New therapies for type 1 diabetes mellitus.

Five to ten percent of patients with diabetes mellitus in the United States suffer from type 1 diabetes: approximately 1.5 million people. Type 1 diabetes occurs when there is no insulin production from the beta cells of the pancreas and has often been associated with younger patients and thin body habitus. Type 2 diabetes, often linked with obesity, is associated with impaired insulin secretion and insulin resistance. Although the therapeutic goal is to maintain strict glycemic control in both types, management of type 1 diabetes is of a dissimilar nature due to differences in pathophysiologic mechanisms and patient characteristics. Newer therapies are aimed at achieving better glycemic control with minimal compromise to lifestyle. Some of these treatment measures, such as insulin pump therapy, have been available for years but were not used frequently until the mid-1990s. The increased use of intensive insulin therapy became more readily acceptable after the Diabetes Control and Complications Trial showed a decrease in microvascular complications with better glycemic control (hemoglobin A1C value of 7% or less). Insulin pumps, along with meal timings and, to a certain extent, regulation of the amount of food consumed, have allowed diabetes patients a more flexible lifestyle. Newer insulins are structured to mimick the pharmacokinetics of the endogenous basal (peakless sustained activity) and bolus (short fast-acting) insulins. Development of continuous, noninvasive, glucose sensing devices may reduce the need for capillary blood glucose testing (needle pricks) and make diabetes management more patient friendly and effective.