Diabetes Dialogue: Screening, Cell Therapy, and Adjunctive Agents at Breakthrough-T1D

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!

Population-level screening for type 1 diabetes (T1D) is moving into clinical practice, raising questions about who to screen, how to stage results, and how to deliver disease-modifying therapy at scale.

On a recent episode of Diabetes Dialogue, hosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, recapped the inaugural Breakthrough T1D Clinical and Research Congress in Philadelphia.

First-degree relatives carry up to a 15-fold increased risk, and screening children at ages two, six, and 10 years identifies roughly 80% of those who will develop the disease. Evidence guiding adult screening and staging remains limited. One health system estimated up to 45,000 candidates after counting relatives and people with autoimmune thyroid disease, celiac disease, or vitiligo.

Placebo-controlled designs, such as the 14-day intravenous infusion regimen in the teplizumab (Tzield) TN10 trial, burden participants. An ongoing comparison of antithymocyte globulin with teplizumab gives every participant active therapy, and involving people with T1D in protocol development may improve enrollment. Eli Lilly is also investigating the Janus kinase inhibitor baricitinib (Olumiant) to delay progression from stage two to stage three disease.

Stem cell-derived islet programs from Vertex aim to overcome donor scarcity, with gene editing intended to reduce immunosuppression requirements. Reports of insulin independence with tegoprubart, an anti-CD40 ligand antibody from Eledon, involve few patients receiving infusions every three weeks, and long-term toxicity of agents such as tacrolimus remains a concern. Long-term Edmonton protocol data show many recipients sustain time in range above 90% despite resuming insulin.

Adjunctive agents layered on automated insulin delivery address residual cardiorenal risk. Dipeptidyl peptidase-4 inhibitors improve time in range without added hypoglycemia, while generic dapagliflozin lowers mean glucose but requires ketone monitoring given euglycemic diabetic ketoacidosis risk. Glucagon-like peptide-1 (GLP-1) and dual GIP/GLP-1 receptor agonists improve time in range, often at low doses such as tirzepatide (Mounjaro) 2.5 mg weekly.

Finerenone (Kerendia) recently gained approval for chronic kidney disease associated with T1D. The 2026 American Diabetes Association Standards of Care also recognize coexisting type 1 and type 2 diabetes, supporting coverage for patients with insulin resistance.

Supply policy compounds the clinical burden. Continuous glucose monitoring sensors frequently fail before their labeled wear time, leaving patients on standard monthly allotments without a sensor for meaningful stretches.

Collectively, these developments point toward individualized T1D care matched to disease stage and residual beta-cell function, with screening infrastructure, trial access, and supply policy shaping how quickly patients benefit.

Editors’ Note: Isaacs reports disclosures with Dexcom, Abbott, Lilly, Novo Nordisk, Medtronic, Insulet, and others. Bellini reports disclosures with Abbott Diabetes Care, MannKind, Povention Bio, and others.

References

1. Breakthrough T1D. Breakthrough T1D Concludes Inaugural Clinical & Research Congress, Highlighting Global Advances in Type 1 Diabetes Research. October 12, 2026. Accessed October 15, 2026. https://www.breakthrought1d.org/for-the-media/press-releases/breakthrough-t1d-concludes-inaugural-clinical-research-congress-highlighting-global-advances-in-type-1-diabetes-research/