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: Type 1 diabetes advances, Insulin analogues, Closed loop system, Continuous glucose monitors, Insulin gene therapy

Core tip: As therapy of type 1 diabetes poses important challenges because of life long insulin dependence,multiple injections, excursions in glucose values and inability to simulate the pancreas, newer modalities of therapy are emerging. Hence, this is the right time to review developments in this front. This review conjures up recent advances in continuous glucose monitors, closed loop systems, insulin analogues, insulin gene therapy, transplantation and immunological vaccination.