Efficacy of immunosuppression in preserving beta cell function and reducing insulin requirements in Type 1 diabetes mellitus: a comprehensive review

Abstract

Objectives: To evaluate the efficacy of immunosuppressive therapies in preserving pancreatic beta-cell function and reducing insulin requirements in patients with Type 1 diabetes mellitus (T1DM).

Design: A systematic review of 48 clinical trials conducted between 1986 and 2023, analysing the short- and long-term effects of various immunosuppressive treatments on beta-cell preservation.

Setting: Data were sourced from international databases including PubMed, Web of Science, Medline, and Cochrane Library.

Subjects: A total of 4 977 participants, of whom 3 084 were in immunosuppressive treatment groups and 1 893 in control groups. All subjects were diagnosed with T1DM.

Outcome measures: The primary outcome was the preservation of beta-cell function, as indicated by C-peptide levels. Secondary outcomes included changes in insulin requirements, glycaemic control (HbA1c), and safety profiles of the therapies.

Results: Short-term benefits in beta-cell preservation were observed with immunosuppressive agents such as cyclosporin and anti-CD3 monoclonal antibodies. However, these therapies did not consistently show long-term efficacy, with variability in patient responses. Adverse effects, such as nephrotoxicity and immune-related complications, were noted.

Conclusions: Immunosuppressive therapies offer potential benefits in reducing insulin dependency and preserving beta-cell function in T1DM. However, long-term efficacy and safety remain uncertain, necessitating further research into personalised treatment approaches to optimise outcomes.