[CITATION][C] Lessons Learned from Use of Cyclosporine for Insulin‐Dependent Diabetes Mellitus: The Case for Immunotherapy for Insulin‐Dependent Diabetics …
JL Mahon, J Dupre, CR Stiller - … of the New York Academy of …, 1993 - Wiley Online Library
JL Mahon, J Dupre, CR Stiller
Annals of the New York Academy of Sciences, 1993•Wiley Online LibraryInsulin-dependent diabetes mellitus (IDDM) is marked by selective loss of the beta-cells of
the pancreas, hyperglycemia, and a tendency to ketosis. For 70 years, the mainstay of
therapy has been lifelong, daily insulin injections following symptomatic beta-cell failure.
Despite this, IDDM has conveyed an immense societal and personal burden of suffering
through premature mortality,'structural complications, 1.2 and the direct and indirect costs
attending these problem^.^ This poor outcome, and laboratory and clinical observations that …
the pancreas, hyperglycemia, and a tendency to ketosis. For 70 years, the mainstay of
therapy has been lifelong, daily insulin injections following symptomatic beta-cell failure.
Despite this, IDDM has conveyed an immense societal and personal burden of suffering
through premature mortality,'structural complications, 1.2 and the direct and indirect costs
attending these problem^.^ This poor outcome, and laboratory and clinical observations that …
Insulin-dependent diabetes mellitus (IDDM) is marked by selective loss of the beta-cells of the pancreas, hyperglycemia, and a tendency to ketosis. For 70 years, the mainstay of therapy has been lifelong, daily insulin injections following symptomatic beta-cell failure. Despite this, IDDM has conveyed an immense societal and personal burden of suffering through premature mortality,'structural complications, 1.2 and the direct and indirect costs attending these problem^.^ This poor outcome, and laboratory and clinical observations that suggested that beta-cell loss was immune mediated in IDDM? led to trials of cyclosporine for newly diagnosed IDDM in the 1980~.~-'~ Long-term use of cyclosporine has not emerged as a viable treatment for IDDM largely because of the drug's potential for irreversible nephrotoxi~ ity.~~ J~ However, these trials yielded insights that may eventually lead to a substantive reduction in the burden of IDDM. In this paper, we will first summarize the experience with cyclosporine for IDDM with emphasis on the randomized trials. We will then outline some lessons from this experience. Finally, using these lessons and the findings of the recently completed Diabetes Control and Complications Trial, we will develop an argument for further, careful testing of immunotherapy in insulindependent diabetics having residual insulin secretion.
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