Type 1 diabetes mellitus: much progress, many opportunities
Alvin C. Powers
Alvin C. Powers
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Review Series

Type 1 diabetes mellitus: much progress, many opportunities

Abstract

As part of the centennial celebration of insulin’s discovery, this review summarizes the current understanding of the genetics, pathogenesis, treatment, and outcomes in type 1 diabetes (T1D). T1D results from an autoimmune response that leads to destruction of the β cells in the pancreatic islet and requires lifelong insulin therapy. While much has been learned about T1D, it is now clear that there is considerable heterogeneity in T1D with regard to genetics, pathology, response to immune-based therapies, clinical course, and susceptibility to diabetes-related complications. This Review highlights knowledge gaps and opportunities to improve the understanding of T1D pathogenesis and outlines emerging therapies to treat or prevent T1D and reduce the burden of T1D.

Authors

Alvin C. Powers

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Figure 3

Emerging or future T1D therapies.

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Emerging or future T1D therapies. (A) Exogenous insulin replacement incl...
(A) Exogenous insulin replacement includes insulin analogs designed to optimize absorption, integrated closed-loop systems combining insulin delivery devices and glucose-sensing technology, and personalized algorithms (AI, artificial intelligence) to tailor insulin replacement. (B) Cell-based insulin delivery options include transplantation of islets or insulin-producing cells (derived from ES or iPS cells), strategies to stimulate β cell proliferation or regeneration, and approaches that encourage transdifferentiation of host cells into insulin-producing cells. (C) Protective strategies include immunomodulatory approaches to block inflammatory cytokines or pathogenic immune cells and prevent damage or loss of β cells. See text for additional information.