Advances in management of type 1 diabetes mellitus

Abstract

Treatment of type 1 diabetes mellitus has always posed a challenge to balance hyperglycemia control with hypoglycemia episodes. The quest for newer therapies is continuing and this review attempts to outline the recent developments. The insulin molecule itself has got moulded into different analogues by minor changes in its structure to ensure well controlled delivery, stable half-lives and lesser side effects. Insulin delivery systems have also consistently undergone advances from subcutaneous injections to continuous infusion to trials of inhalational delivery. Continuous glucose monitoring systems are also becoming more accurate and user friendly. Smartphones have also made their entry into therapy of diabetes by integrating blood glucose levels and food intake with calculated adequate insulin required. Artificial pancreas has enabled to a certain extent to close the loop between blood glucose level and insulin delivery with devices armed with meal and exercise announcements, dual hormone delivery and pramlintide infusion. Islet, pancreas-kidney and stem cells transplants are also being attempted though complete success is still a far way off. Incorporating insulin gene and secretary apparatus is another ambitious leap to achieve insulin independence though the search for the ideal vector and target cell is still continuing. Finally to stand up to the statement, prevention is better than cure, immunological methods are being investigated to be used as vaccine to prevent the onset of diabetes mellitus.

Keywords: Closed loop system; Continuous glucose monitors; Insulin analogues; Insulin gene therapy; Type 1 diabetes advances.

Figure 1

Time line of Insulin and its analogues. NPH: Neutral protamine hagedorn.

Figure 2

Dr. Arnold Kadish with the first insulin pump. (Courtesy: www.medscape.com).

Figure 3

Schematic representation of continuous glucose monitors.

Figure 4

Principle of closed loop system.

Figure 5

Components of proportional integral derivative.

Figure 6

Requirements for insulin gene transfer.

Figure 7

Insulin gene insertion with adeno associated virus.