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Although the success rate of islet transplantation for patients with type 1 diabetes has improved, many issues still need to be resolved. In this Viewpoint, the authors highlight areas of concern, including the inefficiency of current isolation protocols and the occurrence of adverse events, and ask how the efficacy of this procedure can be enhanced.
Hypoglycemia-associated autonomic failure (HAAF) describes the syndromes of defective glucose regulation and hypoglycemia unawareness. Originally characterized in type 1 diabetes, the author of this Viewpoint suggests that HAAF is also a component of iatrogenic hypoglycemia in patients with type 2 diabetes, and represents a barrier to glycemic control.
Foot problems are a very common complication of type 1 and type 2 diabetes. Most are neuropathic in origin and should be preventable. This Review details preventative strategies, and the many monitoring and treatment options currently available, for a condition that has major consequences for patients and health-care providers.
This Review examines the pros and cons of screening for coronary heart disease in asymptomatic subjects with diabetes. At present, there is insufficient evidence of clinical benefit to justify such a practice; therefore, carefully conducted clinical trials are urgently required to resolve the question.
Fulminant type 1 diabetes appears to a disease subtype that features a characteristic range of clinical symptoms, with extremely rapid onset, and thus must be treated very quickly. It is currently prevalent in Japan, and might be associated with particular genotypes and possibly with viral infection.
Endothelial dysfunction occurs commonly in diabetes and insulin resistance. This Review describes mechanisms that promote development of atherosclerosis in these conditions through changes in endothelial cell signaling and function. Such mechanisms might be drug targets, and endothelium-dependent vasodilation and other tests could be used to monitor the efficacy of interventions.
Hyperinsulinism is the single commonest cause of hypoglycemia in infants. This Review describes the five known mutations that cause congenital hyperinsulinism, and the other forms of hyperinsulinism. It also details the diagnostic approach and treatment options, emphasizing the need for a multidisciplinary approach.
