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The therapy for diabetes aims to alleviate hyperglycemia-related symptoms, prevent acute metabolic decompensation, and reduce chronic end-organ complications. Glycemic control is evaluated through short-term (self-monitoring, continuous glucose monitoring) and long-term (A1c, fructosamine) metrics, enabling near real-time tracking of blood glucose levels and reflecting glycemic control over specific time frames.
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Insulin-replacement therapy usually includes both long-acting insulin (basal) and short-acting insulin (to cater to postprandial needs). In a diverse group of type 1 diabetes patients, the average daily insulin dose is typically 0.5-0.7 units/kg body weight. However, obese patients and pubertal adolescents may need more due to insulin resistance.
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Incretins include glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), which stimulate insulin secretion post-meals. In type 2 diabetes, GIP's efficacy is reduced, making GLP-1 a viable drug target. GIP originates from preproGIP.
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Current and future therapies for type 1 diabetes.

Bernt Johan von Scholten1, Frederik F Kreiner1, Stephen C L Gough1

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Summary
This summary is machine-generated.

Type 1 diabetes management is evolving beyond insulin. New strategies focus on protecting insulin-producing beta cells from immune attack and stress, aiming to prevent complications.

Keywords:
Adjunctive therapiesBeta cell preservationImmunomodulationPreventionReviewType 1 diabetes

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Area of Science:

  • Immunology
  • Endocrinology
  • Metabolic Diseases

Background:

  • Type 1 diabetes (T1D) management relies on insulin but fails to prevent severe complications in many patients, especially children and adolescents.
  • Current immune suppression strategies have limited success in preventing the autoimmune destruction of pancreatic beta cells, the hallmark of T1D.
  • Understanding T1D pathophysiology is advancing, necessitating novel prevention and management approaches.

Purpose of the Study:

  • To review recent and proposed strategies for type 1 diabetes prevention and management.
  • To highlight the shift towards beta cell-focused therapies.
  • To address the management of cardiometabolic complications in established T1D.

Main Methods:

  • Review of current literature on T1D pathophysiology and therapeutic strategies.
  • Discussion of emerging beta cell rescue approaches, including antigen vaccination and drugs targeting beta cell stress.
  • Consideration of autoimmune prevention and management of T1D complications.

Main Results:

  • Immune suppression alone has not fully prevented beta cell destruction in T1D.
  • Focus is shifting to protecting beta cells from inflammation and stress.
  • Promising beta cell rescue strategies include oral insulin, peptide vaccines, verapamil, and GLP-1 receptor agonists.

Conclusions:

  • Future T1D management requires a multi-faceted approach, including beta cell protection and addressing cardiometabolic complications.
  • Antigen vaccination and beta cell protective agents represent promising therapeutic avenues.
  • Continued research is crucial for refining T1D prevention and treatment strategies, especially for pediatric populations.