Intensive care medicine

Cell biology

Immunosuppression

Type 2 diabetes

Biology

Transplantation

Endocrinology

Stem cell

Regeneration (biology)

Insulin

Immunology

Bioinformatics

Insulin resistance

Internal medicine

Type 1 diabetes

Regenerative medicine

Medicine

Islet

Disease

Glucose homeostasis

Diabetes mellitus

The Lancet Diabetes & Endocrinology

<h2>Summary</h2> Type 1 diabetes is characterised by autoimmune-mediated destruction of pancreatic β-cell mass. With the advent of insulin therapy a century ago, type 1 diabetes changed from a progressive, fatal disease to one that requires lifelong complex self-management. Replacing the lost β-cell mass through transplantation has proven successful, but limited donor supply and need for lifelong immunosuppression restricts widespread use. In this Review, we highlight incremental advances over the past 20 years and remaining challenges in regenerative medicine approaches to restoring β-cell mass and function in type 1 diabetes. We begin by summarising the role of endocrine islets in glucose homoeostasis and how this is altered in disease. We then discuss the potential regenerative capacity of the remaining islet cells and the utility of stem cell-derived β-like cells to restore β-cell function. We conclude with tissue engineering approaches that might improve the engraftment, function, and survival of β-cell replacement therapies.

Restoring normal islet mass and function in type 1 diabetes through regenerative medicine and tissue engineering