Aug. 19, 2025 – Type 1 diabetes cases are rising faster than ever – up 42% in three decades – with sharp increases among U.S. children and teens. But new and emerging treatments are surging too, as experts say we're now in the most promising era yet.
"These patients are living much longer than they used to with an improved quality of life," said Kupper A. Wintergerst, MD, a pediatric endocrinologist and executive director of the Wendy Novak Diabetes Institute, a part of Norton Children's Hospital in Louisville, Kentucky.
Genetics can increase a person's risk by 40%, but experts say the environment may play a role in triggering the autoimmune condition, which happens when the immune system mistakenly attacks insulin-producing beta cells. These things in the environment include early-childhood infections (like mumps, rubella, and influenza B), childhood obesity, antibiotics overuse, vitamin D deficiency, and the hygiene hypothesis, which suggests that limited microbial exposure in early life may lead to an overactive immune system.
Another possibility: Certain chemicals found in our food and water supply – including PFAS (often called "forever chemicals"), dioxins, and arsenic – may promote inflammation, adding to the immune system mistakenly attacking and destroying its own beta cells. Over time, this lack of beta cells causes the body to stop producing its own insulin, and blood sugar begins to rise.
Researchers are responding with advanced treatment strategies, including new medications that not only control blood sugar but actually slow the disease. From smarter insulin delivery systems, to inhalable insulin, to new drugs that improve how the body responds to insulin – patients have more tools than ever to manage the condition, and advances have tripled the number of patients living past 65 in the last four decades.
Slowing Progression of the Disease
Though often diagnosed in childhood, type 1 diabetes can develop at any age – and a new medication called teplizumab (Tzield) has been shown to delay its start by two to three years. It's given to patients in early, stages of the disease, before there are symptoms. Patients who've tested positive for two or more type 1 diabetes-related autoantibodies are considered good candidates, as are those with abnormal blood sugar levels but no other symptoms yet.
The medication, which must be started weeks or months after diagnosis, binds to CD3 proteins on the surface of white blood cells, helping to block the autoimmune attack. While not right for all patients, it can be helpful particularly for children.
"This medication can help prolong the beta cell function that is remaining and decrease how much insulin a person needs," said Bethany L. Gottesman, MD, a pediatric endocrinologist at Phoenix Children's in Arizona.
Because the drug requires a daily infusion for 14 straight days, patients need access to an infusion center that offers services over the weekend. These are available throughout the country – including Barbara Davis Center for Diabetes in Aurora, Colorado; UNC Children's Hospital in Chapel Hill, North Carolina; Children's Health in Dallas and Plano, Texas; Nicklaus Children's Hospital in Miami, Florida; and the Wendy Novak Diabetes Institute in Louisville, Kentucky. Contact the TZIELD COMPASS Support Program to find a center near you.
What's next? Now that researchers know how to slow the disease, the next step is preserving beta cell function indefinitely. Lab-grown beta cells (derived from stem cells) could be put into the body to replace those destroyed by the immune system, potentially reducing or stopping the need for insulin shots. One such treatment called zimislecel has shown promise in early trials, and if all goes to plan, Vertex (its maker) expects to submit for regulatory approval in 2026. Another possibility on the horizon could be islet cell transplantation, which uses donor cells instead of lab-grown stem cells.
Improved Insulin Delivery Systems
Advances in wearable technology and computer programming have revolutionized insulin delivery systems, which now do a much better job of mimicking the pancreas. Continuous glucose monitors, worn on the body, measure sugar levels in the fluid between cells. This data can be sent to an insulin pump, which automatically adjusts insulin delivery to keep blood sugar in a healthy range.
Experts say these more optimized systems help patients deal with diabetic burnout – the mental and physical exhaustion that results from the demands of dietary restrictions and glucose monitoring. The issue is especially harmful for children who are new to the disease and facing a lifetime of blood sugar management, said Michael Yafi, MD, a pediatric endocrinologist and associate professor at McGovern Medical School at the University of Texas Health Science Center in Houston.
Still, the systems are not perfect – they require the user to input the size of a meal or the amount of carbohydrates they're consuming in order to predict whether blood sugar will go up or down, which can make it harder for young children to use them.
What's next? Future systems aim to be fully automated, handling all dosing decisions without manual input. Someday they may also be able to learn individual patterns, like how a person's body responds to food, exercise, and stress. At the same time, continuous glucose monitors are expected to become even smaller and more discreet – all part of a shift toward helping patients manage their type 1 diabetes with less effort and greater quality of life.
Inhaled Insulin for Both Kids and Adults
After decades of false starts, inhaled insulin is finally gaining meaningful traction, with more studies backing its benefits. Research shows that Afrezza – the only inhaled insulin on the market today – provides rapid insulin delivery, starting to lower blood sugar in about 12 to 15 minutes. While not a replacement for basal insulin (type 1 diabetes still requires shots or an insulin pump for steady, continuous management), it can provide a helpful boost of insulin after meals or workouts. Because it works fast – in and out of the body in about an hour and a half to three hours – it may help reduce the risk of reactive hypoglycemia, low blood sugar after a meal. For example, it may benefit those who carb-load before exercise, helping process the carbs without lingering too long and causing lows after the workout.
Unlike earlier versions of inhaled insulin – like Exubera, which maker Pfizer pulled from the market in 2007 after the product failed to catch on – Afrezza uses a special technology that allows it to be more compact and better tolerated (though coughing remains a side effect). Developed by Mannkind Corporation (Afrezza's maker), the technology involves tiny particles that hold the insulin inside and are just the right size to be breathed into the lungs. When you inhale the powder, it dissolves quickly, allowing it to be absorbed into the bloodstream rapidly.
In studies, many patients say they like inhaled insulin, citing convenience and ease of use. It's also discreet for children who are embarrassed or don't want to inject themselves in public places, like at school. A recent pediatric trial involving patients ages 4 to 17 found that children and parents preferred Afrezza slightly more than shots. While the product is currently only FDA-approved for adults, approval for children is expected later this year.
Still, inhaled insulin does have drawbacks, said Gottesman. "It's not meant to be used if you have lung disease, and some pediatric patients have asthma," she said. "This is also true of older patients with type 1 diabetes, who are more likely to have other lung diseases."
Unlike rapid acting injections, Afrezza doesn't allow for exact dosing. It's only available in fixed-size cartridges – amounts that may not be titrated precisely enough for the youngest patients.
What's next? Newer versions of inhaled insulin are in development. Aerami Therapeutics is working on a liquid formulation – a mist delivered via inhaler – meant to cause less respiratory irritation than Afrezza's dry-powder version. There's no indication when it could be ready for the public.
GLP-1s for Type 1 Diabetes With Insulin Resistance
The difference might seem clear: In type 1 diabetes, the problem is lack of insulin production. In type 2, it's insulin resistance – the body still makes insulin but can't use it well.
But many people with type 1 diabetes, including children, develop insulin resistance, too. Despite lacking natural insulin, their bodies become resistant to the insulin they do receive, for reasons including excess weight, medications, smoking, puberty, and pregnancy. When this happens, patients may need to increase their insulin dose.
This has led researchers to explore treatments once thought to be reserved only for type 2 diabetes – including GLP-1 agonists like Ozempic and Wegovy – to help patients drop excess weight and stave off or improve insulin resistance, said Alexandra De Lellis, a nurse practitioner at Parkview Endocrinology in Fort Wayne, Indiana.
"Insulin resistance plays a large role, especially for type 1 patients diagnosed in adulthood but also those who were diagnosed younger," said De Lellis. Patients can get frustrated when they feel their insulin isn't having the impact it should because the body is resisting it.
A study published this year in Frontiers in Endocrinology found that GLP-1s were a "potential adjunctive therapy in T1D to reduce weight and improve insulin resistance." Studies have shown that GLP-1s can reduce A1c levels by between 0.21% and 0.96% in patients with type 1 diabetes, while also lowering body weight and reducing insulin needs – particularly in those with insulin resistance.
What's next? Larger trials are needed to confirm the benefits of GLP-1s as an adjunct in type 1 diabetes care. Future studies could help researchers identify which patients would benefit most, and better understand the safety in younger patients like adolescents.
