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Background <p>In 2025, diabetes mellitus (DM) and its management is a contentious landscape. Insulin delivery methods and blood glucose monitoring technologies have evolved significantly over the recent decades to include exogenous delivery via continuous glucose monitors/insulin pump technology, or endogenously via pancreas transplantation. Individuals taking exogenous insulin for treating type 1 diabetes (T1D) can experience dangerous hypoglycemic episodes.</p> Objectives <p>To provide a comprehensive overview of the therapeutic outcomes of various insulin&#xa0;delivery modalities and state of the art treatment in individuals with T1D associated with&#xa0;hypoglycemic episodes.</p> Methods <p>A literature review was conducted using articles from PubMed and Google Scholar. Key terms included “diabetes insulin management,” “type 1 diabetes,” “hypoglycemic episodes diabetes,” and “pancreas transplantation.” Peer-reviewed studies, clinical guidelines, and meta-analyses were included in the review.</p> Results <p>Exogenous insulin is the primary therapy for T1D, and insulin regiments can be tailored via finger stick glucose measurements, HgbA1C measurements, or continuous glucose monitors. However, inducing hypoglycemia is a major adverse event with an annual incidence of 4.0% to 8.3%. Solid organ pancreas transplantation can provide an alternative for exogenous insulin and has been shown to provide superior glycemic control and normoglycemia when compared directly to insulin pumps and continuous glucose monitor technology, without inducing hypoglycemia. For patients with end-stage renal disease (ESRD), paired pancreas and kidney transplants provide long-term survival benefits. Islet cell transplants are a less invasive alternative to whole organ transplant but show lower success rates for insulin independence.</p> Conclusions <p>Both endogenous and exogenous insulin delivery methods are effective in patients with T1D. Solid pancreas transplant remains an appropriate, lifesaving and life-extending treatment option for many patients and can provide normoglycemia without the risk of hypoglycemia.</p>

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Exogenous vs Endogenous Insulin Delivery: 2025

  • 期刊论文

  • 发表日期：

    2025年4月23日

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  • Ankita Patel,
  • Rachel Todd,
  • Nina L. Owen-Simon,
  • Kasi McCune

摘要

Background

In 2025, diabetes mellitus (DM) and its management is a contentious landscape. Insulin delivery methods and blood glucose monitoring technologies have evolved significantly over the recent decades to include exogenous delivery via continuous glucose monitors/insulin pump technology, or endogenously via pancreas transplantation. Individuals taking exogenous insulin for treating type 1 diabetes (T1D) can experience dangerous hypoglycemic episodes.

Objectives

To provide a comprehensive overview of the therapeutic outcomes of various insulin delivery modalities and state of the art treatment in individuals with T1D associated with hypoglycemic episodes.

Methods

A literature review was conducted using articles from PubMed and Google Scholar. Key terms included “diabetes insulin management,” “type 1 diabetes,” “hypoglycemic episodes diabetes,” and “pancreas transplantation.” Peer-reviewed studies, clinical guidelines, and meta-analyses were included in the review.

Results

Exogenous insulin is the primary therapy for T1D, and insulin regiments can be tailored via finger stick glucose measurements, HgbA1C measurements, or continuous glucose monitors. However, inducing hypoglycemia is a major adverse event with an annual incidence of 4.0% to 8.3%. Solid organ pancreas transplantation can provide an alternative for exogenous insulin and has been shown to provide superior glycemic control and normoglycemia when compared directly to insulin pumps and continuous glucose monitor technology, without inducing hypoglycemia. For patients with end-stage renal disease (ESRD), paired pancreas and kidney transplants provide long-term survival benefits. Islet cell transplants are a less invasive alternative to whole organ transplant but show lower success rates for insulin independence.

Conclusions

Both endogenous and exogenous insulin delivery methods are effective in patients with T1D. Solid pancreas transplant remains an appropriate, lifesaving and life-extending treatment option for many patients and can provide normoglycemia without the risk of hypoglycemia.