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Published online: 8 December 2015
© European Union 2015
Abstract In spite of modern techniques, the burden for patients with type 1 diabetes mellitus will not disappear, and type 1 diabetes will remain a life-threatening disease causing severe complications and increased mortality. We have to learn of ways to stop the destructive process, preserve residual insulin secretion or even improve the disease via β-cell regeneration. This will give a milder disease, a more stable metabolism, simpler treatment and perhaps even cure. Therapies based on single drugs have not shown sufficient efficacy; however, there are several treatments with encouraging efficacy and no apparent, or rather mild, adverse events. As the disease process is heterogeneous, treatments have to be chosen to fit relevant subgroups of patients, and step by step efficacy can possibly be improved by the use of combination therapies. Thus immuno-suppressive therapies like anti-CD3 and anti-CD20 monoclonal antibodies might be combined with fusion proteins such as etanercept [tumor necrosis factor (TNF)-α inhibitor] and/or abatacept (CTLA4-Ig) early after onset to stop the destructive process, supported by β-cell protective agents. The effect may be prolonged by using autoantigen therapy [glutamate decarboxylase (GAD) proinsulin], and by adding agents facilitating β-cell regeneration [e.g. glucagon-like peptide-1 (GLP-1)] there should be a good chance to make the disease milder, perhaps leading to cure in some patients.
1 Introduction
In spite of modern therapy, type 1 diabetes mellitus (T1DM) still causes serious morbidity and increased mortality [1-3]. Already limited residual b-cell function facilitates treatment, reduces blood glucose fluctuations [4, 5], reduces the risk for both acute [6] and late [7] complications, and reduces mortality [8]. Thus, preserved bcell function, measured as C-peptide, is an important clinical end-point per se, irrespective of insulin dose or glycated hemoglobin (HbA1c). It may actually be that C-peptide is a hormone with its own important effects [9]. Then as expected, it is common that residual b-cell function is accompanied by decreased insulin doses, rarely even complete remission with no need for insulin, and low HbA1c. Thus there are good reasons to try therapies that may preserve b-cell function. If successful enough, they could lead to cure and/or prevention of the disease [10]. The following review will describe how knowledge to preserve residual b-cell function has grown....