• Pluripotent stem cell-derived insulin-producing cells show promise but face immunogenicity and teratogenicity hurdles, necessitating immunoisolation or immunosuppression.
• Genetic engineering to create immune-evasive cells requires rigorous safety evaluation to avoid unforeseen complications.
• Mesenchymal stem/stromal cells (MSCs) offer a viable alternative due to their availability and immunomodulatory properties, with muted allogeneic responses in transplantation.
• Exosomes from naive MSCs show partial efficacy in rodent diabetes models, but euglycemia is not achieved; educated exosomes from β-cells or insulin-producing cells may offer superior therapeutic potential.