[Type 1 diabetes, towards new horizons].

Abstract

Type 1 diabetes (T1D) is an autoimmune disease characterized by the destruction of pancreatic β-cells, leading to lifelong insulin dependence. Although significant advances have been made in insulin therapy and glucose monitoring, these approaches are implemented at a late stage of the disease, when β-cell destruction is already well underway. Recent advances in the understanding of its pathophysiology have highlighted the complexity of interactions between genetic, environmental, and immunological factors, as well as the existence of distinct endotypes that may influence disease progression. These developments have paved the way for innovative therapeutic strategies aimed at modulating the immune response at early stages of the disease to preserve residual β-cell function. Maintaining endogenous insulin secretion may help delay disease progression and improve clinical outcomes. These new approaches mark a paradigm shift in the management of type 1 diabetes, moving from a purely substitutive strategy toward a preventive and disease-modifying approach.