Future Directions


Diabetes after transplantation: revised guidelines target early treatment

People who have a kidney, liver or heart transplant are at high risk of developing diabetes. This can lead to cardiovascular disease and the rejection of the transplant. Factors such as age, weight and family history can increase the risk of new-onset diabetes after transplantation. Importantly, drugs that suppress the immune system and prevent transplant rejection also play a key role. In December 2003, an international panel of experts in transplantation and diabetes met to update the existing guidelines for the management of new-onset diabetes after

New treatments for diabetes: generating new insulin-producing cells

A new generation of treatments for Type 1 diabetes is likely to come from within our own bodies. We know that a wide range of cell types have the ability to regenerate. Although some of these cells are found outside the pancreas, their regenerative capacity can be harnessed to replenish the insulin-producing islet cells in the pancreas that are destroyed in diabetes. In this article, Denise Faustman looks at the potential benefits and pitfalls of four biologically based therapies, all of which take advantage of the body’s own capacity for healing and renewal.

Enhancing insulin secretion: novel approaches to glucose control

When we eat, the concentration of glucose in our blood rises due to the uptake of glucose from the digestion of starch and other carbohydrates in the gut. In healthy people, the increase is modest; eating activates other processes that

Eighty nobel prize winners appeal to President Bush

US President George W Bush received a letter that came straight to the point. “We urge you to support stem cell research.” This appeal did not waste words. The signatories had already said and done enough that is meaningful: no less than eighty of the signatures were Nobel prize winners. Stem cell research promises help to numerous people affected by chronic diseases and illnesses. The supporting argument is that if the embryos are to be destroyed anyway, would it not be better if they could be used to save the chronically ill.

Dietary toxins: digging up the dirt on vegetables

Recent research from Australia has implicated infections of common garden vegetables as a possible source of chemicals which cause damage to the pancreas, the organ that makes insulin. This damage could thereby cause Type 1 diabetes, the insulin-dependent form of the disease.

Gene therapy: looking for alternatives to insulin injection

Both Type 1 and Type 2 diabetes greatly increase the risk of dying from heart disease and are leading causes of blindness, leg amputation and kidney failure. There is now conclusive evidence that these long-term complications of diabetes can be prevented by keeping blood glucose levels as near to normal as possible. However, achieving this with conventional insulin injections results in a three-fold increase in the number of incapacitating attacks due to low glucose levels.

Expensive new drugs: NICE or not so nice?

Around the world, healthcare services face increasing demands from aging populations, with high disease burdens and expensive new ways of managing them. Many new drugs and other health technologies cost considerably more than those they supplant, but may only give a proportionately small health gain. As a result individuals, insurance companies, health maintenance organizations and national health services are forced to take decisions on which new therapies can be afforded for whom.

Hormone Replacement Therapy: controvery, confusion, concern

Post-menopausal women with diabetes derive similar benefits from hormone replacement therapies as women without diabetes. Despite this, women with diabetes represent the group with the lowest frequency of hormone replacement therapy use. This is a result of much scientific controversy about the risks and benefits of this therapy.

Successful islet transplantation has finally arrived: fact or fantasy?

Currently, transplantation of whole pancreases results in insulin independence and normalization of glycosylated haemoglobin values for three years in up to 80 percent of recipients. One group of investigators in Edmonton, Canada, has had initial success with the less invasive procedure of islet transplantation. Should this procedure take precedence?

Educating the educators: an International Curriculum for Health Professionals in Diabetes

The lack of trained healthcare professionals and of programmes to train them has been cited by many member associations of the International Diabetes Federation (IDF) as the most critical issue hindering the delivery of high quality diabetes education and care. To address this, the IDF Consultative Section on Diabetes Education set out to write a curriculum that could be used in all IDF member countries. This goal has now been achieved. Read more for an overview of the most remarkable features of this new publication.