Use of technology to potentially preserve C-Peptide in type 1 diabetes mellitus

Preservation of residual beta-cell function has become a new therapeutic goal in type 1 diabetes (T1DM). A mathematical equation of insulin dose and A1C allows estimating residual beta-cell function without C-peptide measurement. Slowing the decline of C-peptide levels has been established as a surrogate endpoint for different pharmacological treatments preserving betacell mass and beta-cell function in newly onset patients. Age at onset proves to be crucial, both for predicting the rate of decline in beta-cell function and the overall duration of this so-called remission phase. Glycemic control has a role in defining the remission phase as well as in influencing the decline of residual function through glucose toxicity. Recent evidence points to the usefulness of new technologies like insulin pumps and continuous glucose monitors (CGM) for decreasing glycemic variability. This may preserve C-peptide and improve outcomes both with and without additional immunomodulatory therapy at the onset of T1DM.