Good Enough Got Us Here, But It Won’t Get Us To The Promised Land

Please read this recently published visionary article – Starr, L., Dutta, S., Danne, T., Karpen, S.R., Hutton, C., & Kowalski, A. (2025). The Urgent Need for Breakthrough Therapies and a World Without Type 1 Diabetes

Here’s my TLDR,

But I encourage you to read the full article (it has top-notch graphics!)

Gratitude Comes First!

Thank you to the researchers who discovered insulin. To the engineers who gave us sensors and pumps. To the clinicians, carers, and families who’ve fought for better care, day in and day out. And to every single person with type 1 diabetes (T1D) who’s helped move the needle, not just in clinical trials, but in the quiet, relentless work of day-to-day life.

A century ago, a diagnosis was a death sentence. Today, people with T1D live longer, fuller lives than ever. For that, we should be grateful beyond words.

But we can’t stop here.

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Diabetes Made Us Pioneers

There’s a unique kind of wisdom that comes from living with T1D. You learn to trial and error your way through every day. You read your body like a scientist. You sense trends before your CGM does. You know when something is off before a number confirms it.

We are data nerds, detectives, analysts, and artists of adaptation (guilty on all counts!).

But that doesn’t mean it’s easy.

Despite the advances, T1D is still a condition of constant vigilance. It’s waking up to alarms in the night. It’s adjusting doses on holiday. It’s trying to explain to your boss or teacher, or friend that you’re “fine” but actually feeling shaky, foggy, and 3.2 mmol/L. And sometimes it’s just being exhausted.

Even now, only 1 in 4 people reach the recommended glucose targets. Even now, many kids are still diagnosed in DKA. Even now, people with T1D die too early​. Even with a lifetime of A1c’s at target levels, the risk of all-cause death from cardiovascular disease is 3-fold higher (this is me!)

This isn’t a failure. It’s a sign we’ve gone as far as insulin can take us.

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We’re on the Edge of Something Big

Here’s the most exciting part.

The future isn’t just about managing diabetes better. It’s about changing it entirely.

Researchers now understand that T1D develops over time. Before diagnosis, the immune system is already quietly attacking beta cells. That opens a new window of opportunity, one where we can preserve, protect, and possibly restore insulin production​.

We already have proof-of-concept.

• Teplizumab can delay the clinical onset of diabetes by years.
• Donislecel is a cell therapy that has shown people can become insulin-independent.

These aren’t theoretical. They’re happening now. And they mark the beginning of a new chapter, one where we stop simply firefighting blood sugars and start treating the root cause.

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But Progress Needs Permission

There’s a challenge, though. Our systems haven’t caught up with our science.

Regulatory rules still centre HbA1c and hypoglycaemia rates as the key endpoints for trial approval. But these don’t tell the full story. They don’t measure the emotional toll, the disrupted sleep, the burnout, or the mental load of 24/7 decision-making​.

We need smarter tools to assess benefits. We need to include C-peptide to measure beta-cell function. Why? Read this to understand why every bit of residual insulin production (C-Peptide) counts!

We need CGM metrics that show real-time progress. But for that, we need standardisation of CGM accuracy assessments so we are measuring apples and pears! So, get behind the IFCC Working Group on CGM as they drive to an ISO Standard.

And above all, we need patient voices front and centre.

Because here’s the thing.

When people with T1D say they’d accept new trade-offs, like the risk of immunosuppression for the chance of insulin independence, we must believe them. They’ve lived with risk their whole lives. They know what’s worth it​.

Remember, the cost of stagnation is at best a 3-fold increase in risk of death (I never thought of this way till reading this!)

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A Rally, Not a Rant

This isn’t a complaint. It’s a rally.

We are standing at the edge of a true breakthrough. We’ve honoured insulin. Now let’s honour possibility.

Let’s align science, policy, and patient insight. Let’s stop waiting for perfection and start pushing for progress. Let’s say yes to trials that preserve function, not just treat numbers. Let’s advocate for therapies that offer freedom, not just longer lives, but better ones.

To everyone living with T1D, get behind the push for B-cell preservation and restoration!

We are not just managing anymore. We are on the move.

Let’s go get what’s next.

I am in.

Who’s with me?

Share this publication far and wide – Starr, L., Dutta, S., Danne, T., Karpen, S.R., Hutton, C., & Kowalski, A. (2025). The Urgent Need for Breakthrough Therapies and a World Without Type 1 Diabetes.

John