Glucagon-like peptide 1 (GLP-1) exerts many actions that improve glycemic control. GLP-1 stimulates glucose-stimulated insulin secretion and protects β cells, while its extrapancreatic effects include cardioprotection, reduction of hepatic glucose production, and regulation of satiety. Although an appealing antidiabetic drug candidate, the rapid degradation of GLP-1 by dipeptidyl peptidase 4 (DPP-4) means that its therapeutic use is unfeasible, and this prompted the development of two main GLP-1 therapies: long-acting GLP-1 analogs and DPP-4 inhibitors. In this review, we focus on the pancreatic effects exerted by current GLP-1 derivatives used to treat diabetes. Based on the results from in vitro and in vivo studies in humans and animal models, we describe the specific actions of GLP-1 analogs on the synthesis, processing, and secretion of insulin, islet morphology, and β cell proliferation and apoptosis.

Glucagon-Like Peptide 1 Analogs and their Effects on Pancreatic Islets.

Allogeneic islet transplantation (IT) provokes changes in metabolic responses and nutritional behaviors. The durability of these changes needs to be described as well as their impact on the recipients' lifestyle. The goal of this study was to investigate how islet transplantation influenced diet, exercise habits, and body composition during 10 years after IT. A retrospective study performed in 33 (14 males, 19 females) IT recipients used dietary, physical activity open- ended questionnaire and anthropometric measurements. Data were collected before transplantation, every 3 months up to the 18th and every 6 months thereafter. Data were grouped by gender and eras: pre-IT; 0–3 years; 4–6 years, and 7–10 years after IT. Reduction in body mass index (BMI) from pre-IT to 0–3 years was noted: 23.68 ± 2,18 kg/m2 to 22.07 ± 2.94 kg/m2 (P

Ten years' evaluation of diet, anthropometry, and physical exercise adherence after islet allotransplantation.

SUMMARY Most people with Type 1 diabetes are managed by insulin injections, with many not achieving glycemic targets, placing them at an increased risk of complications. The reasons behind suboptimal control are numerous but include limitations of insulin therapy. People with Type 1 diabetes may have residual β-cell function for many years after diagnosis. Almost all have inappropriate glucagon release contributing to poor glycemic control. Agents that preserve or enhance β-cell function along with therapies that improve α-cell function, glucagon regulation and insulin sensitivity are currently being actively evaluated. This review focuses on agents that in combination with insulin are likely to have a beneficial role in the prevention and progression of Type 1 diabetes and the optimization of medical care.

https://www.openaccessjournals.com/articles/an-overview-of-noninsulin-adjunctive-therapies-for-type-1-diabetes.pdf

An overview of non-insulin adjunctive therapies for Type 1 diabetes

The Diabetes Research Institute (DRI) at the University of Miami, Miller School of Medicine has been performing clinical islet transplantation (ITx) for select patients with type-1 diabetes mellitus (T1DM) and hypoglycemia unawareness since 1985. Over these years, the DRI has blossomed into one of the largest independent ITx centers worldwide, spearheading improvements in multiple aspects of islet isolation and transplantation. Our group has also made important strides in the medical management of ITx patients, applying unique aspects of care including adjuvant therapies to sustain islet function, dietetic follow-up during the posttransplant period, and exploration of immunological assays to assist with individualization of immunosuppressive therapy. Overall, our work has demonstrated the ability of ITx to confer improvements in patient quality of life, and additionally provided a foundation to fuel continued efforts to gain governmental approval of ITx as a clinically available therapy for patients with T1DM in the United States.

Treating diabetes with islet transplantation: Lessons from the University of Miami

Type 1 diabetes mellitus is an autoimmune disease that is characterized by the destruction of the islets of Langerhans cells which produce insulin. The current gold standard treatment is exogenous insulin injection, but this is onerous for the patients, and can lead to severe complications. Another approach involves transplanting pancreatic islet cells in order to restore endogenous insulin production under physiologic regulation. Although there has been some success with this treatment plan, there have been several hurdles. The largest hurdle is improving the 5 year survival of the graft, which is currently at 10%. In order to do so, there has been research into better locations for the graft, better isolation techniques, alternate immune suppression regimens, and novel transplantation methodologies utilizing encapsulated grafts. Another hurdle for pancreatic islet transplantation is that current methodologies require islets from several pancreata in order to create one successful graft, which leads to difficulties since there is a limited supply. However, there has been research looking into single donor transplants and porcine xenografts to increase the supply and address this problem. In this article, we review the current state of research regarding pancreatic islet transplantation.

Pancreatic islet transplantation in type 1 diabetes mellitus: an update on recent developments

Objective
To evaluate the effect of exenatide on gastric emptying and long-term metabolic control.

Effect of Exenatide on Gastric Emptying and Graft Survival in Islet Allograft Recipients

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Effect of Exenatide on Gastric Emptying and Graft Survival in Islet Allograft Recipients