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Diabetes mellitus in 2023

Type 1 diabetes mellitus: a brave new world

Nature Reviews Endocrinology volume 20, pages 71–72 (2024)Cite this article

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One hundred years after the Nobel prize was bestowed on Banting and McLeod for the ‘discovery’ of insulin, we are again seeing major evolutions in the management of type 1 diabetes mellitus, with the prospect of achieving disease control beyond mere management now becoming real. Here, we discuss the latest, most notable developments.

Key advances

  • Automated insulin delivery improves glycaemic control and pregnancy outcomes in pregnancy complicated by maternal type 1 diabetes mellitus (T1DM) compared to standard of care2.

  • Once-weekly basal insulin is non-inferior compared to its once-daily counterpart, in terms of HbA1c (ref. 5).

  • Whole-blood gene expression signatures can help in stratifying the heterogeneity of T1DM6.

  • In patients with T1DM, detection of disease earlier in its course rather than later yields a more favourable clinical outcome at symptom onset8.

  • Teplizumab not only preserves β-cell function at stage 2 T1DM7, but also at stage 3 (symptom-onset) T1DM10.

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Fig. 1: Progress in type 1 diabetes mellitus research aligned with the evolution of disease.

References

  1. Phillip, M. et al. Consensus recommendations for the use of automated insulin delivery technologies in clinical practice. Endocr. Rev. 44, 254–280 (2023).

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  2. Lee, T. T. M. et al. Automated insulin delivery in women with pregnancy complicated by type 1 diabetes. N. Engl. J. Med. 389, 1566–1578 (2023).

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Author information

Authors and Affiliations

  1. Endocrinology Department, UZ Leuven, Leuven, Belgium

    Pieter-Jan Martens & Chantal Mathieu

Authors
  1. Pieter-Jan Martens
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  2. Chantal Mathieu
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Corresponding author

Correspondence to Chantal Mathieu.

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Competing interests

C.M. serves or has served on the advisory panel for Novo Nordisk, Sanofi, Merck Sharp and Dohme Ltd, Eli Lilly and Company, Novartis, AstraZeneca, Boehringer Ingelheim, Roche, Medtronic, ActoBio Therapeutics, Pfizer, Imcyse, Insulet, Zealand Pharma, Avotres, Mannkind, Sandoz and Vertex. Financial compensation for these activities has been received by KU Leuven; KU Leuven has received research support for C.M. from Medtronic, Imcyse, Novo Nordisk, Sanofi and ActoBio Therapeutics; C.M. serves or has served on the speakers bureau for Novo Nordisk, Sanofi, Eli Lilly and Company, Boehringer Ingelheim, Astra Zeneca and Novartis. Financial compensation for these activities has been received by KU Leuven. C.M. is president of EASD. All external support of EASD is to be found on http://www.easd.org/. P.M. has no competing interests.

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Martens, PJ., Mathieu, C. Type 1 diabetes mellitus: a brave new world. Nat Rev Endocrinol 20, 71–72 (2024). https://doi.org/10.1038/s41574-023-00936-y

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