Type 1 diabetes, a common type of diabetes, is primarily due to autoimmune factor damage that results in damage to pancreatic islet β cells and an absolute lack of insulin secretion, meaning that there is little or nearly no insulin left in the body. In this state, the patient’s blood glucose rises significantly and is prone to ketoacidosis, requiring insulin to survive.
The main treatments for type 1 diabetes are insulin therapy, pancreas and islet transplantation, and stem cell therapy. Of these, insulin therapy is the most common treatment. Below, we provide a brief overview of these therapies.
Insulin therapy
People with type 1 diabetes require lifelong insulin therapy to maintain life and control hyperglycemia. Insulin regimens should mimic the pattern of physiologic insulin secretion as much as possible, including both basal and mealtime insulin supplementation. Currently, an intensive insulin regimen is recommended for all patients with type 1 diabetes, with basal + mealtime insulin therapy being the most commonly used intensive regimen for patients with type 1 diabetes.
The types of insulin are short-acting insulin, intermediate-acting insulin, long-acting insulin and its analogs, and premixed insulin. Patients with diabetes need to learn how to inject insulin and the technique, with injections mainly in areas rich in subcutaneous fat, including the abdomen, outer thighs, and outer upper arms.
Continuous subcutaneous insulin infusion, commonly known as insulin pump therapy, is an insulin therapy that uses an artificially intelligent insulin input device to control hyperglycemia through continuous subcutaneous insulin infusion that mimics the physiologic secretion pattern of insulin. The use of insulin pumps facilitates glycemic control, improves quality of life, and reduces the risk of severe hypoglycemia.
Pancreas and islet transplantation
Pancreas and islet transplantation is currently the only treatment that can partially or completely restore physiologic insulin secretion.
Pancreatic transplantation
Pancreas transplantation has emerged as an effective treatment for type 1 diabetes, particularly in patients with end-stage renal disease. Pancreas transplantation is the 4th most common organ transplanted after kidney, liver, and heart transplantation among all types of organs.
Pancreas transplantation provides normal functioning pancreatic tissue for diabetic patients, physiologically regulates insulin secretion after surgery, maintains normoglycemia, and prevents and reverses diabetic complications, resulting in significant improvement in health status and quality of life after surgery.
Clinically, there are three types of pancreas transplantation:
- Pancreas-kidney combination transplantation: including staged pancreas-kidney transplantation and simultaneous pancreas-kidney combination transplantation;
- Pancreas transplantation after kidney transplantation;
- Pancreas transplantation alone.
Island transplantation
Island transplantation is the in vitro extraction and purification of islets from the donor pancreas and transplantation through the portal vein to the liver to compensate for severe islet loss, improve the brittle diabetic state, and stabilize glucose metabolism. The islet transplantation approach is closer to the insulin metabolic pathway in the physiological state and has the advantages of being safer, simpler, and with fewer adverse effects than pancreas transplantation.
Island transplantation provides long-term benefits to patients with type 1 diabetes, including a significant reduction or elimination of long-term hypoglycemic reactions. Clinical islet transplantation technology has undergone nearly 40 years of exploration and has evolved to date with advances in both islet isolation technology and transplantation treatment pathways and immunosuppression protocols.
Clinically, there are three types of islet transplantation:
- Islet cell transplantation;
- Island transplantation after kidney transplantation;
- Islet cell combined with kidney transplantation.
Of course, islet transplantation can also result in a progressive decrease in islet function over time due to chronic immune rejection. The main factors affecting the outcome of transplantation include the quantity and quality of islets transplanted, the site of transplantation, and immune rejection.
Stem cell therapy
Stem cell therapy for diabetes is currently in the preclinical research and observation phase and is not yet available for routine clinical use.