Globally, over 537 million adults are living with diabetes mellitus. Treatment of diabetes poses a large burden on patients, since it relies predominantly on the patient’s daily self-management.... Show moreGlobally, over 537 million adults are living with diabetes mellitus. Treatment of diabetes poses a large burden on patients, since it relies predominantly on the patient’s daily self-management. Therefore, providing the patient with a care plan that fits seamlessly in one’s daily routines, is in line with their values and preferences and does not overburden their capacities, is of major importance. In order to make diabetes care fit, clinicians and patients need to collaborate and share their knowledge and experience. One possible approach to this collaboration is shared decision making (SDM). In SDM, patients and clinicians partner up and work together to decide on the best available healthcare strategy for the individual patient, taking into account both the best available evidence, and the patient’s preferences, needs and context. This thesis aimed to explore patient and clinician efforts towards making diabetes care fit. In this exploration we aimed to provide insight in the factors driving the decision making process, discuss various strategies to tailor SDM to the patient’s situation, needs and preferences, and explore ways to support the patient and the patient-clinician partnership in diabetes care. Show less
Control of allo- and auto-immunity is important for pancreas and islet transplantations. In chapter 2 different mechanism of actions of humanized monoclonal antibodies against CD3 and CD25 versus... Show moreControl of allo- and auto-immunity is important for pancreas and islet transplantations. In chapter 2 different mechanism of actions of humanized monoclonal antibodies against CD3 and CD25 versus ATG are described. ATG leads to depletion of auto-reactive T-cells by ADCC, CDC and apoptosis induction, while anti-CD3 and daclizumab inhibited T-cell autoreactivity in a non-depleting fashion. In chapter 3, our experience with induction therapy with ATG and daclizumab was reported. ATG Fresenius or daclizumab were well tolerated and equally effective in reducing the incidence of acute rejections in simultaneous pancreas kidney transplantation. Data in Chapter 4 imply that daclizumab is more specifically affecting diabetes related immune responses compared to ATG. Islet transplantation provides an attractive and less invasive alternative to whole-organ pancreas transplantation. In chapter 5 we demonstrated the ability of our T-cell monitoring methods to determine the fate of repeated islet allografts transplanted into patients that express repeated mismatches. In most pancreas transplantations the enteric drainage is favoured exocrine duct management. Facing a higher risk on anastomotic complications in enteric drained pancreas transplantations, primary bladder drainage may be the preferred option. In Chapter 6, we demonstrated that primary bladder drainage followed by enteric conversion is a safe and effective procedure. Show less
