Type 1 diabetes is not curable today, but the line between “incurable” and “curable” is shifting faster than at any point in the disease’s history. Several experimental therapies have already freed small numbers of patients from insulin injections entirely, and the first drug to delay the disease’s onset won FDA approval in 2022. The medical community now uses the word “remission” rather than “cure” to describe these outcomes, because long-term durability remains unproven.
Why a Cure Is So Difficult
Type 1 diabetes is an autoimmune disease. Your immune system’s T cells mistakenly attack and destroy the insulin-producing beta cells in your pancreas. Any true cure has to solve two problems at once: replace the missing beta cells and stop the immune system from destroying them again. Solving only one side of that equation isn’t enough. Transplanted cells without immune protection get attacked. Immune suppression without new beta cells leaves you with nothing to protect.
This double challenge is why type 1 diabetes has resisted a cure for over a century, even as management tools have improved dramatically.
Remission vs. Cure: What the Terms Mean
Doctors define diabetes remission as maintaining an HbA1c below 6.5% for at least three months without any glucose-lowering medication, including insulin. That’s a normal or near-normal blood sugar level sustained on your own. A cure would mean the disease is permanently gone with no chance of return. No current therapy meets that bar, so researchers and clinicians use “remission” to describe even the most impressive results.
There’s also a natural, temporary version of this. Many people experience a “honeymoon phase” shortly after diagnosis, where surviving beta cells still produce some insulin. Blood sugar is easier to manage and insulin doses drop. This typically lasts a few months to a year, though some people experience it for several years. It always ends as the immune system finishes destroying the remaining beta cells.
Stem Cell Therapy: The Closest Thing to a Cure
The most dramatic results so far come from stem cell-derived islet cell therapy. In an ongoing clinical trial called FORWARD, stem cells are grown into functioning insulin-producing cells in a lab, then infused into patients. Of 10 participants who reached the six-month mark, seven no longer needed insulin injections at all, and two others had reduced their daily insulin use by roughly 70%. Every patient with more than a year of follow-up had eliminated dangerous blood sugar crashes while maintaining an HbA1c below 7%.
These results are striking, but the patients still require immunosuppressive drugs to prevent their bodies from rejecting the new cells. That’s a serious trade-off: immunosuppression raises the risk of infections and other complications. The therapy is also in early-stage trials with small numbers of participants. Whether these results hold up over five, ten, or twenty years is unknown.
Islet Cell Transplantation: A 20-Year Track Record
Transplanting insulin-producing islet cells from donor pancreases has been studied for decades and offers a longer window into what’s realistic. A 20-year study from Italy found that 44% of patients achieved insulin independence, lasting a median of six years. When patients received a higher dose of islet cells paired with an optimized drug regimen, the results improved considerably: 73% achieved insulin independence, and the transplanted cells survived a median of nearly ten years.
The catch, again, is immunosuppression. In that same study, 44% of patients experienced side effects from the immune-suppressing drugs. The immune system also became sensitized over time. At the start, only 6% of patients showed signs of immune sensitization. After stopping therapy, that number jumped to 42%. Islet transplantation works, but it currently trades one chronic medical burden for another.
Teplizumab: Delaying Onset Before It Starts
A different strategy avoids replacing beta cells altogether and instead tries to preserve the ones you still have. Teplizumab, approved by the FDA in November 2022, is the first drug designed to delay the progression of type 1 diabetes. It works by binding to T cells and slowing their attack on beta cells.
The drug is approved for people in Stage 2 of type 1 diabetes, meaning they already have autoantibodies and abnormal blood sugar but haven’t yet developed full-blown symptoms requiring insulin. By intervening at this stage, teplizumab extends the window before a person becomes insulin-dependent. This isn’t a cure, but for someone facing a lifetime of insulin management, even a delay of several years is meaningful, particularly for children diagnosed through screening.
Autoantibody screening through a simple blood test can identify people at risk years before symptoms appear. People can stay in the earliest stage for years before progressing, which creates a window where interventions like teplizumab could make a difference.
Gene Editing and Immune Evasion
The biggest obstacle across all these approaches is the immune system. Gene editing technology is being used to tackle that problem directly. One approach, developed through a collaboration using CRISPR technology, genetically modifies lab-grown pancreatic cells so the immune system can’t recognize and attack them. These “immune-evasive” cells are delivered inside a small perforated device that holds them in place while allowing insulin to flow out into the body.
If this works as intended, it would eliminate the need for lifelong immunosuppression, which is the missing piece that separates current treatments from something that could realistically be called a cure. This research is still in early clinical testing.
Living With Type 1 Today: Automated Insulin Systems
While the search for a cure continues, the technology for managing type 1 diabetes has improved enough that some systems now function as a partial stand-in. Automated “closed-loop” systems pair a continuous glucose monitor with an insulin pump that adjusts delivery in real time, sometimes called a bionic pancreas. A systematic review of these systems found they lowered HbA1c by an average of 0.4 percentage points and increased the time patients spent in a healthy blood sugar range by about 14 percentage points compared to standard care.
These devices don’t cure anything. You still wear them, refill them, and live with the disease. But for many people, they reduce the daily cognitive burden of managing blood sugar to a level that would have been unimaginable 20 years ago. They represent the best available bridge between today’s reality and whatever comes next.
What “Curable” Might Look Like
A genuine cure for type 1 diabetes would mean restoring your body’s ability to produce and regulate insulin permanently, without ongoing drugs or devices. The stem cell and gene editing approaches are the most plausible paths to that outcome. The stem cell trials have already shown that lab-grown cells can function inside a human body and eliminate the need for injected insulin. Gene editing may solve the immune rejection problem that currently limits every transplant-based strategy.
Neither technology is ready for widespread use. Clinical trials take years, and scaling production of living cells for millions of patients is an enormous manufacturing challenge. But the trajectory is clear: for the first time, individual patients in clinical trials are living without insulin injections and maintaining normal blood sugar levels using cells that were grown in a lab. That’s not a cure yet. It’s closer than anything that’s come before.