A holistic approach to type 1 diabetes: From advances in science and technology to equity in diabetes care.

Abstract

Over the past century, the discovery of insulin transformed type 1 diabetes from a fatal disease into a manageable chronic condition, and the subsequent recognition of its autoimmune basis laid the foundation for screening and intervention before clinical onset. Building on these milestones, recent advances in science and technology have transformed the approach to type 1 diabetes across the disease spectrum. Screening for type 1 diabetes is conducted in many research programs, and more people with presymptomatic type 1 diabetes are now identified and monitored, enabling access to disease-modifying therapy. However, screening remains geographically limited, resulting in inequity in access to future opportunities for type 1 diabetes prevention. For glucose management in established type 1 diabetes, continuous glucose monitoring (CGM) and automated insulin delivery (AID) have improved the safety of insulin therapy, glycemic outcomes, and, importantly, everyday quality of life. Nevertheless, access to these technologies remains limited, with inequities between and within countries. Model-based economic evaluations suggest that type 1 diabetes screening and diabetes technologies are projected to be cost-effective, providing evidence to inform reimbursement, resource allocation, and national health policy. Yet, evidence of cost-effectiveness alone will not ensure equitable access. The next challenge is to reduce disparities and achieve equity by addressing differences in access to specialist care, socioeconomic circumstances, geographic location, racial and ethnic background, age, education, and clinical support system. Achieving this goal will require close collaboration among people with type 1 diabetes, healthcare professionals, and all stakeholders. Through these advocacy efforts, we can help ensure equitable implementation of science and technology for all people who may benefit.