The evolution of type 1 diabetes mellitus care
AbstractDiabetes mellitus is currently a common disease, which is characterized by a high level of disability and mortality from complications. Nowadays in Russia there are about 229 thousand people among the adult population suffer from type 1 diabetes mellitus (T1DM), and about 48 thousand people among children and adolescents. To reduce the risk of developing diabetic complications, it is necessary to achieve compensation for diabetes and maintain blood glucose levels in the target range. However, this is not an easy task. Treatment of T1DM significantly reduces the quality of life, so researchers from different countries are searching for new ways of T1DM treatment that could maintain optimal control of carbohydrate metabolism, while not reducing the quality of life of patients and not limiting them. Since the 1920s, the main treatment for T1DM has been insulin administration. Since then, insulin production technologies have improved. In 1946 NPH-insulin was obtained, and in the early 2000s insulin analogues (glargine and detemir) were produced. Also, an important aspect of treatment is the optimization of the method of insulin administration. The first insulin pen appeared in 1981. A smart Bluetooth-enabled insulin pen that records the amount and time of insulin administration, displays the last dose, and also transfers information to a special mobile application appeared in 2017. A real breakthrough in the treatment of T1DM was the development of an insulin pump – a programmable device that continuously delivers rapid-acting insulin. Such a device helps patients to achieve diabetes compensation and improve the quality of life.
A promising and fundamentally new method of treating T1DM is transplantation of the entire pancreas or part of it. However, in this case, lifelong immunosuppression is required, and there is also the problem of the availability of islet donors and cell survival after the procedure. The possibility of using stem cells as a source of α- and β-cells and growing islets in vitro is being considered. At the same time, 3D bioprinting technology will ensure the correct distribution of cells in the scaffold, which will help solve the problems of creating a natural environment for pancreatic islets with an extracellular matrix and a vascular network. Currently, work is underway to improve this technology.
Keywords:type 1 diabetes mellitus; insulin therapy; syringe pen; insulin pump; self-control; transplantation; stem cells
Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Bulgakova S.V., Dolgikh Yu.A., Sharonova L.A., Kosareva O.V., Treneva E.V., Kurmaev D.P., Lebedeva E.A., Galkin R.A. The evolution of type 1 diabetes care. Endokrinologiya: novosti, mneniya, obuchenie [Endocrinology: News, Opinions, Training]. 2023; 12 (3): 46–53. DOI: https://doi.org/10.33029/2304-9529-2023-12-3-46-53 (in Russian)
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