, Volume 79, Issue 1, pp 43–61 | Cite as

Disease-Modifying Therapies in Type 1 Diabetes: A Look into the Future of Diabetes Practice

  • Carla GreenbaumEmail author
  • Dana VanBueckenEmail author
  • Sandra Lord
Review Article


The novel understanding that the presence of multiple islet autoantibodies, indicating islet autoimmunity, inevitably leads to type 1 diabetes mellitus (T1DM) has necessitated the development of a new staging classification system for the condition. Coupled with an improved understanding of the disease course, the realization that T1DM appears to be more heterogeneous than previously thought has led to unique opportunities to develop more targeted therapies that may be applied even before the onset of dysglycemia or symptoms. To date, several therapies have been trialed to delay or halt disease progression in both presymptomatic and clinical T1DM, each demonstrating varying degrees of effectiveness, toxicity, and utility. Key research supports the eventual implementation of immunotherapy in autoimmune diabetes, potentially calling for a paradigm shift among care providers. It will likely be necessary to develop new approaches to trial design and to address potential barriers to progress before an effective treatment for the disease may be achieved.


Compliance with Ethical Standards


No sources of funding were used to conduct this study or prepare this manuscript.

Conflict of interest

Carla Greenbaum has received personal fees from Lilly, Bristol-Myers Squibb, and Pfizer and grants and personal fees from NovoNordisk and Janssen. Sandra Lord and Dana VanBuecken declare that they have no conflict of interest.

Human and animal rights and informed consent

All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).


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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Benaroya Research InstituteSeattleUSA

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