Pharmacotherapy of type 1 diabetes - part 3: Tomorrow

The last 100 years has seen type 1 diabetes, a previously fatal disease, transformed by the administration of exogenous insulin. a standard literature search using the Google and Microsoft search engines and PubMed was performed. The development of synthetic insulins with varying onsets and duration of action improved glucose control, essential to mitigate the microvascular and macrovascular consequences of diabetes. Today insulin pumps guided by continuous glucose monitors are approaching the objective of normalized glucose levels. The area of greatest development is now in attempting to suppress the immune process which results in progressive destruction of the beta cell. It is possible to identify family members of patients with type 1 diabetes who may eventually develop the disease by measuring several beta cell antibodies. Very recently teplizumab, a CD3 inhibitor, has been approved to delay onset of hyperglycemia in these individuals. The future will see progress in immunosuppression, possibly using specific CAR-Treg cells directed at the beta cell antigens which trigger the immune process. In parallel, stem cell derived beta cells may eventually make it possible to replace lost beta cells, resulting in a true cure for type 1 diabetes.