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Type 1 Diabetes Mellitus is of autoimmune origin, appearing suddenly with polyuria, polydipsia, polyphagia and then fatigue, exhaustion and weight loss, reaching even diabetic coma if one is slow to react.

Insulin stops being produced by the β-cells of the pancreas, which have been attacked by our own immune system.

Only our brain can receive the necessary glucose without the mediation of insulin. Insulin is so necessary that before its discovery in 1922, the life expectancy (LE) of patients with insulin-dependent Diabetes Mellitus (T1DM) was less than 3 years. In 1975, patients with type 1 diabetes lost 27 years of life and in 2000, 19 years – compared to the general population.

According to a recent United Nations report (2019), the loss in LE has now been limited to 12 years.

As type 1 diabetes is the main and by far the longest-lasting factor in cardiovascular damage, strict regulation with a target of glycosylated hemoglobin (HbA1c ≤ 6.5%) but with small fluctuations with at least 75% of the time within the normal range is the only way forward.

These have now been achieved with the use of the hyper-intensified regimen with the newest 24-hour ultra-slow-acting insulins without peaks, with the very fast-acting newer rapid-acting analogs that are administered immediately before each meal, with the use of 24-hour automatic sugar recording systems with an electrochemical subcutaneous sensor even every 1 minute – which also offer a modern prediction of the evolution of the sugar value by giving its rate of change – and of course with the use of insulin pumps, which in their recent development try to take over the regulation with automated decisions to correct hyperglycemia and prevent hypoglycemia through a “closed circuit”.

Technological developments are rapid and the means that we, as specialized doctors, now have are sufficient, so that we can achieve this through an intensive education program for the child and the parents using algorithms that allow for continuous self-regulation to a very large extent, resulting in perfect regulation, to the point where it is almost impossible for someone to easily understand from a 24-hour recording of a diabetic child whether they have diabetes or not. Technology is also advancing very quickly with the creation of apps that are able to calculate the necessary insulin for a specific patient with just a photo or a short video of the dish that is about to be consumed, giving even greater flexibility and freedom.

The modern alleviation of psychological burdens and the timely treatment of metabolic disorders (e.g. obesity, dyslipidemia, microalbuminuria, hypertension) from a very early age, combined with excellent regulation, can now eliminate the effects and damage from DM, so that when the long-awaited time of definitive treatment comes, which seems to be closer than ever with the use of appropriately differentiated stem cells, the person with DM will be healthy.

With the 1st successful application of such treatment in a person who had 40 years of DM1 as recently as October 2021 at Harvard, the thought that today’s children will not grow old with DM1 is now becoming a very likely reality.

However, we are not just dealing with it and we are not just hoping for a cure.

The incidence of type 1 diabetes in children has not stopped increasing, with the age of onset constantly falling. There are now serious indications that the global pandemic of hypovitaminosis D is very seriously involved in this development (The big Vitamin D mistake https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5541280/). Research into the prevention of autoimmune diabetes continues intensively and there is now evidence that early immunomodulation with the active form of the hormone – active vitamin D – calcitriol (https://onlinelibrary.wiley.com/doi/abs/10.1111/1753-0407.12023) and its potent synthetic analogues (https://www.sciencedirect.com/science/article/abs/pii/S0003426620304182) can prevent the progression to T1DM. For all this, we will have the honor of participating as invited speakers in a special symposium of the European Society of Endocrinology on the topic ‘Role of Vitamin D in the prevention of T1 and T2 Diabetes’ at the 25th European Congress of Endocrinology, in May 2023, in Istanbul