British Journal of Diabetes最新文献_第4页

Islet cell transplantation 胰岛细胞移植

IF 0.6

British Journal of Diabetes Pub Date : 2022-12-22 DOI: 10.15277/bjd.2022.364

Y. Cheah

引用次数: 0

Reﬂections on 60 years of caring for people with diabetes 糖尿病患者60年护理回顾

IF 0.6

British Journal of Diabetes Pub Date : 2022-12-22 DOI: 10.15277/bjd.2022.362

A. Wright

引用次数: 0

beginning of the end for insulin? – enter immunotherapy for T1DM 胰岛素的终结开始了吗?-进入T1DM的免疫治疗

IF 0.6

British Journal of Diabetes Pub Date : 2022-12-22 DOI: 10.15277/bjd.2022.369

C. Dayan

{"title":"beginning of the end for insulin? – enter immunotherapy for T1DM","authors":"C. Dayan","doi":"10.15277/bjd.2022.369","DOIUrl":"https://doi.org/10.15277/bjd.2022.369","url":null,"abstract":"Although we have treated type 1 diabetes (T1DM) with insulin for more than 100 years, it has been apparent since the discovery of insulitis in the 1960s and islet cell antibodies in 1974 that T1DM is fundamentally an autoimmune disease, not a metabolic disease.1 Almost all other autoimmune diseases, from inflammatory bowel disease to rheumatoid arthritis, are treated with immunotherapy but not T1DM. In large part this is because of the discovery of insulin: unlike most other autoimmune diseases, a replacement therapy exists for T1DM. As a result, the discovery of insulin can be viewed as both a blessing and a curse. It is a “curse” because most of the major drug companies have developed their large immunotherapy portfolios of drugs for autoimmune diseases other than T1DM, including some such as psoriasis or alopecia areata that might be considered less life-threatening. And it is likely that diabetes practitioners are also partly to blame since they fear immunotherapy since it is a treatment with which they are not familiar. It is important to remind ourselves of the challenges of insulin therapy. It is not a drug without risk: deaths still occur from underdosage (DKA) and overdosage (hypoglycaemia). According to ONS data, in 2021 in England and Wales, 44 people under the age of 50 died of DKA and 154 died of hypoglycaemia.2 Set against this, even despite the introduction of CGM and insulin pumps, fewer than 30% of adults and children with diabetes achieve a target HbA1c < 7.0%, or 53 mmol/mol which obviates the risks of longterm complications.3 Furthermore, insulin management consumes millions of hours of patients and healthcare professional time in training, adjustments, testing and decision-making. Despite this, 36% of children and families continue to need psychological support more than five years after diagnosis (NPDA national audit 2018-2019,3 and up to 50% of adults with T1DM report significant diabetes-related distress. 4 There is a large and expanding world of highly selective immunotherapies that does not include the classic immunosuppressents (e.g. cyclosporin, tacrolimus) used in transplantation. Rather, it includes many drugs known as “biologics” that have been widely used and have been very well tolerated in other autoimmune diseases for more than 20 years. Many are monoclonal antibodies, but small molecule inhibitors such as JAK kinase inhibitors are being introduced.5 At least seven selective immunotherapies have shown efficacy in Phase 2 studies in preserving beta cell function from diagnosis compared to controls.6,7 These treatments reduce progression of the underlying disease process but do not cause regrowth of beta cells. In current clinical practice, T1DM is diagnosed at the time that insulin replacement is required. This is late in the disease course, when it is estimated that more than 80% of functional beta cells have been lost. When selective immunotherapy is given at this stage, some impact on insulin dose (and in some","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2022-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43790790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

What does the next 100 years hold? The perspective of a patient with T1DM 未来100年会怎样？T1DM患者的观点

IF 0.6

British Journal of Diabetes Pub Date : 2022-12-22 DOI: 10.15277/bjd.2022.380

Tim J. Street

引用次数: 0

ﬂash glucose monitoring revolution: the Sat Nav journey 血糖监测革命：卫星导航之旅

IF 0.6

British Journal of Diabetes Pub Date : 2022-12-22 DOI: 10.15277/bjd.2022.372

E. Wilmot

引用次数: 0

Sanger, Hodgkin, Yalow and the impact of insulin analogues Sanger, Hodgkin, yellow和胰岛素类似物的影响