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.

Diabetes and Body Mass Index Are Associated with Neuropathy and Prognosis in Colon Cancer Patients Treated with Capecitabine and Oxaliplatin Adjuvant Chemotherapy

“…We considered type I and type II diabetes together. Diabetes is a complex group of diseases with different etiologies; type 1 is caused by an autoimmune destruction of insulin-producing beta cells in the pancreas, type 2 (the most common form of diabetes) occurs due to a combination of multiple factors, including insulin resistance, a condition in which cells do not use insulin effectively [22,23]. However, both the Kaplan-Meyer graphs of DFS and the multivariate analysis clearly showed a strong prognostic role of diabetes in our homogeneous cohort of patients independently from the etiology.…”

Proposed mechanisms for oligonucleotide IMT504 induced diabetes reversion in a mouse model of immunodependent diabetes

“…MLDS mice (blood glucose Ն12 mM) and control mice were treated with IMT504 doses of 2, 10, or 20 mg·kg body wt Ϫ1 ·day Ϫ1 . Animals were randomly assigned to the treatment groups and injected subcutaneously (sc) for 10 consecutive days (days [1][2][3][4][5][6][7][8][9][10]. The groups were as follows: control-IMT504 (2), control-IMT504 (10), control-IMT504 (20), STZ-IMT504 (2), STZ-IMT504 (10), and STZ-IMT504 (20).…”

“…of doses : 20). Glycemia was measured in tail blood samples in nonfasted conditions on days 1,6,11,17,21,26,29,32,36,41,46,53, and 66 at 11-12 AM (last IMT504 injection on day 40). Intraperitoneal glucose tolerance tests (IPGTT) were performed on day 60.…”

“…To prevent or cure T1D, research has aimed largely at understanding and modulating immunological responses (19,43) and/or restoring ␤-cell mass, which is limited by the availability of transplantable ␤-cells and the need for chronic immunosuppression (1). Furthermore, mesenchymal stem cells (MSCs) have been assayed as cell-based treatments for inflammatory disorders, including T1D (27), since they promote immunomodulation and regeneration (47).…”

Use of Human Embryonic Stem Cells in the Treatment of Diabetes Mellitus: A Case Series

“…Transplantation therapies that have been investigated include whole pancreas transplantation, islet cell transplantation and stem cell transplantation [12]. However, in the last decade stem cell therapy has gained a greater momentum than other treatments.…”