Preserving Insulin Secretion in Type 1 Diabetes

Although the treatment of type 1 diabetes (T1D) has greatly improved over the past few decades, researchers have yet to find a way to completely normalize blood sugar levels. Because managing T1D  requires extensive self-monitoring and self-care, new approaches are needed.

In the Annals of the New York Academy of Sciences, Mary Pat Gallagher, MD, and Robin Goland, MD, of Columbia’s Naomi Berrie Diabetes Center, along with Carla J. Greenbaum, MD, of the Benaroya Research Institute in Seattle, review the progress in treating T1D.

In T1D, the immune system destroys the pancreas’s beta cells, which store and release insulin. The authors describe promising trials aimed at preserving insulin production in new-onset cases of T1D by modifying the immune system’s assault on the beta cells. Less successful have been attempts to prevent onset of the disease.

Several experimental drugs that slowed the rate of beta cell deterioration during the early stages of T1D became less effective over time, until they were no better than a placebo. It may be that such drugs should be taken at an earlier stage of the disease.

In T1D the autoimmune response would attack any new, transplanted beta cells. Therefore, once beta cell replacement becomes clinically feasible, a therapy will still be needed to stop beta cell destruction.