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Diabetes Mellitus Interagency Coordinating Committee (DMICC): Coordinating the Federal Investment in Diabetes Programs to Improve the Health of Americans. Bethesda, MD: National Diabetes Information Clearinghouse.2009. 43 p.
This booklet describes in detail the Diabetes Mellitus Interagency Coordinating Committee (DMICC), a group that facilitates cooperation, communication, and collaboration on diabetes research and programs among the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health (NIH), other agencies of the Department of Health and Human Services, and other federal departments and agencies that conduct or support diabetes-related activities. The DMICC holds meetings several times a year to identify emerging issues and opportunities, and to develop ways in which different government components can work together and build on each other’s expertise and resources. The booklet lists DMICC member organizations and explains how the DMICC coordinates activities across the government. The bulk of the booklet describes some examples of diabetes activities that have been successfully coordinated across the government, with the help of the DMICC. Programs described include the National Diabetes Education Program (NDEP); the Diabetes Prevention Program (DPP) clinical trial; programs to improve the health of Hispanic and Latino communities, African American communities, American Indian communities, and to combat diabetes in children; programs to improve the delivery of health care to special populations; the U.S. Centers for Disease Control and Prevention’s Division of Diabetes Translation (CDC DDT); and collaborative research efforts including the Diabetes Prevention Program Outcomes Study (DPPOS), the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, Look AHEAD: Action for Health in Diabetes, the Environmental Determinants of Diabetes in the Young (TEDDY) study, the Clinical Islet Transplantation Consortium (CIT), and the SEARCH for Diabetes in Youth study. One section briefly summarizes some of the future DMICC activities in the areas of membership development, strengthening collaboration, and enhancing outreach efforts. Readers are encouraged to visit the DMICC’s website at www2.niddk.nih.gov/AboutNIDDK/CommitteesAndWorkingGroups/DMICC. The booklet is illustrated with full-color photographs. A list of acronyms is provided. 9 references.
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Controversies in Treating Diabetes: Clinical and Research Aspects. Totowa, NJ: Humana Press. 2008. 367 p.
This book addresses diabetes controversies, specifically in the etiology and management of the disease. The volume covers commonly accepted forms of therapies and complications, as well as new and emerging advances, therapies, and inadequacies in several standard treatments. The book offers 17 chapters, each written by experts in the field. Topics are patient selection for pancreas transplantation; the effectiveness of islet transplantation; appropriate treatment for metabolic syndrome; reducing the complications of diabetes through intensive treatment; when to introduce insulin into the treatment for type 2 diabetes; the prevention of diabetic retinopathy; the evaluation, management, and controversies in treatments for diabetic neuropathies; endpoints in clinical research studies on diabetic neuropathy; intensive insulin therapy for the critically ill patient; the recent explosion in childhood type 1 and type 2 diabetes; weight loss in type 2 diabetes patients; a unifying hypothesis of diabetic complications; the diabetic foot; developments in incretins; controversies in the evaluation and management of lipid disorders in diabetes; polypharmacy for the treatment of type 2 diabetes; and the natural history and clinical aspects of comorbid depression and diabetes. Each chapter includes an outline, a summary, and a list of references. A list of contributors and their affiliations is provided. A subject index concludes the volume.
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Diabetes Overview. Bethesda, MD: National Diabetes Information Clearinghouse. 2008. 16 p.
This fact sheet provides an overview of information about diabetes, defined as a disorder of metabolism. The fact sheet describes the three main types of diabetes: type 1 diabetes, an autoimmune disease in which the pancreas produces little or no insulin; type 2 diabetes, in which the body does not produce enough insulin or uses insulin inefficiently; and gestational diabetes, which is associated with pregnancy and a subsequent increased risk for type 2 diabetes. The fact sheet discusses diagnostic considerations, the condition of pre-diabetes, the complications that may be associated with diabetes, epidemiology of type 1 and type 2 diabetes, and patient care for people with diabetes. The fact sheet describes current research efforts in the diabetes arena, including the Diabetes Prevention Trial–Type 1 (DPT-1), the Environmental Determinants of Diabetes in the Young Consortium (TEDDY), Type 1 Diabetes TrialNet, the Immune Tolerance Network, the Trial to Reduce IDDM in the Genetically at Risk (TRIGR), islet transplantation studies, the Diabetes Prevention Program (DPP), studies on type 2 diabetes in children and teens, and studies focusing on preventing and treating cardiovascular disease in people with type 2 diabetes. Contact information for three resource organizations is listed: the American Diabetes Association at www.diabetes.org or 1–800–342–2383, the National Diabetes Education Program at www.ndep.nih.gov or 1–888–693–6337, and the Juvenile Diabetes Research Foundation International at ww.jdrf.org or 1–800–533–2873. A final section provides contact information and a brief description of the goals and activities of the National Diabetes Information Clearinghouse (NDIC), a Government service that provides information about diabetes to people with diabetes and to their families, health care professionals, and the public. 1 figure.
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Islet Cell Transplantation: How Effective Is It?. IN: LeRoith, D.; Vinik, A., eds. Controversies in Treating Diabetes: Clinical and Research Aspects. Totowa, NJ: Humana Press. 2008. pp 11-32.
This chapter about the effectiveness of islet transplantation is from a book that addresses diabetes controversies, specifically in the etiology and management of the disease. The authors of this chapter note that islet transplantation as a treatment for diabetes has shown great promise but has significant limitations. The chapter covers a brief history of islet transplantation, islet isolation, limits of the procedure, clinical islet transplantation, immunosuppression, the Edmonton advance, islet transplantation outcome follow-up, benefits, risk and limitations, new methods of beta-cell replacement and encapsulation, and endogenous beta-cell regeneration. Although islet transplantation can restore insulin independence to the patient with type 1 diabetes, nearly all patients must return to insulin therapy by 5 years after procedure due to loss of islet function. Other problems include the need for immunosuppression, an inadequate islet supply, risks associated with the portal vein cannulation, host sensitization against the donor islets, allogeneic islet effects on the surrounding host liver tissue, and great expense. The authors conclude by encouraging ongoing research in this area. 102 references.
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Islet Transplant Activity. IN: Collaborative Islet Transplant Registry Fifth Annual Report. Bethesda, MD: National Diabetes Information Clearinghouse. 2008. pp 33-44.
This chapter on islet transplant activity is from the 2008 annual report of the Collaborative Islet Transplant Registry (CITR) on islet/beta cell transplantation. CITR’s mission is to expedite progress and promote safety in islet/beta cell transplantation through the collection, analysis, and communication of comprehensive and current data on all islet/beta cell transplants performed in North America, Europe, and Australia. After a brief textual introduction, most of the information is presented in charts and figures. This chapter includes eight tables and figures: islet transplant centers reporting data to CITR: participating North American centers, 1999 to 2007; number of islet transplantation centers performing islet allografts per year and number with data entered in CITR database all North American islet transplant centers, 1999 to 2007; total number of islet transplant recipients; recipients at CITR-participating centers; and recipients with detailed data reported to CITR by year of first islet allograft infusion all North American islet transplant centers, 1999 to 2007; total number of islet allograft infusion procedures performed and number with data reported to CITR: CITR-participating North American islet transplant centers, 1999 to 2007; total number (n = 649) of islet allograft infusion procedures conducted and entered in CITR database, by year and infusion procedure number at CITR-participating North American and international centers, 1999 to 2007; total number (n = 649) of islet allograft infusion procedures per recipient at CITR-participating North American and international centers, 1999 to 2007; total number (n = 712) of deceased donors per islet allograft infusion procedure at CITR-participating North American and international centers, 1999 to 2007; islet alone and islet after kidney recipients: CITR-participating North American and international centers, 1999-2007. 9 figures.
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Scientific Summary. IN: Collaborative Islet Transplant Registry Fifth Annual Report. Bethesda, MD: National Diabetes Information Clearinghouse. 2008. pp 9-25.
This scientific summary chapter begins the 2008 annual report that presents data from the Collaborative Islet Transplant Registry (CITR) on islet/beta cell transplantation. Funded by the National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK) with supplemental funding from the Juvenile Diabetes Research Foundation (JDRF), CITR’s mission is to expedite progress and promote safety in islet/beta cell transplantation through the collection, analysis, and communication of comprehensive and current data on all islet/beta cell transplants performed in North America, Europe, and Australia. Islets are clusters of insulin-producing cells located in the pancreas. In patients with type 1 diabetes mellitus (T1DM), all islets are destroyed by an autoimmune attack and patients need to inject insulin every day to stay alive. In patients with T1DM and poor kidney function, a whole pancreas transplant is sometimes performed. T1DM patients with severe hypoglycemia may be eligible for an alternative procedure using insulin-producing cells (islets of Langerhans) extracted from a deceased donor pancreas which, in the United States, is an experimental procedure. A small subset of these allogenic islet recipients have previously received a kidney transplant for end-stage renal disease and were already receiving long-term immunosuppression therapy at the time of their islet transplant. For all types of recipients, islets are implanted typically via the portal vein in the liver, where the islets produce insulin as needed by the recipient. Thirty-one medical institutions in the United States and Canada are currently or were previously active in islet transplantation since 1999. Of the 325 North American and European recipients included in this report, 279 (96 percent) were recipients without a previous kidney transplant who received one or more islet-alone infusions (IA), while 46 recipients (14 percent) had previously received a kidney transplant (IAK). This scientific summary discusses the background and purpose of the report, describes the patients and methods covered, and summarizes the results found in the areas of recipient characteristics, donor information, pancreas procurement, immunosuppression therapy, graft function, metabolic measures, concomitant medications, elevated laboratory tests, adverse events, and reported deaths. The authors stress that islet transplantation continues to show short-term benefits of insulin independence, normal or near normal HbA1c levels, sustained marked decrease in severe hypoglycemic episodes, and a return of hypoglycemia awareness. Long-term primary effectiveness and safety of immunosuppression, as well as the effects on secondary complications, are less well understood and are the focus of ongoing research. Readers are referred to the CITR website for more information and copies of the data collection forms (www.citregistry.org). 16 figures. 3 tables.
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Closer and Closer to a Cure? Latest Research Holds Promise for Reversing the Most Severe Form of Diabetes. Diabetes Wellness News. 13(3): 3-4. March 2007.
This article reports on recent animal studies that may be a positive step along the way to a cure for diabetes. A study completed in 2006 successfully reversed diabetes in 12 monkeys by transplanting islets from pigs. The author briefly reviews the physiology and pathology of type 1 diabetes and outlines the problems with complications associated with the disease. The author then considers the obstacles that must be overcome before islet transplantation can be considered a viable cure, including problems with the availability of islets; studies that must be conducted before pig islet transplantation into humans can enter into clinical trials; and funding issues. 1 figure.
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Experimental Diabetes Therapies. Today’s Dietitian. 9(11): 22, 24. November 2007.
This article brings dietitians up to date on the experimental diabetes therapies now under investigation. The author emphasizes that new therapies and experimental approaches to curing diabetes promise better health and greater hope as the understanding of diabetes’ pathophysiology increases. Topics include pancreas or simultaneous pancreas-kidney transplantation, transplanting islets, and stem cell research. The author notes that pancreatic transplants are highly successful in temporarily curing diabetes, but the 10-year outcomes are less encouraging. The disadvantages of organ transplantation include the side effects of lifelong immunosuppression to prevent rejection as well as procedure-associated morbidity and mortality. Islet transplantation is showing improved results, particularly with improved immunosuppressive regimens, but is still considered experimental. Because stem cell research is hampered by federal and state laws, studies and results are scant. A final section considers the role of endothelial progenitor cells (EPCs) on the development of major diabetes complications. Research in this area is focused on developing methods that either infuse healthy EPCs or stimulate production of endogenous cells.
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Future Developments in Diabetes. IN: Scobie, I.N. Atlas of Diabetes Mellitus. 3rd ed. New York, NY: Informa Healthcare USA. 2007. pp 117-120.
This chapter is from an atlas of diabetes mellitus that outlines future developments in diabetes care. The volume portrays the wide and varied expressions of diabetes and its complications as an aid to their more ready recognition in clinical practice. This chapter helps readers understand some of the changes that are currently being studied, with clinical applications perhaps not long behind. Topics include pancreatic and islet transplantation, implantable insulin pumps, insulin analogs, incretin gut hormones, exenatide, pramlintide, and the endocannabinoid system. 4 figures. 4 references.
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Diabetes Overview. Bethesda, MD: National Diabetes Information Clearinghouse. 2006. 16 p.
This fact sheet provides an overview of information about diabetes, defined as a disorder of metabolism. The fact sheet describes the three main types of diabetes: type 1 diabetes, an autoimmune disease in which the pancreas produces little or no insulin; type 2 diabetes, in which the body does not produce enough insulin or uses insulin inefficiently; and gestational diabetes, which is associated with pregnancy and an increased risk of type 2 diabetes subsequently. The fact sheet then discusses diagnostic considerations, the condition of pre-diabetes, the complications that may be associated with diabetes, epidemiology of type 1 and type 2 diabetes, and patient care for people with diabetes. The fact sheet also describes current research efforts in the diabetes arena, including the Environmental Determinants of Diabetes in the Young Consortium (TEDDY), Type 1 Diabetes TrialNet, the Immune Tolerance Network, islet transplantation studies, the Diabetes Prevention Program (DPP), studies on type 2 diabetes in children and teens, and studies focusing on preventing and treating cardiovascular disease in people with type 2 diabetes. The contact information for four resource organizations is listed. A final section provides the contact information and a brief description of the goals and activities of the National Diabetes Information Clearinghouse. 2 figures.
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