Therapy concepts in type 1 diabetes mellitus treatment: disease modifying versus curative approaches

Abstract

For many autoimmune diseases, including type 1 diabetes mellitus (T1DM), efforts have been made to modify the disease process through pharmacotherapy. The ultimate goal must be to develop therapies with curative potential by achieving an organ without signs of parenchymal cell destruction and without signs of immune cell infiltration. In the case of the pancreas, this means regenerated and well-preserved beta cells in the islets without activated infiltrating immune cells. Recent research has opened up the prospect of successful antibody combination therapy for autoimmune diabetes with curative potential. This goal cannot be achieved with monotherapies. The requirements for the implementation of such a therapy with curative potential for the benefit of patients with T1DM and LADA (latent autoimmune diabetes in adults) are considered.

Keywords: Autoimmune diseases; Disease modifying and curative therapies; Latent autoimmune diabetes in adults; Type 1 diabetes mellitus.

Fig. 1

Starting points of type 1 diabetes mellitus therapy. The metabolic stages before and after diabetes manifestation with C-peptide concentrations and islet autoantibodies (ABs) in the human situation and the changes in the immune cell infiltration (in particular CD4 and CD8 T cells and macrophages) in the islets of the pancreas in the IDDM rat model of human T1DM are depicted