Advancing Type 1 Diabetes Treatment: 3 PM-Oriented Innovations in Islet Transplantation and Biomaterial Engineering

Abstract

Type 1 Diabetes (T1D) is an autoimmune disorder marked by the immune-mediated destruction of pancreatic β-cells, resulting in insulin deficiency and dysregulated glucose control. Current therapies—such as insulin replacement and artificial pancreas systems—manage symptoms but fail to restore endogenous β-cell function or halt disease progression. Transplantation strategies, including islet allo- and xenotransplantation, offer potential cures but remain limited by immune rejection, donor scarcity, and the adverse effects of systemic immunosuppression. Within the framework of predictive, preventive, and personalised medicine (3 PM), T1D management requires a paradigm shift towards early detection, targeted prevention, and individualised therapy. Predictive biomarkers and molecular phenotyping can identify high-risk individuals and forecast graft outcomes, while preventive strategies—such as localised immunomodulation, bioenergetic support, and control of systemic inflammation—improve tolerance and graft longevity. Personalised interventions, including patient-specific biomaterials, immunoprotective encapsulation, and regulatory T cell–based or stem-cell–derived β-cell replacement, address immune and metabolic heterogeneity. Recent progress in biomaterials, encapsulation, and 3D bioprinting enables the practical implementation of this 3 PM approach by enhancing oxygenation, vascular integration, and specific scaffold design. Integration of AI-driven analytics, digital health monitoring, and multi-modal diagnostics further supports predictive control of transplant outcomes. This review highlights advances in islet transplantation and regenerative biomaterial engineering as key enablers of the transition from reactive treatment to 3 PM-guided, patient-tailored therapy for T1D.