Paediatric diabetes care 100 years after insulin discovery – closer to closing the loop but still yearning for the cure

When more than 25 years ago I started to work with children with type 1 diabetes I hoped (or at some moments even believed!) that at the 100th anniversary of insulin discovery there would be a cure for them and insulin will not be necessary any more. One of the reasons for that I thought so was that during several months of my internship in Paris in 1995, I had the opportunity to see children with type 1 diabetes participating in a promising study in which cyclosporine was tested (we hoped it would stop autoimmune destruction of pancreatic b cells), and later me myself (not having diabetes), together with several other young colleagues from Professor Jerzy Bodalski’s team from Lodz, we received subcutaneous insulin in an initial part of a French study testing the usefulness of insulin in pre-diabetes (the idea behind was to initiate immune tolerance). Years passed, and despite the fact that also in the next decades therapies designed to protect insulin secretion (sophisticated, like anti-CD-3 antibodies or T-regulatory cells and more simple, including the very early use of oral insulin), poly-therapies combining drugs with different mechanisms of action, as well as stem cell-derived beta cells have been extensively studied and some of them seemed to be promising, still today in a hospital room, when talking to a parent of a child with newly diagnosed type 1 diabetes I am forced to say that for their small one we do not have any other effective medicine apart from insulin administered by pen or pump [1–3].