Childhood diabetes mellitus: Advances & challenges

[...]studies indicate that in certain individuals, the destruction of β-cells is patchy, suggesting a role for additional factors conferring resistance to this autoimmune-mediated destruction in certain β-cells [10]. First introduced in clinical practice in the early 1980s, CSII has become ubiquitous in developed countries with the newer insulin pump models being less intrusive, more user-friendly and offering more flexibility. The ultimate goal is to develop an insulin regimen that accurately mimics the physiology of insulin release and action - the right type (kinetics) of insulin administered at the right time (preprandial) in the right amount (commensurate with prevailing blood glucose levels) and in the right location (portal circulation). Despite technologies for monitoring glucose in real time, an expanded array of modified insulin preparations and delivery systems such as pumps, including those simulating a closed-loop 'artificial pancreas', control of blood glucose remains imperfect, in part because normal insulin secretion occurs into the portal vein, whereas subcutaneous insulin delivery initially passes through the systemic circulation.