Update in type 1 diabetes

Context: Type 1 diabetes is a heterogeneous disorder characterized by severe beta-cell loss. The great majority of patients have type 1A or immune-mediated diabetes. Synthesis: There has been recent progress in defining the genetics, pathogenesis, and natural history of the disease. In addition, there is a major effort to develop immunotherapies to prevent the disorder and to cure the disease with islet transplantation, and there is potential for dramatic improvement in care with introduction of continuous glucose monitoring devices. The discovery of "metabolic memory" underscores the importance of excellent metabolic control. With comprehensive care, major microvascular complications (e. g. blindness and renal failure) are preventable for most patients. Conclusion: The existence of multiple "competing" technologies to deal with this devastating disorder holds promise of improved outcomes.