Type 1 diabetes is characterised by autoimmune-mediated destruction of pancreatic β-cell mass. With the advent of insulin therapy a century ago, type 1 diabetes changed from a progressive, fatal disease to one that requires lifelong complex self-management. Replacing the lost β-cell mass through transplantation has proven successful, but limited donor supply and need for lifelong immunosuppression restricts widespread use. In this Review, we highlight incremental advances over the past 20 years and remaining challenges in regenerative medicine approaches to restoring β-cell mass and function in type 1 diabetes. We begin by summarising the role of endocrine islets in glucose homoeostasis and how this is altered in disease. We then discuss the potential regenerative capacity of the remaining islet cells and the utility of stem cell-derived β-like cells to restore β-cell function. We conclude with tissue engineering approaches that might improve the engraftment, function, and survival of β-cell replacement therapies.

1 型糖尿病的特征是自身免疫介导的胰腺 β 细胞团破坏。随着一个世纪前胰岛素疗法的出现，1 型糖尿病从一种进行性的、致命的疾病转变为一种需要终生复杂的自我管理的疾病。通过移植替换丢失的 β 细胞团已被证明是成功的，但供体供应有限和对终生免疫抑制的需求限制了广泛使用。在这篇综述中，我们重点介绍了过去 20 年的渐进进展以及在 1 型糖尿病中恢复 β 细胞质量和功能的再生医学方法中存在的挑战。我们首先总结内分泌胰岛在葡萄糖稳态中的作用以及它在疾病中是如何改变的。然后我们讨论剩余胰岛细胞的潜在再生能力以及干细胞衍生的 β 样细胞恢复 β 细胞功能的效用。我们总结了可能改善 β 细胞替代疗法的植入、功能和存活的组织工程方法。