International Journal of Molecular Medical Science, 2024, Vol.14, No.2, 144-152 http://medscipublisher.com/index.php/ijmms 148 immunosuppression and its associated risks (Stabler et al., 2019). These advancements highlight the potential for immunotherapy to fundamentally change the treatment landscape for type 1 diabetes. In summary, the emerging trends in insulin therapy for type 1 diabetes, including smart insulins, beta-cell replacement, and immunomodulatory therapies, offer hope for more effective and sustainable management of the disease. These innovations are driven by a deeper understanding of the disease's pathogenesis and the development of advanced technologies aimed at improving patient outcomes. 5 Clinical Trials and Evidence-Based Outcomes 5.1 Clinical trials on insulin analogues Clinical trials have demonstrated the efficacy of insulin analogues in managing type 1 diabetes. A meta-analysis revealed that continuous subcutaneous insulin infusion (CSII) significantly reduced mean HbA1c by 1.2% compared to conventional or multiple insulin injections without increasing hypoglycemia risk (Jacobsen et al., 2009). Another study comparing short-acting insulin analogues to regular human insulin found a minor but statistically significant reduction in HbA1c by 0.15% in favor of insulin analogues, although the evidence quality was low (Fullerton et al., 1996). Additionally, rapid-acting insulin analogues showed a statistically significant reduction in HbA1c by 0.1% and a 14% reduction in hypoglycemia frequency compared to human soluble insulin (Jacobsen et al., 2009). 5.2 Trials on insulin delivery systems Recent advancements in insulin delivery systems have shown promising results. A multicenter trial on a tubeless, on-body automated insulin delivery system demonstrated significant reductions in HbA1c and improvements in time-in-range (TIR) for both pediatric and adult participants (Brown et al., 2021). Another study on the Medtronic MiniMed Advanced Hybrid Closed-Loop system showed a 12.5% improvement in TIR compared to sensor-augmented pump therapy with predictive low glucose management (Collyns et al., 2021). Furthermore, a trial on the Diabeloop Generation 1 hybrid closed-loop system reported a significant increase in the proportion of time glucose levels were within the target range compared to sensor-assisted pump therapy (Benhamou et al., 2019). 5.3 Comparative studies on new and conventional therapies Comparative studies have highlighted the benefits of new insulin therapies over conventional methods. The REPOSE trial compared insulin pump therapy with multiple daily injections (MDI) and found that while both methods improved HbA1c and reduced severe hypoglycemia, the difference in HbA1c reduction was not statistically significant (Heller et al., 2017). Another study on open-source automated insulin delivery systems showed a 12.2% higher TIR and a 0.5% reduction in HbA1c compared to sensor-augmented pump therapy, with no increase in severe hypoglycemia or diabetic ketoacidosis (Burnside et al., 2023). These findings suggest that while new technologies offer improvements in glycemic control, the clinical significance varies, and long-term studies are needed to fully understand their impact (Timmons et al., 2022). 6 Challenges and Barriers in Modern Insulin Therapy 6.1 Accessibility and cost issues One of the primary challenges in modern insulin therapy is the accessibility and cost of insulin. Despite the advancements in insulin formulations and delivery systems, the high cost of insulin remains a significant barrier for many patients. This issue is exacerbated by the rising prices of insulin analogs, which can limit access for those without adequate insurance coverage or financial resources (Sorli and Heile, 2014; Perkins et al., 2021). The healthcare system-related challenges also include the need to control the rising cost of insulin therapy while making it available to patients (Sorli and Heile, 2014). 6.2 Patient education and adherence Patient education and adherence to insulin therapy are critical for effective diabetes management. However, many patients face challenges related to understanding the importance of insulin therapy, managing their fears and concerns, and adhering to prescribed regimens. Education programs that integrate behavioral change techniques,
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