beta-Cell replacement therapy's great promise is that it can safely and effectively restore insulin-independent euglycemia to individuals with diabetes. Although difficult and expensive, modern insulin-based treatment for type 1 diabetes has lead to remarkable improvements in disease prognosis (1-3). Based on recent population-based epidemiological studies, we have estimated that an individual diagnosed with type 1 diabetes today faces an excess mortality over the next 20 years of -2% or ~0.1% per year (4). Even individuals with long-standing type 1 diabetes sufficiently problematic to be listed for a pancreas transplant have an annual mortality <2.0% per year (5). The perceived weaknesses associated with intensive insulin therapy are its cost estimated in 1996 to be 116,000 USD over a lifetime (6) and its inconvenience requiring meticulous attention to diet, exercise, frequent daily blood glucose measurements, and multiple daily injections. In addition, insulin therapy carries with it an increased risk of serious hypoglycemia (1). We attempt to address whether current 3-cell replacement therapies overcome the shortcomings associated with medical management. Certainly, beta-cell replacement therapy should not increase the sub-jects' risk above that associated with standard clinical care.
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