Hope vs hype: where are we in type 1 diabetes?

Abstract

Much progress has been made in type 1 diabetes research. Biological replacement of islet function has been achieved with pancreas transplantation and with islet transplantation. In the future, human embryonic stem cells and/or induced pluripotent stem cells may offer a potentially unlimited source of cells for islet replacement. Another potential strategy is to induce robust beta cell replication so that regeneration of islets can be achieved. Immune interventions are being studied with the hope of arresting the type 1 diabetes disease process to either prevent the disease or help preserve beta cell function. Mechanical replacement of islet cell function involves the use of glucose sensor-controlled insulin infusion systems. As all of these avenues are pursued, headlines often overstate the case, thus hyping any given advance, which provides enormous hope for patients and families seeking a cure for type 1 diabetes. Often, however, it is an animal study or a pilot trial that is being described. The reality is that translation to successful trials in human beings may not be readily achievable. This article discusses both the hype and the hopes in type 1 diabetes research.

Persistent C‐peptide is associated with reduced hypoglycaemia but not HbA1c in adults with longstanding Type 1 diabetes: evidence for lack of intensive treatment in UK clinical practice?

“…It is possible that C‐peptide may have direct protective effect on complications although a recent therapeutic trial of C‐peptide did not achieve its primary endpoint . These results are important evidence for international efforts to prevent or reverse β‐cell loss . Although DCCT provides clear evidence of benefit from preserved endogenous insulin secretion in an intensively treated trial setting, and studies of islet cell transplants show the clear benefit of restoring relatively large amounts of endogenous insulin secretion, the impact of preserved endogenous insulin in people with long‐standing diabetes receiving usual clinical care is unclear.…”

Conformal Coating of Stem Cell-Derived Islets for β Cell Replacement in Type 1 Diabetes

“…More than a million children and adolescents were estimated to have T1D globally in 2017 (International Diabetes Federation, 2017). Despite sustained scientific progress in the field, most patients still rely on exogenous insulin to manage T1D (Redondo et al, 2018;Skyler, 2018). In the most severe cases, asymptomatic hypoglycemia can result in coma or death.…”

Regenerative Medicine and Diabetes: Targeting the Extracellular Matrix Beyond the Stem Cell Approach and Encapsulation Technology

“…In the recent past, the use of stem cells for T1D has expanded enormously, shifting from adult stem cells (mostly represented by bone-marrow derived hematopoietic and mesenchymal stem cells) to pluripotent stem cells ( 12 ). Previously, progress made possible the differentiation of embryonic stem cell populations (ESCs) into functional β cell clusters, providing a source of islets suitable for replacement therapy ( 13 ).…”