Type 1 diabetes: research aims to stop the disease at its onset

The future of treatment for type 1 (juvenile) diabetes aims to overcome insulin dependence. The winning strategy that science is focusing on is twofold: prevent autoimmune damage in the early stages and regenerate pancreatic cells.

This scenario is outlined by Lorenzo Piemonti, director of the Institute for Diabetes Research at IRCCS San Raffaele in Milan, in a recent editorial published in The Lancet.

Stopping the disease in its tracks: The goal is to intervene before the immune system destroys insulin-producing cells. Currently, teplizumab, a monoclonal antibody capable of countering the autoimmune attack, is already available, but the researcher anticipates the arrival of new therapeutic tools in the coming years.

Cell regeneration: When prevention is no longer possible, the main path becomes the replacement of damaged cells. Advanced clinical trials using stem cells are already underway, concretely opening the possibility of definitive therapies in the near future.

The economic challenge: changing the way treatments are evaluated

The main obstacle to the adoption of these therapies is not only scientific but also economic. The current models used by healthcare systems to reimburse treatments are based on glycemic control and cost containment.

According to Piemonti, this view is limited: "The real transformation lies in recognizing insulin independence as a therapeutic goal."

Therefore, a paradigm shift is necessary in the models of Health Technology Assessment (HTA). Assessment bodies must include indicators that take into account the immense value of a potential "definitive cure", a benefit that goes far beyond simple daily metabolic management and requires new economic evaluation metrics to become truly accessible to patients.