New Scientific Statement outlines future research directions for type 1 diabetes

A new Scientific Statement released today by the Endocrine Society highlights potential research directions related to the pathogenesis of type 1 diabetes (T1D) that should help with the development of new and improved treatment options.

Type 1 diabetes is a chronic disease where the body's immune system attacks and destroys insulin-producing cells in the pancreatic islet. Type 1 diabetes requires lifelong insulin administration and may result in complications such as eye, kidney, nerve, and heart disease. Type 1 diabetes is usually thought to be a disease of children and adolescents, but it is now recognized that T1D often has its onset in adults and can occur at any age.

The Endocrine Society develops Scientific Statements to explore the scientific basis of hormone-related conditions and diseases, discuss how this knowledge can be applied in practice, and identify areas that require additional research. Topics are selected on the basis of their emerging scientific impact. Scientific Statements are developed by a Task Force of experts appointed by the Endocrine Society, with internal review by the relevant Society committees and expert external reviewers prior to a comment period open to all members of the Society.

The Endocrine Society chose type 1 diabetes for a Scientific Statement because research related to T1D is rapidly expanding, and the field is poised for new advances. The hope is that the Scientific Statement will provide scientists, physicians, and funding agencies with a guide for areas of research that seem particularly promising."

Alvin C. Powers, M.D., of Vanderbilt University Medical Center in Nashville, Tenn., member of the writing group

According to the International Diabetes Federation, 9 million people had type 1 diabetes in 2024 with considerable variation in the rates across countries.

The causes and factors that lead to type 1 diabetes are unknown. The Scientific Statement summarized research and suggested directions for new research in these areas related to T1D: genetics, heterogeneity, pathology of the pancreas, assessment of β cell function and mass, immunologic biomarkers in peripheral blood, changes in the exocrine pancreas, and screening to identify individuals at-risk for T1D.

"The data highlights the need for population-based screening for type 1 diabetes and more research into the causes of the disease," Powers said. "We hope addressing these research gaps and incorporating more widespread screening efforts will help identify those at risk sooner and improve treatment and long-term health outcomes for people living with type 1 diabetes."

The statement is based on the authors' updated version of the widely cited and often modified Eisenbarth model, which outlines the different stages of progression to type 1 diabetes. The Scientific Statement proposes that Stage 0 be added to this model which already included Stages 1, 2, and 3, to highlight that there are likely events occurring earlier in the disease that currently are not understood or being studied.

"We hope that research in these areas infused with information from the application of emerging technological and analytical tools will lead to a new understanding of the pathogenesis of type 1 diabetes," Powers concluded.

Other statement authors are Aaron Michels of University of the Colorado School of Medicine in Denver, Colo.; Todd Brusko of the University of Florida in Gainesville, Fla.; Carmella Evans-Molina of Indiana University School of Medicine and the Roudebush VA Medical Center in Indianapolis, Ind.; Dirk Homann of the University of Miami, Miami, Fla.; and Sarah Richardson of the University of Exeter Medical School in Exeter, U.K.

The statement, "Challenges and Opportunities for Understanding the Pathogenesis of Type 1 Diabetes: An Endocrine Society Scientific Statement," was published online in the Society's journal, The Journal of Clinical Endocrinology & Metabolism.