Ning Xinyuan, Munir Kashif M, Davis Stephen N
Division of Endocrinology, Diabetes, and Nutrition, University of Maryland School of Medicine, Center for Diabetes and Endocrinology, Baltimore, MD, USA.
Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
Expert Opin Investig Drugs. 2024 Dec;33(12):1199-1208. doi: 10.1080/13543784.2024.2439501. Epub 2024 Dec 12.
Type 1 diabetes is a chronic autoimmune condition characterized by the selective destruction of insulin-producing beta cells in the pancreas. The etiology of T1D is multifactorial, with a combination of genetic susceptibility and environmental triggers believed to underlie beta-cell destruction. Preserving and prolonging beta-cell function in T1D is a pivotal therapeutic objective that can mitigate disease progression and improve glycemic control.
Insulin secretagogues have long been used in the management of type 2 diabetes, but do not have a significant beneficial effect in individuals with long-standing type 1 diabetes. Enhancement of beta-cell function early in the course of type 1 diabetes may offer important benefits in glycemic control and reduced hypoglycemia risk. Glucagon-like peptide-1 receptor agonists, glucokinase activators, free fatty acid receptor agonists, and glimins are drug classes which may offer benefit in enhancing insulin secretion in individuals with type 1 diabetes.
Drugs which enhance insulin secretion in individuals may offer clinical benefits to individuals with type 1 diabetes. However, the lack of beta-cell capacity introduces a challenge without regeneration of insulin-producing cells. Stem cell therapies combined with regulation of islet autoimmunity may offer the best prospect of increased insulin secretion in individuals with T1D.
1型糖尿病是一种慢性自身免疫性疾病，其特征是胰腺中产生胰岛素的β细胞被选择性破坏。1型糖尿病的病因是多因素的，遗传易感性和环境触发因素的结合被认为是β细胞破坏的基础。在1型糖尿病中保留和延长β细胞功能是一个关键的治疗目标，可减轻疾病进展并改善血糖控制。
胰岛素促分泌剂长期以来一直用于2型糖尿病的管理，但对长期患1型糖尿病的个体没有显著的有益效果。在1型糖尿病病程早期增强β细胞功能可能在血糖控制和降低低血糖风险方面带来重要益处。胰高血糖素样肽-1受体激动剂、葡萄糖激酶激活剂、游离脂肪酸受体激动剂和格列明类药物可能对增强1型糖尿病患者的胰岛素分泌有益。
增强个体胰岛素分泌的药物可能对1型糖尿病患者具有临床益处。然而，缺乏β细胞功能会带来挑战，因为无法再生产生胰岛素的细胞。干细胞疗法与胰岛自身免疫调节相结合可能为增加1型糖尿病患者的胰岛素分泌提供最佳前景。
