Type 1 diabetes (T1D) management is entering a new era in which treatment may extend beyond insulin replacement to include interventions that delay disease progression, preserve residual beta-cell function, and improve metabolic outcomes in established disease. Although advances in insulin delivery and glucose monitoring have substantially improved care, many people with T1D continue to experience suboptimal glycaemic outcomes, treatment burden, weight gain, and increased cardiometabolic risk. Furthermore, insulin therapy does not address the autoimmune processes responsible for pancreatic beta-cell destruction.

The identification of presymptomatic T1D has created opportunities to intervene before clinical onset. At the same time, emerging immunomodulatory therapies are being investigated to delay progression, preserve endogenous insulin secretion, and improve outcomes following diagnosis. For people with established T1D, adjunctive pharmacotherapies, including incretin-based therapies, SGLT inhibitors, amylin analogues, and other emerging agents may help improve glycaemic control, reduce insulin requirements, support weight management, and address cardiometabolic risk.

However, important questions remain regarding patient selection, treatment timing, durability of response, safety, and the practical integration of these therapies into routine clinical care.

This Research Topic aims to examine disease-modifying and adjunctive therapeutic strategies across the T1D continuum, from presymptomatic disease to established T1D. We welcome original research, clinical and translational studies, real-world evidence, and focused reviews that advance the clinical development and implementation of therapies beyond conventional insulin replacement.

Themes of interest include:
• Screening, risk stratification, and early intervention in presymptomatic T1D
• Patient selection for disease-modifying therapy in presymptomatic T1D
• Biomarkers and predictors of response to disease-modifying therapies
• Adjunctive pharmacotherapies for improving glycaemia, weight and other cardiometabolic outcomes in established T1D, including but not limited to: amylin and GLP1 analogues, metformin, and SGLT2 inhibitors
• Patient selection, treatment timing, and precision therapeutic approaches
• Clinical trials and real-world evidence relating to the implementation of disease-modifying and adjunctive therapies
• Barriers to access, uptake, and integration of emerging therapies into clinical practice

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Disease-Modifying and Adjunctive Therapies Across the Type 1 Diabetes Continuum