Specific therapeutic attempts in experimental and clinical type-I diabetes.

The morphological basis of type-I diabetes is the destruction of the islets of Langerhans by an inflammatory process. Immunosuppressive and immunomodulatory mechanisms can prevent diabetes in NOD-mice and BB-rats when given before onset of the disease. In man at the time of diagnosis of diabetes insulitis has progressed already to a loss of more than 80% of the Beta-cells. Several immunosuppressive drugs and immunobiological regimen may influence the course of the disease only in the sense of a temporary remission. Cyclosporine-A was the most effective drug, but can not be recommended for general use at present time because of side effects on the kidney at least when given in higher doses. Whether minimizing the effective dose will be equally effective remains open. Other drugs as ciamexone which seems to be safer have to be taken into account for further studies. Suppression of insulitis most probably will be more successful when the treatment starts at an earlier phase i.e. before onset of the disease. The criteria at what time this may be justified have to be elaborated.