The prevalence of diabetes for all age-groups worldwide is estimated to be 4.4% by 2030. Type 1 diabetes accounts for 5-10% of the total cases of diabetes worldwide. 10% of subjects with Type 1 diabetes may have impaired awareness of hypoglycaemia and may benefit from islet transplantation. Diabetes is also the most common pregnancy disorder with the prevalence of type 1, type 2 and gestational (GDM) diabetes all increasing among women of childbearing age.
The Scottish National Pancreatic Islet Transplant Programme
The Scottish National Pancreatic Islet Transplant Programme was launched in Scotland five years ago and has now carried out over 55 islet transplants for patients with type 1 diabetes.
The process involves islets extracted from a deceased donor's pancreas being injected into the liver of patients with type 1 diabetes. The procedure has shown to be an effective treatment for patients with type 1 diabetes who have problems recognising when their blood sugar becomes dangerously low resulting in confusion, seizures and coma. All of the patients who have received the transplant are now able to recognise when their blood sugar level drops, with some patients no longer requiring insulin injections at all.
Dr Forbes and team have published results from their programme showing excellent metabolic results with all patients regaining awareness of hypoglycaemia and many patients regaining their driver's license.
The Scotland wide programme is one of seven centres in the UK and since the inception of the programme has performed the largest proportion of islet transplants across the UK. The Scottish National Islet Transplant Programme is funded by the Scottish Government and is commissioned by NHS National Services Division.
The difference this makes to the patient's quality of life as well as their relatives quality of life is truly remarkable. All patients that require this treatment are able to access it through the NHS, although we are still only seeing the tip of the iceberg
Diabetes and Pregnancy
Diabetes is the most common pregnancy disorder with the prevalence of type 1 diabetes, type 2 diabetes and gestational (GDM) diabetes all increasing among women of childbearing age. Women with diabetes have an increased risk of perinatal complications including stillbirth, congenital anomaly and delivery of a large for gestational age infant. There is increasing evidence that infants born to mothers with type 2 diabetes and gestational diabetes are at increased risk of obesity and cardiometabolic disorders in later life.
A recent audit undertaken shows that women attending the metabolic clinic are more likely to have screening for gestational diabetes and be correctly diagnosed and managed than women with similar BMI who don’t attend the clinic. Professor Reynolds et al have recently published studies investigating insulin sensitivity in obese pregnant women attending the clinic and the results of a large randomized controlled trial ‘EMPOWAR’ in which they used the insulin sensitizer metformin as a potential candidate to improve outcomes in obese women without diabetes. In ongoing work they are investigating new treatments for women with gestational diabetes, carrying out novel MRI studies to image the developing brain of the fetuses of mothers with diabetes and making use of Scotland’s ‘big data’ to link diabetes health care records to pregnancy outcomes.
Obesity in pregnancy is a major risk factor for gestational diabetes. In our research we have been working with support from Tommy’s to understand more about the complications of obese pregnancy including gestational diabetes. We have set up a multidisciplinary antenatal metabolic clinic for women with BMI>40.