An artificial pancreas, either biological (pancreas/islets) or electromechanical (glucose sensor + insulin pumps) is a promising option.
Closed-loop insulin pumps pave the way. Nevertheless, the acceptance of an electromechanical artificial pancreas by patients is not established, given the necessity to wear a bulky system that has to be refilled with insulin every few days. Pancreas transplantation and islet transplantation are currently the only known therapies that reliably establish a long-term stable glycemic state and offer the opportunity to the patient to stop insulin injections. Following successful islet or pancreas transplantation, endogenous insulin secretion in response to normal glucose feedback control is restored and glycated hemoglobin levels are normalized without the need for exogenous insulin therapy.
Unfortunately, the Achille’s heel of both therapies remains the realistic safe and reliable organ or cell sources and the requirement for life-long immunosuppression frequently associated with adverse effects such as higher blood pressure, higher susceptibility to infections, and higher risks for cancers.
However whole organ transplant is a major surgery burdened by a higher morbidity and mortality than islet transplantation.
In addition, many developments are ongoing on other cell sources (e.g. porcine islets, human cell lines, stem cells) making cell therapies a more realistic option in the near future.