Preserving beta cells
At the time of diagnosis of type 1 diabetes most patients have considerable endogenous beta cell function. There has been a long term interest in attempts to preserve this remaining beta cell function in the hope of improving long term glycaemic control and reducing hypoglycaemia. Type 1 Diabetes TrialNet (1), an international collaborative group, has undertaken trials of mycophenolic mofetil + anti-CD25, anti-CD20, glutamic acid decarboxylase, canakinumab and CTLA4-Ig in patients with type 1 diabetes within 90 days of diagnosis. Both anti-CD20 (2) and CTLA4-Ig (3) led to preservation of endogenous beta cell function but this effect was lost over time. These observations have led TrialNet to launch a multicentre, randomized, placebo-controlled trial to determine whether treatment of subjects at risk for type 1 diabetes with CTLA4-Ig results in delay or prevention of abnormal glucose tolerance. We will review the trial findings and design.
Pump and continuous sensing
A number of clinical trials, including several key trials from Australia, have evaluated the efficacy of addition of continuous sensing to improve HbA1c and reduce hypoglycaemia. The most recent such study (4) concludes that continuous glucose monitoring was associated with decreased HbA1c levels and reduced hypoglycaemia time. We will review the key trials and current state of knowledge.