Emerging frontiers in type 1 diabetes: exploring novel therapies and their potential to transform care
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Citation
Abstract
Incidence of type 1 diabetes mellitus (T1DM) is rapidly increasing and there are no cures for this disease. There is a significant cost burden placed on patients and healthcare systems due to type 1 diabetes mellitus. Most patients diagnosed are not meeting their glycemic targets with insulin administration alone. There is a call for therapies and treatments that replenish beta cell mass in turn halting or even reversing disease progression. Current treatments for T1DM include insulin monotherapy, adjunctive therapies to insulin, such as biguanide, GLP-1 RA, SGLT2 inhibitor, and amylin analog drugs, and transplantation. The adjunctive therapies have been shown to be beneficial for an overweight and obese patient population by reducing BMI, HbA1C, and insulin resistance. However, some of these adjuvant therapies, such as SGLT2 inhibitors and amylin analogs, have been shown to increase the risk of adverse events such as diabetic ketoacidosis, nausea, and vomiting. Whole-organ and islet transplantation both require donor tissue and lifelong immunosuppressive drug administration. There is a significant shortage of donor tissue and lifelong immunosuppression can lead to increased risk of infection. Even with the benefits of transplantation, such as achieving insulin independence, most patients revert back to insulin monotherapy after five years. Emerging research has led to new avenues of treatment such as stem cell-derived islet transplantation, fully closed-loop insulin delivery systems, pancreatic organoid models, and immunotherapies like teplizumab. Fully closed-loop insulin delivery systems, also known as artificial pancreas systems, have reduced the burden of carbohydrate counting and bolus administration, as well as increase the time spent in the optimal blood glucose range, improving overall glycemic control, however, these systems are not yet widely available. Pancreatic organoid models have been shown to be useful in modeling T1DM pathophysiology as well as testing the efficacy of drugs such as liraglutide, a GLP-1 RA. Therapies such as stem-cell derived islet transplantation and teplizumab treatment have shown promise in reversing or delaying the onset of T1DM. Teplizumab has also shown that it can increase C-peptide to clinically significant levels (>0.2 pmol/mL) in patients with new-onset T1DM. Although these treatments are not without their side effects, they should be more widely available as standard treatments and prevention for T1DM.
Description
2025
License
Attribution 4.0 International