Advancements in Type 1 Care – And What Comes Next

In a virtual event, an online audience of hundreds heard from a panel of diabetes experts on technology advancements, exciting research news, and potential future breakthroughs.

The panel was moderated by Dr. Alan Moses, board chair for the diaTribe Foundation. He was joined by:

• Jeanne Jacoby, certified diabetes care and education specialist (CDCES) and senior director of medical affairs at Sequel
• Marlon Pragnell, Ph.D., vice president of research and science at the American Diabetes Association
• Dr. Peter Senior, Ph.D., Charles A. Allard chair in diabetes research and director of the Alberta Diabetes Institute 

Advances and challenges in diabetes technology

Jeanne Jacoby, who was diagnosed with type 1 just four days after graduation from college, opened the discussion by highlighting how using automated insulin delivery (AID) systems has reduced the burden of managing diabetes. 

She also expressed how challenges remain, even for users of advanced automated technology, when managing meals, exercise, and the everyday spontaneity of activities like taking a walk – and the need for that technology to reliably work.

“I think CGM has been an incredible piece of technology," Jacoby said. "It's important to make sure the readings are accurate, and for the most part, they are. But there are times when your CGM could be off. And when the pump is using that as its main source of information to decide on insulin dosing, it can be challenging." 

Marlon Pragnell and Peter Senior offered perspectives on diabetes technology and emphasized the need for continued improvement to assure reliability and to improve the technology-human interface. 

"It's amazing where we are now compared with even 10-20 years ago – linking the pump and sensor to deliver the right amount of insulin at the right time," Pragnell said. “The whole idea is to take the person with diabetes out of the loop, so to speak. It’s democratized this in the sense that you no longer have to get an A in math to do diabetes."

The promise of immunotherapy

Peter Senior, who has spent more than 20 years researching islet transplantation, explained the immune system’s role in type 1 diabetes, illustrating how immune cells and antibodies are involved in type 1 diabetes.  

"The immune system, which normally fights foreign invaders to keep us safe, somehow gets confused and mistakes our own beta cells for the enemy, attacking and destroying them," he said. "We hear a lot about autoantibodies in diabetes, and certainly these are often the clues that the immune system has been activated, but they're the smoke. They're not the fire."

Because antibodies are released in the process of the autoimmune response, a simple screening test can detect them, signaling the onset of type 1 diabetes – often well before blood sugar levels rise or symptoms appear.

Senior then explained how immune therapies can then be used to keep glucose levels stable, reduce hypoglycemia, and potentially reduce long-term complications.

"The honeymoon period [where beta cells are still producing insulin] is something that you only appreciate once it's over," Senior said. "I've become convinced that keeping beta cells working as long as we can with some of these immune therapies will be very worthwhile."

Adjunctive therapies for type 1 diabetes

Pragnell discussed the growing evidence for using GLP-1s and other medicines (like Ozempic and Mounjaro) and SGLT-2 inhibitors (like Jardiance and Farxiga) to support glucose management and cardiovascular health in type 2 diabetes, and urged more research to establish a regulatory pathway for their use in type 1 diabetes as adjunctive therapies along with insulin.

"We're seeing these therapies being used in type 2 with tremendous benefits," Pragnell said. "And it's time – we need to see these benefits occur in type 1 diabetes, and we need large clinical trials of these therapies to show that they demonstrate effectiveness."

Senior explained how these medicines can “bend the curve,” improving A1C, weight management, insulin needs, and hypoglycemia risk simultaneously.

"These therapies bring A1C down, bring the weight down, bring the insulin dose down, and hypoglycemia risk is either the same or no different," Senior said. "When you put that package together, it's really quite compelling. My experience in clinical trials has been that many patients have said they would like to continue, and say, ‘I like how I feel. I like what I see with the numbers. I like how I can eat and do the things I want.’”

Jacoby agreed with the need to get these beneficial therapies to people with type 1 as part of a move to more personalized care for people with diabetes. 

"We need to leave it to the providers who are providing that individualized care to make the decision," she said. "We are people first, and just because I have type 1 diabetes doesn't mean that I also can't benefit from those other medications.”

What's next?

While the panelists acknowledged challenges in diabetes care that need to be addressed, they also pointed to current breakthroughs and near-future advances that offer hope. 

Senior pointed to recent findings in islet transplantation therapy, noting that lab-grown insulin-producing cells are now performing as well as donor islets in early studies.

“I've worked in islet transplantation for 23 years," he said. "And what we've seen in the last year is that stem cell-derived islets can deliver insulin independence with a single dose. That is really exciting to me, because it potentially opens up the supply chain issue – there are unlimited cells.”

Pragnell offered a similar perspective but from the area of immunotherapy, describing progress in this emerging area that until recently would have seemed impossible. 

"Now we're seeing disease-modifying therapies where you can delay the onset of type 1 diabetes," he said. "Years ago, that was a pipe dream. That's really exciting."

Meanwhile, current diabetes technology is increasingly automating decision-making, and researchers are developing systems that require no user input – something that would have been hard to imagine a decade ago.

And while Senior expressed how AID systems have been able to deliver results practitioners couldn't before, he emphasized that each person is different and the idea of automation can prompt concerns about handing off some aspects of diabetes management. Those conversations should always be personalized, he said.

“There's a fear of rocking the boat," he said. "They don't like the boat they're in, but they know what it is. It speaks deeply to me about how impactful and burdensome diabetes is all the time. And again, I think that requires increasing amounts of empathy from healthcare providers, family members, and others to help give the support so that people are brave enough and able and supported to take those steps of faith. Nobody yet has said to me, 'I wish I hadn't done this.'"

The bottom line

Automation and adjunctive medicine are changing how type 1 diabetes is managed, yet challenges remain, such as maintaining stable blood sugar levels while dealing with meals, physical activity, and the general unpredictability of life.  

Progress is being made in slowing or modifying the autoimmune attack during early stages of type 1 using screening-based immunotherapies, and recent breakthroughs in islet transplantation could soon provide a potentially unlimited supply of islet cells for those who would most benefit from this therapy. 

The treatment of diabetes could soon be transformed through both advanced technology that requires little or no input from the user and rapidly advancing new forms of therapy, providing a cause for optimism about the future of diabetes care.

 Learn more about advances in diabetes treatment here:

• How Artificial Intelligence Is Changing Diabetes Care
• Diabetes Technology Highlights From ADA 2025
• Turning Challenges Into Change: What’s Solvable in Diabetes Care?
• Could AID Transform Type 2 Diabetes Care?
• Benefits of Automated Insulin Delivery for Children
• Tech Watch: The Latest in Diabetes Tech News