Current treatment options and challenges in patients with Type 1 diabetes: Pharmacological, technical advances and future perspectives

Abstract

Type 1 diabetes mellitus imposes a significant burden of complications and mortality, despite important advances in treatment: subjects affected by this disease have also a worse quality of life-related to disease management. To overcome these challenges, different new approaches have been proposed, such as new insulin formulations or innovative devices. The introduction of insulin pumps allows a more physiological insulin administration with a reduction of HbA1c level and hypoglycemic risk. New continuous glucose monitoring systems with better accuracy have allowed, not only better glucose control, but also the improvement of the quality of life. Integration of these devices with control algorithms brought to the creation of the first artificial pancreas, able to independently gain metabolic control without the risk of hypo- and hyperglycemic crisis. This approach has revolutionized the management of diabetes both in terms of quality of life and glucose control. However, complete independence from exogenous insulin will be obtained only by biological approaches that foresee the replacement of functional beta cells obtained from stem cells: this will be a major challenge but the biggest hope for the subjects with type 1 diabetes. In this review, we will outline the current scenario of innovative diabetes management both from a technological and biological point of view, and we will also forecast some cutting-edge approaches to reduce the challenges that hamper the definitive cure of diabetes.

Patient Satisfaction of Telemedicine in Pediatric and Young Adult Type 1 Diabetes Patients During Covid-19 Pandemic

“…A large number of patients were unable or unwilling to participate in routine follow-up visits in person and strict infection prevention protocols were established; therefore, many diabetes centers have begun to rely more on virtual health care ( 3 ). Diabetes more than other areas is able to pioneer technological advances in medicine thanks to the use of many tools such as continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion (CSII) connected to online platforms for sharing data; therefore, patients are always able to share glucose data with healthcare professionals and eventually modify insulin treatment if required ( 4 ).…”

Diabetes-related research priorities of people with type 1 and type 2 diabetes: a cross-sectional study in Germany

“…In T1DM, prioritization of research objectives on the research topic ‘treatment with the aim to cure diabetes’ was also mentioned by others 18 and may occur due to frequent life-threatening complications 2 and lifelong insulin treatment 35 . In future, T1DM could be cured through biological approaches such as pancreas transplantation 36 , 37 . Respondents’ research priorities may be influenced by new scientific advances expected in the search for a cure in the coming years 36 .…”

Structural principles of insulin formulation and analog design: A century of innovation

“…Based on surveys of mutations at or near insulin's dimer interface [ 3 , 38 , 147 ], these analogs exhibit receptor-binding affinities indistinguishable from that of native human insulin and are amenable to pharmaceutical formulation. First-generation products insulin lispro (the active component of Humalog® and URLi®; Eli Lilly), insulin aspart (Novolog® and Fiasp®; Novo Nordisk) and insulin glulisine (Apidra®; Sanofi-Aventis) have proven safe and effective in multi-injection regimens and in pump use [ [148] , [149] , [150] ]. These analog formulations are nonetheless more susceptible to degradation above room temperature than corresponding human insulin formulations [ 151 ].…”