From Diagnostics to Prevention: How Type 1 Diabetes Management May Transform in Five Years

Type 1 diabetes management has long relied on insulin injections, carbohydrate counting, and vigilant blood sugar monitoring. But how will the landscape in the near future look like? According to prominent German pediatric endocrinologist Felix Reschke (Kinder- und Jugendkrankenhaus in Hannover), the next five years could redefine treatment strategies entirely – he said in an interview after attending the German Diabetes Congress (DDG)¹.

From Symptom Control to Immune Reboots

Type 1 diabetes arises from the immune system mistakenly attacking insulin-producing beta cells in the pancreas. Traditionally, the approach has focused on managing blood sugar levels (via insulin therapy) rather than tackling the autoimmune root cause. Dr. Reschke, however, anticipates a future in which the management of type 1 diabetes symptoms will be complemented by the active modulation of the immune system. This approach will involve the preservation of existing beta-cell function and the maintenance of endogenous insulin production, provided that the immunological assault is identified and mitigated in a timely manner. 

The Promise and Challenges of Clinical Trials

These approaches are not theoretical; early-phase clinical trials are now underway. The aim? Early intervention. The most effective window for immunomodulatory therapy appears to be shortly after diagnosis—before extensive beta-cell loss occurs. If successful, these therapies could prolong patients’ endogenous insulin secretion, simplify insulin needs, and—crucially—improve long-term metabolic control.

One of the most exciting areas of current research involves repurposing immunomodulatory antibodies—agents already under evaluation for diseases like multiple sclerosis—to treat emerging Type 1 diabetes.

Although exciting advances are emerging, insulin therapy, glucose monitoring, dietary and lifestyle guidance, and psychological support remain essential components of diabetes care. Immunotherapies will complement, rather than replace, comprehensive diabetes care.

A Future of Prevention?

While current trials target newly diagnosed or early-stage patients, researchers are also exploring prevention. In the future, similar immune-targeting strategies could be used in high-risk individuals—before the disease fully manifests. These include identifying at-risk individuals through autoantibody screening, predicting disease progression, and determining the best timing for intervention.

This is primarily done through the detection of specific autoantibodies. The most commonly used markers include islet cell antibodies (ICA), glutamic acid decarboxylase antibodies (anti-GAD), insulinoma-associated antigen-2 antibodies (anti-IA2), and insulin autoantibodies (IAA). The presence of two or more of these autoantibodies significantly increases the likelihood of disease progression. Autoantibody screening can therefore play a vital role in identifying candidates for early intervention and preventive trials.

Conclusion: A Paradigm Shift on the Horizon

While insulin remains a life-saving foundation, we may soon be entering a new era. We may witness a fundamental shift where Type 1 diabetes therapy evolves from reactive symptom control to proactive immunological intervention.

We invite clinical laboratories to explore our high-quality assays for the detection of Type 1 diabetes autoantibodies (ICA, anti-GAD, anti-IA2, and IAA). Our solutions support early risk assessment and help laboratories contribute to the future of preventive diagnostics in autoimmune diabetes.

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References

1. Ärzteblatt – Interview with Prof. von Herrath [in German]. ↩︎