Hepatic insulin production for type 1 diabetes

Type 1 diabetes, along with its long-term complications, imposes a serious impact on public health. In spite of the development and application of var ious insulin formulations, exogenous insulin neither achieves the same degr ee of glycemic control as that provided by endogenous insulin, nor prevents the long-term complications associated with type 1 diabetes. As an alterna tive strategy, insulin gene transfer is being explored to restore endogenou s insulin production in type 1 diabetes. Sustained hepatic insulin producti on has been shown to reverse ketonuria, prevent ketoacidosis, improve body weight gain and significantly ameliorate the adverse effects of insulin def iciency in diabetic animals. However,to achieve adequately regulated insuli n production in response to changes in blood glucose concentrations remains a major hurdle. This article will review the most recent advances made to address this crucial limitation. In addition, based on the significance of maintaining basal plasma insulin far management of type 1 diabetes, we disc uss the feasibility of developing basal hepatic insulin production as an au xiliary treatment to current insulin therapy for achieving tight glycemic c ontrol in type 1 diabetes.