Since the early 1900’s when the first life-saving treatment for Type 1 Diabetes, insulin, was discovered, science has improved the treatment options for T1D in leaps and bounds. This includes the identification of the autoantibodies and corresponding genetic contributions, advances in insulin developments resulting in improved safety and effectiveness, and the insurgence of new technologies in the glucose monitoring and insulin delivery field. There has not however been a “cure” to halt or reverse the autoimmune pathway that results in T1D.
The advances in the understanding of the autoimmune markers that underpin the development of T1D have identified several potential targets for both prevention and possible reversal. T1D being an autoimmune condition commonly begins with immune molecules known as T cells, whose usual role is to defend the body from infection by destroying infected cells and triggering the action of other immune cells. In T1D however, certain genetic coding results in the T cells targeting the cells in the pancreas responsible for insulin production (β cells), falling insulin levels and rising glucose levels. Other autoimmune conditions have seen new targeted medical therapies developed, the technology and science behind them may pave the way for future prevention or reversal of T1D.
Options that are currently being studied for prevention of the autoimmune pancreas destruction include medications that target the action of different T cells. Teplizumab is one of such therapies; this monoclonal antibody prevents the T cells from activating and progressing towards β cell destruction. Due to the variety of genes involved however in the action of T cell destruction, the effectiveness of teplizumab seems to vary for different genetic combinations. Abatacept is a medication currently used in Australia to treat autoimmune conditions such as rheumatoid arthritis and is also being trailed and is currently in stage 3 testing in the US as a prevention of T1D. It also prevents T cell activation and this preventing the autoimmune β cell destruction. Medical therapies such as these which target T cells make optimistic candidates in this field, however, are still a way off making useful treatments due to mixed results.
A range of different treatment options are also being considered, however, are still in very early modelling and development. These include therapies to increase the immune tolerance to the T cells (including vaccination). Combination approaches are also being considered, by combining different immune therapies to improve the effectiveness such as previously mentioned T cell target. Different insulin therapies including oral delivery of insulin in a special coating to protect the insulin from stomach acid when digested are also being explored. Some medications for Type 2 diabetes have been studied for effectiveness with T1D including tablets and non-insulin injections. Some of the results of such studies have been mixed or shown limited or short-lived benefits for people with T1D, however, it does prompt for more research into the area.
Research is still being conducted into the automated closed-loop systems referred to as an “artificial pancreas”. Currently there are two hybrid-closed-loop systems listed on the marked in the US; the Medtronic MiniMed 670G and the Control-IQ. The hybrid-closed-loop systems automate basal insulin rates, however, they still need manual entry for bolus doses, and adjusting for exercise and meals. While there is not a fully closed-loop system approved, this is an area of current research.
The advancements in the field of T1D is a growing field, while we are constantly seeing new insulins and technologies introduced into the market, there are several avenues for medical treatment and prevention options under investigation.