Assessment of Insulin Sensitivity and β Cell Function by Clamps Studies
Condition: Diabetes Mellitus, Non-Insulin-Dependent
MeSH terms: Insulin Resistance; Diabetes Mellitus, Type 2
Study type: Interventional
Phase: Phase 2/Phase 3

Summary: 
      India is the "Diabetes Capital of the World" with 41 million Indians having diabetes i.e.
      every fifth diabetic in the world is an Indian. Type 2 Diabetes Mellitus (T2DM) constitutes
      the major chunk of diabetes and has insulin resistance as the hallmark feature in the
      pathogenesis. However, with the progression of the disease the insulin resistance becomes
      stable whereas β - cell function shows a gradual decline due to its ongoing apoptosis. This
      ultimately leads to inability of the β - cells to cope up with the increased demand of
      insulin caused due to insulin resistance and manifests as hyperglycemia. As β - cell failure
      is progressive and inexorable, as demonstrated in United Kingdom Prospective Diabetes Study,
      most of the patients with T2DM would eventually require insulin and it would be difficult to
      achieve to attain a strict glycemic control . It is well known that diabetes related
      complications which account for morbidity and mortality in this disease can be prevented or
      delayed by strict glycemic control. However, even with intensive insulin therapy it has been
      shown that glycemic control can never be perfect with patients exhibiting hyperglycemia or
      hypoglycemia during 24 hour glucose profile. Also insulin therapy is not physiological as
      there is no hepatic "first - pass" metabolism of insulin which is required for halting the
      hepatic glucose output, which is responsible for fasting hyperglycemia. This led the
      researchers to evolve various strategies of β - cell replacement therapy e.g. pancreatic
      transplantation and islet cell transplantation. Initially the results of islet cell
      transplantation were dismal but after the induction of glucocorticoid free immunosuppressive
      therapy and the use of adequate number of islet cells from multiple donors, the results of
      islet cell transplantation have been better. However, islet cell transplantation has its own
      limitations viz insufficient supply, being technically demanding and requirement of lifelong
      immunosuppressive therapy in the recipient.
    

Detailed description: 
      The shortcomings can be overcome by the use of stem cells which is an inexhaustible source of
      β -cells. Stem cells are primitive cells capable of differentiating into mature cells of the
      body of various lineages. Stem cells can be obtained from various sources like blastocyst
      (embryonal stem cells), umbilical cord or bone marrow. There is an evidence to suggest that
      stem cell transplantation can lead to improvement in pancreatic endocrine function and
      improvement in glycemic control in diabetic mice through various mechanisms such as
      transdifferentiation or regeneration of endothelial cell in the damaged islets which in turn
      lead to regeneration of islet cells by paracrine action. However, till date there is no study
      that demonstrates that stem cell therapy can be effective in patients with T2DM for their
      glycemic control.

      The investigators propose to carry out autologous bone marrow - derived stem cell
      transplantation (ABMSCT) in patients of T2DM, obtained from their own bone marrow and its
      superselective injection into the gastroduodenal artery after purification without any
      immunosuppressive regimen.
    

Intervention name(s): MNCs
Intervention type(s): Biological
Intervention description(s): 200 - 300 ml of bone marrow will be aspirated and layered on density gradient medium (Ficoll - hypaque ) and stem cells will be separated. Separated mono nucleated cells will injected into superior pancreatico duodenal artery. Patients will be urged to monitor and document blood glucose readings for next 6 months. Glucagon stimulated C - peptide HYPERGLYCEMIC CLAMP FOR ASSESSMENT OF BETA CELL FUNCTION , AND EUGLYCEMIC CLAMP TO ASSESS INSULIN SENSITIVITY .Homeostasis Model of Assessment - Insulin Resistance and Beta cell function ,HbA1c, lipid profile and biochemistry will be done at baseline and 6 months
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment