 raises questions about the therapy)
The present article summarizes some of the recent, prominent findings about type 1 diabetes (T1DM). These findings highlighted the great genetic variety of this disease, which point out that a more individualized management may be needed.
T1DM involves the destruction of pancreatic β cells (cells that produce insulin, the main hormone that controls blood sugar levels). The cause of T1DM is still debated. Recently, a theory about oxidative stress – damage to cells due to reactive oxygen species (ROS), chemically-reactive molecules containing oxygen – has been mentioned as a possible cause.
One laboratory study (performed on mice) showed that mice deficient of macrophages (immune cells that produce ROS) were protected from T1DM. These findings suggest that this mechanism should be considered as target for the prevention and early treatment of T1DM.
Other studies revealed the potential of immunotherapy (treatment that produces an immune response) to protect β cells from destruction. The potential of Abatacept (Orencia) was investigated in a trial involving 112 patients. Use of Abatacept has led to increased levels of insulin, suggesting a protective effect. However, after 6-months, the decrease in β cell function was the same in the Abatacept and placebo (or control) groups, suggesting that the effect of Abatacept declined over time. Another trial tested the ability of an immuno-suppressive drug called Teplizumab to decrease insulin needs in younger diabetics (of less than 35 years of age). At 1 year, only 5% of the patients did not require insulin administration.
Another study evaluated the risk of developing complications due to long-lasting diabetes, in T1DM patients older than 50 years of age. More than 1/3 of them did not develop kidney, eye or nerve disorders. The highest risk was observed in patients who had raised levels of Advanced Glycation End-products, AGEs – proteins or lipids that become glycated after exposure to sugars, indicating a poorly controlled disease.
Taken together, the accumulated data suggests that attempts to protect against β cell destruction or to prevent late complications have variable success. Individualized treatments may offer more benefit.
Published By :
Nature Reviews Endocrinology
Date :
Dec 20, 2011
