Update on Treatment of Type 1 Diabetes in Childhood
- PDF / 209,436 Bytes
- 10 Pages / 595.276 x 790.866 pts Page_size
- 30 Downloads / 196 Views
ENDOCRINOLOGY (LL LEVITSKY, SECTION EDITOR)
Update on Treatment of Type 1 Diabetes in Childhood Johnny Ludvigsson
Published online: 15 February 2013 Springer Science + Business Media New York 2013
Abstract After 90 years of using insulin to treat type 1 diabetes, there has been no radical change in the treatment. Although several discoveries have improved both quality of life and metabolic control, they have not eradicated, morbidity, and mortality. Insulin analogues are sometimes helpful, and pens, pumps, smart glucometers, and educational tools have facilitated and improved treatment. Soon, better insulin pumps and glucose sensors together with sophisticated algorithms and connections leading to closedloop systems will probably further improve and facilitate treatment of many patients with type 1 diabetes. However, the burden for patients will not disappear completely, and modern therapy will still require both competence and motivation of patients. Therefore, the goal should be either to cure the disease via replacement therapy (transplantations) or to stop the destructive process, preserve residual insulin secretion, or even improve insulin secretion via beta-cell regeneration. This will result in a milder disease, a stabler metabolism, simpler treatment, and perhaps even cure. Several studies are ongoing, but nothing has proved useful so far in clinical practice.
Introduction
Keywords Type 1 diabetes Closed loop Monoclonal antibodies GAD C-peptide Immune intervention
Children with diabetes are best served if they can receive a supply of basal insulin and also receive a rapidly absorbed insulin before meals. There has been a gradual improvement of insulin preparations. These preparations have made life somewhat easier for children with diabetes, but because diabetes management is so complex, there are few studies suggesting that they actually improve long-term glycemic control. As a human being with no residual insulin secretion should in principal receive human insulin as treatment, the discovery and production of such insulin in the early 1980s could have been regarded as the final goal. Unfortunately, human insulin injected subcutaneously forms hexameric structures and is slowly absorbed into the
J. Ludvigsson (&) Division of Pediatrics, Department of Clinical and Experimental Medicine, Linko¨ping University, 58185, Linko¨ping, Sweden e-mail: [email protected]
123
Since insulin treatment became available 90 years ago, there has been no radical change in the treatment of type 1 diabetes (T1D). Although a large proportion of children with cancer can be cured, T1D remains chronic and continuously life-threatening. Furthermore, it has become commoner and commoner all over the world, with rapidly increasing incidence not least in recent decades [1]. Intensive treatment with multiple daily injections of insulin, adjusted to regular meals with suitable content, evaluated by regular self-monitoring of blood glucose concentration has decreased the incidence of late vascular complications [2,
Data Loading...
