Iatrogenic Diabetes

Diabetes following surgical removal of the pancreas for organic diseases is one other possible indication for (3-cell replacement. Total pancreatectomy performed to relieve the pain associated with chronic pancreatitis invariably results in insulin-dependent diabetes. Approximately 50% of the patients develop diabetes within 5 to 10 years from onset of chronic pancreatitis, even in the absence of surgery. After surgery, one of the main reasons for hospital readmission is poor management of diabetes mellitus in these patients, suggesting the importance of preserving endocrine function by (-cell replacement. Additional causes of iatrogenic diabetes that could benefit of (-cell transplantation include total pancreatectomy following trauma or benign neoplasm.

Metabolic Disorders

Diabetes can also be associated with metabolic disorders. A proportion of patients affected by cystic fibrosis (CF) may develop diabetes, and its development appears to have substantial impact on pulmonary function and significantly increases morbidity and mortality rates. Most patients with cirrhosis have insulin resistance and impaired glucose tolerance, and about 20% eventually develop type 2 diabetes (Bahtiyar et al, 2004). Patients with type 2 diabetes may require insulin treatment and develop diabetes-related complications, including kidney failure. Transplantation of insulin producing cells in these patients may provide the same benefits discussed for patients with T1DM, although advanced age and obesity may represent contraindications due to the increased risk of morbidity (Sutherland et al, 2001; Friedman and Friedman, 2002).

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