Etiology and Pathogenesis of Diabetes Mellitus IN Children

In the above chapter, we have reviewed T1DM, with particular emphasis on the most common immune mediated form. Whereas T2DM appears to be an increasing price paid for societal affluence, there is also evidence worldwide of a rising tide of T1DM. The increase in understanding of the pathogenesis of T1DM has made it possible to consider interventions to slow the autoimmune disease process in an attempt to delay or even prevent the onset of hyperglycemia. Although the prevention of T1DM is still at the stage of research trials, the trials are often mentioned in the lay press. The results of antigenic immunostimulatory studies in NOD mice hold great promise for similar beneficial effects in humans who have just begun to develop the clinical disease or are at high risk for T1DM. Current investigations will determine if antigen based therapies can in fact abrogate ongoing autoimmunity via immunostimulation and ultimately prevent diabetes in humans without the risks of general immunosuppression. Advances in islet cell transplantation continue to show promise, though its role in the treatment of T1DM, especially for children, remains to be seen. The ongoing improvements in insulin pump therapy and continuous glucose sensing, however, continue to transform the care of T1DM, with the prospect of closed loop systems involving dual secretion by insulin and glucagon in pumps directed by glucose sensors appearing increasingly likely in the near future.