The heterogeneity of type 1 diabetes: implications for pathogenesis, prevention, and treatment—2024 Diabetes, Diabetes Care, and Diabetologia Expert Forum – Published online 30/07/2025

Carmella Evans‑Molina, Yuval Dor, Åke Lernmark, Chantal Mathieu, Jeffrey R. Millman, Raghavendra G. Mirmira, Flemming Pociot, Maria J. Redondo, Stephen S. Rich, Sarah J. Richardson, Michael R. Rickels, R. David Leslie

In 2024, an international Expert Forum organised by the editors of Diabetes, Diabetes Care and Diabetologia reviewed key factors contributing to the development and progression of type 1 diabetes. In this issue, this review by Evans-Molina et al (https://doi.org/10.1007/s00125-025-06462-y) summarises the findings of this Expert Forum.  The authors review a diverse palette of risk factors, present in individuals along gradients of influence, that contribute to or protect against progression from the preclinical stages of type 1 diabetes to frank clinical disease. These risk factors aggregate to affect beta cell dysfunction and other pathological processes, and this heterogeneity in pathogenesis may be leveraged to design targeted disease-modifying immunotherapies and improved approaches to islet cell replacement. The authors identify key research priorities that will need to be addressed to bring these efforts to fruition. The multiple forms of heterogeneity in type 1 diabetes offer both rich opportunities and formidable challenges in the quest to develop new, clinically beneficial strategies for both prevention and treatment of the disease. The figures from this review are available as a downloadable slideset.

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