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Insulin therapy versus cell-based therapy for type 1 diabetes mellitus: what lies ahead?

Nature Clinical Practice Endocrinology & Metabolism volume 4, pages 664–665 (2008)Cite this article

The current or emerging therapeutic options for type 1 diabetes mellitus (T1DM) can be divided into three broad categories: insulin replacement by injection or infusion (insulin therapy); insulin replacement by transplantation of a pancreas or insulin-producing cells (cell-based therapy); and modification or amelioration of the autoimmune process in individuals with new-onset T1DM or at high risk for the development of T1DM.1,2 Rapidly advancing research in all three areas is leading to new therapeutic options with considerable potential to 'cure' T1DM. In this Viewpoint, I will focus on the prospects for insulin therapy and cell-based therapy, and discuss how these two therapeutic approaches may compare in the future in terms of benefits, risks and challenges.

The efficacy and safety of any new therapy for T1DM must be judged against the outcomes achieved with standard or current therapy. In considering new therapies, several aspects about T1DM warrant emphasis. First, all current approaches are imperfect, as patients still have hyperglycemia and/or hypoglycemia and develop diabetes-related complications in the long term. Second, hypoglycemia resulting from a mismatch of insulin need and insulin delivery is the major limitation of current therapy. Third, although the duration and magnitude of hyperglycemia are important, they are not the only determinants of diabetes-related complications. Only a minority of individuals will develop diabetic nephropathy and not everyone with T1DM develops complications, regardless of the level of glucose control. Fourth, the risk of cardiovascular disease is increased in individuals with T1DM of long duration.3,4,5

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References

  1. Sherr J et al. (2008) Prevention of type 1 diabetes: the time has come. Nat Clin Pract Endocrinol Metab 4: 334–343

    Article  PubMed  Google Scholar 

  2. Eisenbarth GS (2007) Update in type 1 diabetes. J Clin Endocrinol Metab 92: 2403–2407

    Article  CAS  PubMed  Google Scholar 

  3. Pambianco G et al. (2006) The 30-year natural history of type 1 diabetes complications: the Pittsburgh Epidemiology of Diabetes Complications Study experience. Diabetes 55: 1463–1469

    Article  CAS  PubMed  Google Scholar 

  4. Retnakaran R and Zinman B (2008) Type 1 diabetes, hyperglycaemia, and the heart. Lancet 371: 1790–1799

    Article  CAS  PubMed  Google Scholar 

  5. Finne P et al. (2005) Incidence of end-stage renal disease in patients with type 1 diabetes. JAMA 294: 1782–1787

    Article  CAS  PubMed  Google Scholar 

  6. Hirsch IB (2005) Insulin analogues. N Engl J Med 352: 174–183

    Article  CAS  PubMed  Google Scholar 

  7. Pickup JC and Renard E (2008) Long-acting insulin analogs versus insulin pump therapy for the treatment of type 1 and type 2 diabetes. Diabetes Care 31: S140–S145

    Article  PubMed  Google Scholar 

  8. Robertson RP (2004) Islet transplantation as a treatment for diabetes—a work in progress. N Engl J Med 350: 694–705

    Article  CAS  PubMed  Google Scholar 

  9. Fiorina P and Secchi A (2007) Pancreatic islet cell transplant for treatment of diabetes. Endocrinol Metab Clin North Am 36: 999–1013

    Article  CAS  PubMed  Google Scholar 

  10. Kroon E et al. (2008) Pancreatic endoderm derived from human embryonic stem cells generates glucose-responsive insulin-secreting cells in vivo. Nat Biotechnol 26: 443–452

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

Research in the author's laboratory is supported by grants from the Juvenile Diabetes Research Foundation International, the VA Research Service, the NIH (DK68764, DK66636, DK69603, DK63439, DK62641, DK068751), the Vanderbilt Mouse Metabolic Phenotyping Center (DK59637), and the Vanderbilt Diabetes Research and Training Center (DK20593), and by human islets provided by the Islet Cell Resource Centers.

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  1. Vanderbilt Diabetes Center, 8435 MRBIV, Nashville, TN 37232-0615, USA al.powers@vanderbilt.edu

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  1. AC Powers is a Professor in the Departments of Medicine (Division of Diabetes, Endocrinology, and Metabolism) and Molecular Physiology and Biophysics at Vanderbilt University, the Director of Vanderbilt Diabetes Center, and a physician at the Tennessee Valley Health Care System, Nashville, TN, USA.,

    Alvin C Powers

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Powers, A. Insulin therapy versus cell-based therapy for type 1 diabetes mellitus: what lies ahead?. Nat Rev Endocrinol 4, 664–665 (2008). https://doi.org/10.1038/ncpendmet0971

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