New therapeutic approaches for type 1 diabetes: Disease-modifying therapies

Abstract

It has been 100 years since the first successful clinical use of insulin, yet it remains the only treatment option for type 1 diabetes mellitus (T1DM) patients. Advances in diabetes care, such as insulin analogue therapies and new devices, including continuous glucose monitoring with continuous subcutaneous insulin infusion have improved the quality of life of patients but have no impact on the pathogenesis of the disease. They do not eliminate long-term complications and require several lifestyle sacrifices. A more ideal future therapy for T1DM, instead of supplementing the insufficient hormone production (a consequence of β-cell destruction), would also aim to stop or slow down the destructive autoimmune process. The discovery of the autoimmune nature of type 1 diabetes mellitus has presented several targets by which disease progression may be altered. The goal of disease-modifying therapies is to target autoimmune mechanisms and prevent β-cell destruction. T1DM patients with better β-cell function have better glycemic control, reduced incidence of long-term complications and hypoglycemic episodes. Unfortunately, at the time symptomatic T1DM is diagnosed, most of the insulin secreting β cells are usually lost. Therefore, to maximize the salvageable β-cell mass by disease-modifying therapies, detecting autoimmune markers in an early, optimally presymptomatic phase of T1DM is of great importance. Disease-modifying therapies, such as immuno- and regenerative therapies are expected to take a relevant place in diabetology. The aim of this article was to provide a brief insight into the pathogenesis and course of T1DM and present the current state of disease-modifying therapeutic interventions that may impact future diabetes treatment.

Keywords: Type 1 diabetes; Mesenchymal stem cell; Immunotherapy; Islet cells; Auto-immunity; Regenerative medicine

Core Tip: Our knowledge is rapidly growing about the pathomechanism of type 1 diabetes mellitus, and new and improved therapies have emerged. However, the long-term complications and the required lifestyle changes cannot be eliminated. There is a growing number of research that aims to find specific immunological markers/targets that have a role in disease development. The ultimate goal is finding new therapeutic ways to treat the disease and to delay or even prevent its development. The aim of this review was to provide a brief insight into the current state of disease-modifying therapeutic interventions that may impact future diabetes care.