Although insulin is a lifesaver for those with type 1 diabetes, daily management is challenging. Current research looks to lessen these burdens, with larger goals of delaying disease onset and uncovering possible cures.
ILLUSTRATION: JASON SOLO/THE JACKY WINTER GROUP
Type 1 diabetes is caused by autoimmune destruction of insulin-producing β cells in the pancreas and is typically treated with exogenous insulin delivered through injections or other devices. A century ago, a diagnosis of type 1 diabetes was uniformly fatal. However, the discovery of insulin by Banting and Best in 1921 offered hope for this disease, transforming it into a chronic condition, but one that still requires onerous lifelong treatment.
A century later, scientific advances have expanded our understanding of this disease and the available therapeutic options, but many challenges remain. Genetic testing and autoantibody profiling now make it possible to identify some individuals at risk for type 1 diabetes and delay the onset of disease by using immunomodulatory therapies, with the hope of one day preventing it altogether. Clinical symptoms can be kept at bay using cell-based therapeutics such as donor-derived or engineered pancreatic islets, as well as immunosuppressive treatments. Engineering advances such as modified insulins, glucose sensors, and closed-loop devices for insulin delivery can make treatment more streamlined and physiologically accurate.
However, many obstacles remain, including labor-intensive disease management; the difficulty of balancing food with insulin intake to avoid the harmful effects of abnormal glucose concentrations; and, in some cases, the need for lifelong immunosuppression. In addition, the cost and availability of treatment can be problematic, because patient survival depends on an uninterrupted supply of insulin. Thus, more work is needed to overcome these challenges as we move into our second century of treating this common and increasingly prevalent disease, with the eventual goal of prevention or a cure.