Insulin and immunotherapy in children and adolescents with type 1 diabetes

Abstract

Insulin treatment has improved very much in recent years. There are not only better and more useful insulin analogues, but pump therapy has improved, and the combination with continuous glucose monitoring (CGM) has meant a great step forward. Furthermore, closed-loop systems knock on the door for becoming part of clinical practice. Even though we do not know the result of the last modern devices, we have to admit that in spite of intensive treatment, type 1 diabetes (T1D) up to now causes unacceptable morbidity and mortality [1, 2]. Furthermore, treatment of the disease remains a heavy burden for the patient and also a heavy burden for the healthcare systems. The aim must be to cure T1D and at best also prevent this disease which should be eradicated in the same way as, e.g. polio. However, the cause of T1D is still unknown. Efforts to prevent the disease have failed [3-5]. Transplantation of the pancreas has so far developed to no more than a rare alternative for highly selected patients with life-threatening complications, and islet cell transplantation will not become a solution until several problems are solved such as rejection and islet survival, and not least until successful, stem cell research produce enough beta cells to transplant.