Full Text :
- https://doi.org/10.2174/092986707781058922