New developments in an experimental transplant could soon make the "Edmonton Protocol" more widely available to Canadians with Type 1 diabetes.
People with Type 1 diabetes are at high risk of kidney damage and need dialysis. They can also develop eye damage that leads to blindness, and nerve damage that requires amputations. Some, who have a hard time controlling their blood sugars, are at risk of death.
Dr. James Shapiro developed and performs the Edmonton Protocol — injecting islet cells that make insulin into the liver of people with Type 1 diabetes. The procedure is done under local anesthetic. Within weeks, many patients can stop taking insulin.
"A few of the very first patients we did are still completely free of insulin now more than 11 years later," said Shapiro.
For most patients, the effect diminished over time and they had to go back for more injections, although at lower doses.
Now, Shapiro has research that shows improvements to the procedure and the anti-rejection drugs patients have to take mean more patients are staying off insulin longer.
Half are now insulin-free at five years, the same results as for pancreas transplants, said Shapiro. He estimated 20,000 Canadians with hard-to-control diabetes could benefit from the procedure, which helps regulate the amount of insulin the body needs to keep sugar levels in the right range.
Travelling for treatment
Halifax-resident Bob Inglis, 49, is one of them. Despite taking eight shots of insulin a day, Inglis's blood sugars fluctuated dangerously. For years, Inglis and his wife worried he would go to bed and not wake up.
"I would pass out or go in a coma, which has happened quite a few times in the past," recalled Inglis, who was diagnosed about 25 years ago.
In August, Inglis traveled to Edmonton for the procedure. He hasn't needed to take insulin for three months.
But there are challenges, such as a limited number of donor organs from cadavers. Alberta's research budget pays for the 10-minute procedure itself but other provinces won't pay to send patients like Inglis to Edmonton.
"It is still a research program and the evidence is not sufficient yet to warrant it being an insured procedure," said Dr. Anne Tweed, a consultant for Nova Scotia's health department in Halifax.
Fewer kidney problems
Dr. Garth Warnock's lab in Vancouver is offering such evidence. When Warnock studied patients who've had islet transplants, he found they're better off. Even if they have to take insulin again, they have fewer complications, he said.
"The long-term benefits now into the fifth year of comparison show us that kidney failure, or at least the decline of kidney function, is halted in persons who received islet transplants," said Warnock.Islet recipients are also less likely to have eye problems that can lead to blindness, Warnock has found.
Inglis said life has changed not only for himself but his family. He hopes the protocol will become the standard of care for all people with Type 1 diabetes.
So far, the protocol has been adopted in 40 centres worldwide.