Top

Published in:

01-08-2014 | Transplantation (A Pileggi, Section Editor)

Autologous Islet Transplantation in Patients Requiring Pancreatectomy for Neoplasm

Authors: Gianpaolo Balzano, Lorenzo Piemonti

Published in: Current Diabetes Reports | Issue 8/2014

Abstract

Autologous islet cell transplantation is a procedure performed to prevent or reduce the severity of diabetes after pancreatic resection. Autologous islet cell transplantation is being used almost exclusively in patients undergoing pancreatectomy because of painful, chronic pancreatitis, or multiple recurrent episodes of pancreatitis that is not controlled by standard medical and surgical treatments. Here, we discuss the possibility of extending the clinical indications for this treatment on the basis of our experience in patients undergoing pancreatic surgery for both nonmalignant and malignant diseases, including patients undergoing completion pancreatectomy because of anastomosis leakage after pancreaticoduodenectomy and those with pancreatic anastomosis deemed at high risk for failure.

1.•

Maeda H, Hanazaki K. Pancreatogenic diabetes after pancreatic resection. Pancreatology. 2011;11:268–76. This is a state-of-the-art review of pancreatogenic diabetes.PubMedCrossRef

Cui Y, Andersen DK. Pancreatogenic diabetes: special considerations for management. Pancreatology. 2011;11:279–94.PubMedCrossRef

3.••

Parsaik AK, Murad MH, Sathananthan A, et al. Metabolic and target organ outcomes after total pancreatectomy: Mayo Clinic experience and meta-analysis of the literature. Clin Endocrinol. 2010;73:723–31. This systematic review and meta-analysis focused on the clinical outcomes of total pancreatectomy in a large tertiary center, demonstrating that hypoglycemic episodes continue to be a major problem of pancreatogenic diabetes.CrossRef

Pezzilli R. Diabetic control after total pancreatectomy. Dig Liver Dis. 2006;38:420–2.PubMedCrossRef

Jethwa P, Sodergren M, Lala A, et al. Diabetic control after total pancreatectomy. Dig Liver Dis. 2006;38:415–9.PubMedCrossRef

Stauffer JA, Nguyen JH, Heckman MG, et al. Patient outcomes after total pancreatectomy: a single centre contemporary experience. HPB (Oxford). 2009;11:483–92.CrossRef

Muller MW, Friess H, Kleeff J, et al. Is there still a role for total pancreatectomy? Ann Surg. 2007;246:966–74. discussion 974–5.PubMedCrossRef

Lahat G, Ben Haim M, Nachmany I, et al. Pancreatic incidentalomas: high rate of potentially malignant tumors. J Am Coll Surg. 2009;209:313–9.PubMedCrossRef

Lemmens VE, Bosscha K, van der Schelling G, et al. Improving outcome for patients with pancreatic cancer through centralization. Br J Surg. 2011;98:1455–62.PubMedCrossRef

10.

Balzano G, Zerbi A, Capretti G, et al. Effect of hospital volume on outcome of pancreaticoduodenectomy in Italy. Br J Surg. 2008;95:357–62.PubMedCrossRef

11.

Priestley JT, Comfort MW, Sprague RG. Total pancreatectomy for hyperinsulinism due to islet-cell adenoma: follow-up report 5 1/2 years after operation, including metabolic studies. Ann Surg. 1949;130:211–7.PubMedCentralPubMedCrossRef

12.

Slezak LA, Andersen DK. Pancreatic resection: effects on glucose metabolism. World J Surg. 2001;25:452–60.PubMedCrossRef

13.

Alberti K. Diabetes secondary to pancreatopathy: an example of brittle diabetes. In: Diabetes Secondary to Pancreatopathy. International Congress Series 762. Tiengo A, DelPrato S, Vranic M, editors. Amsterdam: Excerpta Medica; 1988. p. 7–20.

14.

Billings BJ, Christein JD, Harmsen WS, et al. Quality-of-life after total pancreatectomy: is it really that bad on long-term follow-up? J Gastrointest Surg. 2005;9:1059–66. discussion 1066–7.PubMedCrossRef

15.

Kahl S, Malfertheiner P. Exocrine and endocrine pancreatic insufficiency after pancreatic surgery. Best Pract Res Clin Gastroenterol. 2004;18:947–55.PubMedCrossRef

16.

Hutchins RR, Hart RS, Pacifico M, et al. Long-term results of distal pancreatectomy for chronic pancreatitis in 90 patients. Ann Surg. 2002;236:612–8.PubMedCentralPubMedCrossRef

17.

Hutchins RR, Kojodjojo P, Ho R, et al. Short and long-term outcome of pancreatic surgery in a district general hospital. J R Coll Surg Edinb. 2002;47:548–51.PubMed

18.

Reddy S, Wolfgang CL, Cameron JL, et al. Total pancreatectomy for pancreatic adenocarcinoma: evaluation of morbidity and long-term survival. Ann Surg. 2009;250:282–7.PubMedCrossRef

19.

Sakata N, Egawa S, Motoi F, et al. Institutional indications for islet transplantation after total pancreatectomy. J Hepatobiliary Pancreat Surg. 2008;15:488–92.PubMedCrossRef

20.

Gaia E, Salacone P. Medical complications of pancreatic resections. JOP. 2007;8:114–7.PubMed

21.

Andersen DK, Andren-Sandberg A, Duell EJ, et al. Pancreatitis-diabetes-pancreatic cancer: summary of an NIDDK-NCI workshop. Pancreas. 2013;42:1227–37.PubMedCrossRef

22.

Roberts KJ, Blanco G, Webber J, et al. How severe is diabetes after total pancreatectomy? A case-matched analysis. HPB (Oxford). 2013

23.

Nosadini R, del Prato S, Tiengo A, et al. Insulin sensitivity, binding, and kinetics in pancreatogenic and type I diabetes. Diabetes. 1982;31:346–55.PubMedCrossRef

24.

Gall FP, Muhe E, Gebhardt C. Results of partial and total pancreaticoduodenectomy in 117 patients with chronic pancreatitis. World J Surg. 1981;5:269–75.PubMedCrossRef

25.

Muggeo M, Moghetti P, Faronato PP, et al. Insulin receptors on circulating blood cells from patients with pancreatogenic diabetes: a comparison with type I diabetes and normal subjects. J Endocrinol Invest. 1987;10:311–9.PubMedCrossRef

26.

Seymour NE, Volpert AR, Lee EL, et al. Alterations in hepatocyte insulin binding in chronic pancreatitis: effects of pancreatic polypeptide. Am J Surg. 1995;169:105–9. discussion 110.PubMedCrossRef

27.

Andersen DK, Ruiz CL, Burant CF. Insulin regulation of hepatic glucose transporter protein is impaired in chronic pancreatitis. Ann Surg. 1994;219:679–86. discussion 686–7.PubMedCentralPubMedCrossRef

28.

Seymour NE, Spector SA, Andersen DK, et al. Overexpression of hepatic pancreatic polypeptide receptors in chronic pancreatitis. J Surg Res. 1998;76:47–52.PubMedCrossRef

29.

Inoue K, Tobe T, Suzuki T, et al. Plasma cholecystokinin and pancreatic polypeptide response after radical pancreatoduodenectomy with Billroth I and Billroth II type of reconstruction. Ann Surg. 1987;206:148–54.PubMedCentralPubMedCrossRef

30.

Sive A, Vinik AI, Van Tonder S, Lund A. Impaired pancreatic polypeptide secretion in chronic pancreatitis. J Clin Endocrinol Metab. 1978;47:556–9.PubMedCrossRef

31.

Adrian TE, McKiernan J, Johnstone DI, et al. Hormonal abnormalities of the pancreas and gut in cystic fibrosis. Gastroenterology. 1980;79:460–5.PubMed

32.

Bajorunas DR, Fortner JG, Jaspan J, Sherwin RS. Total pancreatectomy increases the metabolic response to glucagon in humans. J Clin Endocrinol Metab. 1986;63:439–46.PubMedCrossRef

33.

Schrader H, Menge BA, Breuer TG, et al. Impaired glucose-induced glucagon suppression after partial pancreatectomy. J Clin Endocrinol Metab. 2009;94:2857–63.PubMedCrossRef

34.

Donowitz M, Hendler R, Spiro HM, et al. Glucagon secretion in acute and chronic pancreatitis. Ann Intern Med. 1975;83:778–81.PubMedCrossRef

35.

Linehan IP, Lambert MA, Brown DC, et al. Total pancreatectomy for chronic pancreatitis. Gut. 1988;29:358–65.PubMedCentralPubMedCrossRef

36.

Knop FK, Vilsboll T, Larsen S, et al. Increased postprandial responses of GLP-1 and GIP in patients with chronic pancreatitis and steatorrhea following pancreatic enzyme substitution. Am J Physiol Endocrinol Metab. 2007;292:E324–30.PubMedCrossRef

37.

Ewald N, Bretzel RG, Fantus IG, et al. Pancreatin therapy in patients with insulin-treated diabetes mellitus and exocrine pancreatic insufficiency according to low fecal elastase 1 concentrations. Results of a prospective multi-center trial. Diabetes Metab Res Rev. 2007;23:386–91.PubMedCrossRef

38.

Kendall DM, Sutherland DE, Najarian JS, et al. Effects of hemipancreatectomy on insulin secretion and glucose tolerance in healthy humans. N Engl J Med. 1990;322:898–903.PubMedCrossRef

39.

Kumar AF, Gruessner RW, Seaquist ER. Risk of glucose intolerance and diabetes in hemipancreatectomized donors selected for normal preoperative glucose metabolism. Diabetes Care. 2008;31:1639–43.PubMedCentralPubMedCrossRef

40.

Malka D, Hammel P, Sauvanet A, et al. Risk factors for diabetes mellitus in chronic pancreatitis. Gastroenterology. 2000;119:1324–32.PubMedCrossRef

41.

Andersen DK, Frey CF. The evolution of the surgical treatment of chronic pancreatitis. Ann Surg. 2010;251:18–32.PubMedCrossRef

42.

Bellin MD, Balamurugan AN, Pruett TL, Sutherland DE. No islets left behind: islet autotransplantation for surgery-induced diabetes. Curr Diab Rep. 2012;12:580–6.PubMedCentralPubMedCrossRef

43.

Bramis K, Gordon-Weeks AN, Friend PJ, et al. Systematic review of total pancreatectomy and islet autotransplantation for chronic pancreatitis. Br J Surg. 2012;99:761–6.PubMedCrossRef

44.

Dong M, Parsaik AK, Erwin PJ, et al. Systematic review and meta-analysis: islet autotransplantation after pancreatectomy for minimizing diabetes. Clin Endocrinol. 2011;75:771–9.CrossRef

45.

Najarian JS, Sutherland DE, Matas AJ, Goetz FC. Human islet autotransplantation following pancreatectomy. Transplant Proc. 1979;11:336–40.PubMed

46.

Piemonti L, Pileggi A. 25 Years of the Ricordi Automated Method for islet isolation. CellR4. 2013;1:e128.

47.••

Sutherland DE, Radosevich DM, Bellin MD, et al. Total pancreatectomy and islet autotransplantation for chronic pancreatitis. J Am Coll Surg. 2012;214:409–24. This is the largest published cohort of IAT after pancreatectomy for chronic pancreatitis.PubMedCentralPubMedCrossRef

48.

Bellin MD, Beilman GJ, Dunn TB, et al. Islet autotransplantation to preserve beta cell mass in selected patients with chronic pancreatitis and diabetes mellitus undergoing total pancreatectomy. Pancreas. 2013;42:317–21.PubMedCentralPubMedCrossRef

49.

Bellin MD, Freeman ML, Schwarzenberg SJ, et al. Quality of life improves for pediatric patients after total pancreatectomy and islet autotransplant for chronic pancreatitis. Clin Gastroenterol Hepatol. 2011;9:793–9.PubMedCentralPubMedCrossRef

50.

Bellin MD, Carlson AM, Kobayashi T, et al. Outcome after pancreatectomy and islet autotransplantation in a pediatric population. J Pediatr Gastroenterol Nutr. 2008;47:37–44.PubMedCrossRef

51.

Wilson GC, Sutton JM, Salehi M, et al. Surgical outcomes after total pancreatectomy and islet cell autotransplantation in pediatric patients. Surgery. 2013;154:777–83. discussion 783–4.PubMedCrossRef

52.

Sutton JM, Schmulewitz N, Sussman JJ, et al. Total pancreatectomy and islet cell autotransplantation as a means of treating patients with genetically linked pancreatitis. Surgery. 2010;148:676–85. discussion 685–6.PubMedCrossRef

53.

Webb MA, Illouz SC, Pollard CA, et al. Islet auto transplantation following total pancreatectomy: a long-term assessment of graft function. Pancreas. 2008;37:282–7.PubMedCrossRef

54.

Clayton HA, Davies JE, Pollard CA, et al. Pancreatectomy with islet autotransplantation for the treatment of severe chronic pancreatitis: the first 40 patients at the Leicester General Hospital. Transplantation. 2003;76:92–8.PubMedCrossRef

55.

White SA, Davies JE, Pollard C, et al. Pancreas resection and islet autotransplantation for end-stage chronic pancreatitis. Ann Surg. 2001;233:423–31.PubMedCentralPubMedCrossRef

56.

Garcea G, Weaver J, Phillips J, et al. Total pancreatectomy with and without islet cell transplantation for chronic pancreatitis: a series of 85 consecutive patients. Pancreas. 2009;38:1–7.PubMedCrossRef

57.

Ahmad SA, Lowy AM, Wray CJ, et al. Factors associated with insulin and narcotic independence after islet autotransplantation in patients with severe chronic pancreatitis. J Am Coll Surg. 2005;201:680–7.PubMedCrossRef

58.

Morgan KA, Nishimura M, Uflacker R, Adams DB. Percutaneous transhepatic islet cell autotransplantation after pancreatectomy for chronic pancreatitis: a novel approach. HPB (Oxford). 2011;13:511–6.CrossRef

59.

Sutherland DE, Gruessner AC, Carlson AM, et al. Islet autotransplant outcomes after total pancreatectomy: a contrast to islet allograft outcomes. Transplantation. 2008;86:1799–802.PubMedCrossRef

60.

Dudeja V, Beilman GJ, Vickers SM. Total pancreatectomy with islet autotransplantation in patients with malignancy: are we there yet? Ann Surg. 2013;258:219–20.PubMedCrossRef

61.••

Balzano G, Maffi P, Nano R, et al. Extending indications for islet autotransplantation in pancreatic surgery. Ann Surg. 2013;258:210–8. This is the largest published cohort of IAT after pancreatectomy for diseases other than chronic pancreatitis.PubMedCrossRef

62.•

Ris F, Niclauss N, Morel P, et al. Islet autotransplantation after extended pancreatectomy for focal benign disease of the pancreas. Transplantation. 2011;91:895–901. This article reports on a cohort of IAT after partial pancreatectomy for benign neoplasm with longer follow-up.PubMedCrossRef

63.•

Jin SM, Oh SH, Kim SK, et al. Diabetes-free survival in patients who underwent islet autotransplantation after 50 % to 60 % distal partial pancreatectomy for benign pancreatic tumors. Transplantation. 2013;95:1396–403. This is the largest published cohort of IAT after partial pancreatectomy for benign neoplasm.PubMedCrossRef

64.

Launois B, Franci J, Bardaxoglou E, et al. Total pancreatectomy for ductal adenocarcinoma of the pancreas with special reference to resection of the portal vein and multicentric cancer. World J Surg. 1993;17:122–6. discussion 126–7.PubMedCrossRef

65.

Tryka AF, Brooks JR. Histopathology in the evaluation of total pancreatectomy for ductal carcinoma. Ann Surg. 1979;190:373–81.PubMedCentralPubMedCrossRef

66.

Motojima K, Urano T, Nagata Y, et al. Detection of point mutations in the Kirsten-ras oncogene provides evidence for the multicentricity of pancreatic carcinoma. Ann Surg. 1993;217:138–43.PubMedCentralPubMedCrossRef

67.

Balamurugan AN, Loganathan G, Bellin MD, et al. A new enzyme mixture to increase the yield and transplant rate of autologous and allogeneic human islet products. Transplantation. 2012;93:693–702.PubMedCentralPubMedCrossRef

68.

Karpoff HM, Klimstra DS, Brennan MF, Conlon KC. Results of total pancreatectomy for adenocarcinoma of the pancreas. Arch Surg. 2001;136:44–7. discussion 48.PubMedCrossRef

69.

Schnelldorfer T, Lombardo KR, Farnell M, Sarr M. Total Pancreatectomy for Treatment of Pancreatic Adenocarcinoma. In: Lowy A, Leach S, Philip P, editors. Pancreatic Cancer. US: Springer; 2008. p. p. 329–39.CrossRef

70.

Kloppel G, Lohse T, Bosslet K, Ruckert K. Ductal adenocarcinoma of the head of the pancreas: incidence of tumor involvement beyond the Whipple resection line. Histological and immunocytochemical analysis of 37 total pancreatectomy specimens. Pancreas. 1987;2:170–5.PubMedCrossRef

71.

Kobayashi T, Sato Y, Hirukawa H, et al. Total pancreatectomy combined with partial pancreas autotransplantation for recurrent pancreatic cancer: a case report. Transplant Proc. 2012;44:1176–9.PubMedCrossRef

72.

Alsaif F, Molinari M, Al-Masloom A, et al. Pancreatic islet autotransplantation with completion pancreatectomy in the management of uncontrolled pancreatic fistula after whipple resection for ampullary adenocarcinoma. Pancreas. 2006;32:430–1.PubMedCrossRef

73.

Forster S, Liu X, Adam U, et al. Islet autotransplantation combined with pancreatectomy for treatment of pancreatic adenocarcinoma: a case report. Transplant Proc. 2004;36:1125–6.PubMedCrossRef

74.

Iyegha UP, Asghar JA, Beilman GJ. Total pancreatectomy and islet auto-transplantation as treatment for ampullary adenocarcinoma in the setting of pancreatic ductal disruption secondary to acute necrotizing pancreatitis. A case report. JOP. 2012;13:239–42.PubMed

75.

Lee BW, Jee JH, Heo JS, et al. The favorable outcome of human islet transplantation in Korea: experiences of 10 autologous transplantations. Transplantation. 2005;79:1568–74.PubMedCrossRef

76.

Callery MP, Pratt WB, Vollmer Jr CM. Prevention and management of pancreatic fistula. J Gastrointest Surg. 2009;13:163–73.PubMedCrossRef

77.

Kuroki T, Tajima Y, Kanematsu T. Surgical management for the prevention of pancreatic fistula following distal pancreatectomy. J Hepatobiliary Pancreat Surg. 2005;12:283–5.PubMedCrossRef

78.

Niedergethmann M, Farag Soliman M, Post S. Postoperative complications of pancreatic cancer surgery. Minerva Chir. 2004;59:175–83.PubMed

79.

Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138:8–13.PubMedCrossRef

80.

Bassi C, Butturini G, Molinari E, et al. Pancreatic fistula rate after pancreatic resection. The importance of definitions. Dig Surg. 2004;21:54–9.PubMedCrossRef

81.

Yeo CJ, Cameron JL, Maher MM, et al. A prospective randomized trial of pancreaticogastrostomy vs pancreaticojejunostomy after pancreaticoduodenectomy. Ann Surg. 1995;222:580–8. discussion 588–92.PubMedCentralPubMedCrossRef

82.

Strasberg SM, Linehan DC, Clavien PA, Barkun JS. Proposal for definition and severity grading of pancreatic anastomosis failure and pancreatic occlusion failure. Surgery. 2007;141:420–6.PubMedCrossRef

83.

Richter A, Niedergethmann M, Sturm JW, et al. Long-term results of partial pancreaticoduodenectomy for ductal adenocarcinoma of the pancreatic head: 25-year experience. World J Surg. 2003;27:324–9.PubMedCrossRef

84.

Batignani G, Fratini G, Zuckermann M, et al. Comparison of Wirsung-jejunal duct-to-mucosa and dunking technique for pancreatojejunostomy after pancreatoduodenectomy. Hepatobiliary Pancreat Dis Int. 2005;4:450–5.PubMed

85.

Yeo CJ. The Johns Hopkins experience with pancreaticoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma. J Gastrointest Surg. 2000;4:231–2.PubMedCrossRef

86.

Matsumoto Y, Fujii H, Miura K, et al. Successful pancreatojejunal anastomosis for pancreatoduodenectomy. Surg Gynecol Obstet. 1992;175:555–62.PubMed

87.

Kojima Y, Katayama K, Note M, et al. Pancreaticojejunostomy and pancreatic leakage after pancreaticoduodenectomy. Int Surg. 1992;77:80–3.PubMed

88.

Kollmar O, Moussavian MR, Bolli M, et al. Pancreatojejunal leakage after pancreas head resection: anatomic and surgeon-related factors. J Gastrointest Surg. 2007;11:1699–703.PubMedCrossRef

89.

Pratt WB, Callery MP, Vollmer Jr CM. Risk prediction for development of pancreatic fistula using the ISGPF classification scheme. World J Surg. 2008;32:419–28.PubMedCrossRef

90.

Balzano G, Pecorelli N, Piemonti L, et al. Relaparotomy for a pancreatic fistula after a pancreaticoduodenectomy: a comparison of different surgical strategies. HPB (Oxford). 2014;16:40–5.CrossRef

91.

Christoffersson G, Henriksnas J, Johansson L, et al. Clinical and experimental pancreatic islet transplantation to striated muscle: establishment of a vascular system similar to that in native islets. Diabetes. 2010;59:2569–78.PubMedCentralPubMedCrossRef

92.

Berney T, Mathe Z, Bucher P, et al. Islet autotransplantation for the prevention of surgical diabetes after extended pancreatectomy for the resection of benign tumors of the pancreas. Transplant Proc. 2004;36:1123–4.PubMedCrossRef

93.

Oberholzer J, Mathe Z, Bucher P, et al. Islet autotransplantation after left pancreatectomy for non-enucleable insulinoma. Am J Transplant. 2003;3:1302–7.PubMedCrossRef

94.

Garraway NR, Dean S, Buczkowski A, et al. Islet autotransplantation after distal pancreatectomy for pancreatic trauma. J Trauma. 2009;67:E187–9.PubMedCrossRef

95.

Dardenne S, Sterkers A, Leroy C, et al. Laparoscopic spleen-preserving distal pancreatectomy followed by intramuscular autologous islet transplantation for traumatic pancreatic transection in a young adult. JOP. 2012;13:285–8.PubMed

96.

Sakata N, Goto M, Motoi F, et al. Clinical experiences in the treatment of pancreatic arteriovenous malformation by total pancreatectomy with islet autotransplantation. Transplantation. 2013;96:e38–40.PubMedCrossRef

97.

Jung HS, Choi SH, Kim SJ, et al. Delayed improvement of insulin secretion after autologous islet transplantation in partially pancreatectomized patients. Metabolism. 2009;58:1629–35.PubMedCrossRef

98.

Gala-Lopez BL, Semlacher E, Manouchehri N, et al. Autologous islet transplantation after total pancreatectomy for renal cell carcinoma metastases. Am J Transplant. 2013;13:2487–91.PubMedCrossRef

99.

Khan A, Jindal RM, Shriver C, et al. Remote processing of pancreas can restore normal glucose homeostasis in autologous islet transplantation after traumatic whipple pancreatectomy: technical considerations. Cell Transplant. 2012;21:1261–7.PubMedCrossRef

100.

Jindal RM, Ricordi C, Shriver CD. Autologous pancreatic islet transplantation for severe trauma. N Engl J Med. 2010;362:1550.PubMedCrossRef

101.

Liu X, Forster S, Adam U, et al. Islet autotransplantation combined with total pancreatectomy for treatment of pancreatic adenocarcinoma. Transplant Proc. 2001;33:662–3.PubMedCrossRef

Title: Autologous Islet Transplantation in Patients Requiring Pancreatectomy for Neoplasm
Authors: Gianpaolo Balzano
Lorenzo Piemonti
Publication date: 01-08-2014
Publisher: Springer US
Published in: Current Diabetes Reports / Issue 8/2014
Print ISSN: 1534-4827
Electronic ISSN: 1539-0829
DOI: https://doi.org/10.1007/s11892-014-0512-2

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 8/2014

Goal Setting: An Integral Component of Effective Diabetes Care

Anti-VEGF Therapy for Diabetic Macular Edema

Ultra Widefield Fundus Imaging for Diabetic Retinopathy

Obesity and Type 2 Diabetes in Children: Epidemiology and Treatment

Resistant Hypertension in Diabetes Mellitus

Genetics of Diabetic Retinopathy

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials