Diabetes and NCDs health systems and access
Type 1 Diabetes
UNDERSTANDING TYPE 1 DIABETES (T1D): CAUSES AND CONSEQUENCES
T1D is an autoimmune condition in which the immune system attacks and destroys the beta cells in the pancreas by mistake. Without these cells, the body can no longer produce insulin, a hormone that is essential for transporting sugar from the blood into the body’s cells to be used as energy. Consequently, people living with T1D must rely on lifelong insulin therapy to survive. While anyone can develop T1D, certain genetic factors increase the likelihood, and having a family member with the disease slightly raises the risk. Screening relatives of people with T1D for diabetes-related autoantibodies can help identify those who are more likely to develop the disease, especially if several antibodies are present.
The exact cause is not fully understood, but research suggests that a combination of genetic predisposition and environmental triggers, such as viral infections, can initiate the autoimmune attack. T1D often appears suddenly in childhood or young adulthood, causing symptoms such as frequent urination, excessive thirst and unexplained weight loss. In adults, the onset may be slower. If left undiagnosed and untreated, the disease can lead to diabetic ketoacidosis, which is a dangerous and potentially life-threatening emergency. Over time, poorly controlled blood sugar can damage blood vessels, nerves, the eyes, kidneys, and the heart.
Managing T1D requires daily insulin therapy, regular blood sugar monitoring, and making healthy lifestyle choices. Some people experience a short 'honeymoon' period soon after diagnosis, during which the pancreas produces a small amount of insulin, making diabetes easier to control. This phase usually lasts a few weeks or months, but eventually the pancreas stops producing insulin. One of the biggest risks for people with T1D is hypoglycaemia, or blood sugar dropping too low. This can cause confusion, seizures or even loss of consciousness if not treated promptly.
THE GLOBAL BURDEN OF TYPE 1 DIABETES
According to the International Diabetes Federation, it is estimated that 9.2 million people worldwide were living with type 1 diabetes (T1D) in 2024, including 1.8 million people under the age of 20. This figure is expected to rise to 14.7 million by 2040. As the disease often starts in childhood, those affected live with it for decades, managing insulin delivery, blood glucose checks and lifestyle adjustments daily. This long-term management presents emotional, physical and financial challenges for individuals and their families. In areas with limited resources, a lack of access to insulin, continuous glucose monitoring devices and diabetes education exacerbates this burden, often resulting in poorer health outcomes.
CURRENT TREATMENTS AND FUTURE DIRECTIONS
Currently, there is no cure for T1D and it cannot be prevented. The only current treatment is to replace the missing insulin, which is delivered through multiple daily injections or insulin pumps, often guided by continuous glucose monitoring technology. Successful management also depends on comprehensive, team-based care, including diabetes education, nutrition counselling, mental health support, and regular screening for complications.
Recently, new disease-modifying therapies have begun to emerge. In 2022, the U.S. Food and Drug Administration approved Teplizumab, an immunotherapy that can delay the onset of T1D in high-risk individuals. Teplizumab works by altering immune cell activity to protect the remaining beta cells in the pancreas for longer, thereby reducing the need for insulin and slowing progression. Research is also underway to understand how to target alpha cells, which are the pancreatic cells that produce glucagon, a hormone that raises blood sugar. In T1D, alpha-cell function is often impaired, which can lead to severe hypoglycaemia. Therapies aimed at restoring healthy alpha cell responses could therefore help to protect against dangerous low blood sugar levels.
For some people with difficult-to-control T1D, islet transplantation from deceased donors is an option. In this procedure, islets are taken from donor pancreases and implanted into the recipient’s liver. Although this can greatly improve blood sugar control and reduce the risk of severe hypoglycaemia, donor islets are scarce and patients must take lifelong immunosuppressants to prevent rejection.
There is also a growing focus on regenerative strategies that aim to restore insulin production. These include stem cell-derived islet transplants, which involve creating new insulin-producing cells from stem cells. Several of these therapies are now in human clinical trials, which is an important step towards making them available in the future. Another experimental approach is cell reprogramming, which involves converting other pancreatic cells, such as alpha cells, into beta-like cells that can produce insulin. While these methods are still in the experimental stage, they offer hope of moving beyond the need for lifelong insulin replacement.
The future of T1D care lies in earlier detection, targeted intervention, and regenerative approaches that could one day enable people living with T1D to live without the daily need for insulin and without the fear of high or dangerously low blood sugar levels.
