Type 1 diabetes: from insulin to artificial pancreas

Answer: Type 1 diabetes is an autoimmune disease that results in the destruction of pancreatic beta cells responsible for the production of insulin, a hormone that is crucial for regulating blood glucose levels. Since the body is no longer able to produce insulin in adequate amounts, the main treatment consists of administering exogenous insulin, which must be carefully dosed to keep blood glucose within safe values.

Insulin therapy is the cornerstone of type 1 diabetes treatment. Today, thanks to technological and pharmacological advances, there are different types of insulin, ranging from fast-acting ones used at mealtimes to long-acting ones, even weekly, to maintain a stable basal level. The customised combination of these drugs makes it possible to simulate natural insulin physiology as closely as possible.

In addition to insulin therapy, the daily management of type 1 diabetes relies on continuous blood glucose monitoring and insulin infusion pumps. Modern technologies, such as continuous monitoring systems (CGM), allow more accurate and timely control, helping to prevent both hyperglycaemia and hypoglycaemia. The goal is to maintain a glycaemic balance that minimises long-term complications.

In recent years, research has led to the development of the so-called 'hybrid artificial pancreas', a device that combines continuous glycaemic monitoring with an insulin pump and an intelligent algorithm capable of automatically administering the required amount of insulin. This system represents a huge step forward in improving the quality of life for people with type 1 diabetes, reducing the burden of daily management and improving metabolic control. However, it is important to remember that currently, rapid insulin boluses at mealtimes still have to be administered by the person, as the automated system does not always cover the glycaemic rise due to feeding. Managing type 1 diabetes is not only limited to glycaemic control through insulin, diet and physical activity, but requires an integrated approach that also involves psychological support, especially during adolescence. This period is particularly delicate, as young people have to deal not only with the physiological challenges of the disease, but also with the emotional and social challenges of accepting a chronic condition, managing therapy on a daily basis, and adapting to school and social life.

Psychological support therefore becomes essential to prevent episodes of stress, anxiety or depression that may compromise adherence to treatment and, consequently, metabolic control

Diet must be customised to avoid glycaemic peaks, balancing carbohydrates, proteins and fats well, while exercise helps improve insulin sensitivity, weight control and cardiovascular health. Also important is attention to prevention and management of complications, such as cardiovascular, eye, kidney and neurological diseases, that may arise over time due to chronic hyperglycaemia. Regular monitoring and specialist checks are therefore essential to intervene in good time.

A very innovative front in research concerns the possibility of postponing the onset of type 1 diabetes. Recent studies focus on immunomodulating therapies, i.e. treatments that seek to 'switch off' or modulate the autoimmune response that destroys beta cells before the disease becomes clinically manifest. These approaches aim to identify people at risk early, through screening for specific autoantibodies, and intervene to slow or stop the progression of the damage. Among the most promising experimental strategies are cell therapies, such as the use of stem cells to regenerate beta cells. Pancreatic islet transplantation, already practised in selected cases of type 1 diabetes with severe glycaemic instability, is a real possibility, although it remains limited to specialist centres and requires immunosuppressive therapy.