People with type 1 diabetes have significantly improved life expectancy thanks to recent advances in the effective management of the disease, according to a Clinical Focus published in the Medical Journal of Australia.

Prof Peter Colman, Dr Mervyn Kyi and a team of fellow Endocrinologists at the Royal Melbourne Hospital wrote that the incidence of type 1 diabetes (T1D) has doubled over the past 20 years and the disease is still associated with considerable premature mortality. Nevertheless, "recent findings show that a significant improvement in life expectancy has occurred".

New technologies, such as more convenient blood glucose meters with built-in bolus dose calculators, smartphone applications, insulin pumps, continuous glucose-monitoring systems and closed-loop insulin systems (the "artificial pancreas"), are assisting patients' self-management of T1D.

Trials of the use of type 2 diabetes medications to help reduce cardiovascular disease in T1D, including the REducing with Metformin Vascular Adverse Lesions in type 1 diabetes (REMOVAL) study currently underway in Europe, Canada and Australia, are in progress, Kyi and colleagues wrote.

Further, there is hope that T1D might eventually be preventable. "The ability to predict T1D on the basis of genetic, immunological and metabolic markers has provided opportunities for prevention at different preclinical stages", they noted. "Much attention has focused on interventions at diagnosis and in the preclinical antibody positive stage"

Transplantation of the pancreas or the islets of Langerhans are being performed at hospitals in Sydney and Melbourne, but the authors warned that "the benefits must be weighed against the morbidity associated with the surgery and associated immunosuppression".

"Limited tissue supply is a key barrier to more widespread use of islet transplantation. Advances in stem- cell technologies or in the production of porcine islets for human transplant may overcome this problem in the future."

Kyi and colleagues commented that, "despite recent advances, T1D is still associated with considerable premature mortality caused by acute and chronic complications, particularly ischaemic heart disease. "The presence and severity of chronic kidney disease and ischaemic heart disease predict all-cause mortality in T1D. Recent reports of improved life expectancy ... nonetheless provide great hope for persons with T1D and their clinicians", they concluded.