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Type 1 diabetes — master index¶
Last curated: 2026-10-29 · status: sweep complete; independent audit pending
The condition in five sentences. Type 1 diabetes is a chronic autoimmune disease in which T-cell-mediated destruction of pancreatic β cells produces lifelong dependence on exogenous insulin, and it is now formally staged as a continuum beginning years before symptoms: two or more islet autoantibodies define presymptomatic stage 1, and 69.7% of multiply-seropositive children progress to clinical disease within 10 years (Insel 2015, PMID 26404926; Ziegler 2013, PMID 23780460). About 8.4 million people lived with it worldwide in 2021 — most of them adults, with a median onset age of 39 — and prevalence is projected to grow 60–107% by 2040 (Gregory 2022, PMID 36113507). Intensive glycemic control prevents complications (DCCT 1993, PMID 8366922), and automated insulin delivery is now the technology anchor of care, raising time-in-range by ~11 percentage points in its pivotal trial (Brown 2019, PMID 31618560). The field crossed a historic threshold when teplizumab delayed clinical onset by a median ~2 years in at-risk relatives — the first approved disease-modifying therapy — and stem-cell-derived islets have now produced insulin independence in 10 of 12 early-trial recipients (Herold 2019, PMID 31180194; Reichman 2025, PMID 40544428). Yet burden remains stark: roughly two in five children worldwide still present in ketoacidosis, life expectancy is shortened by over a decade even in high-income registries, and a child diagnosed in a low-income country has a mean remaining life expectancy of 13 years versus 65 in a high-income one (Zhang 2026, PMID 42303108; Livingstone 2015, PMID 25562264; Gregory 2022, PMID 36113507).
Start here: overview.md. Frontier: OPEN-QUESTIONS.md. Growth history: LOG.md.
Build at a glance: 17 wiki pages (8 curated; 9 draft after this sweep) · 282 bibliography records · 19 rechecked clinical trials · 5 landmark paper notes · 30 guideline/consensus catalog records · 6 previously verified patient organizations.
Reading paths¶
| Reader goal | Suggested path |
|---|---|
| Understand disease evolution | overview → staging → immunopathogenesis |
| Find and delay early disease | screening → biomarkers → immunotherapy |
| Understand current management | insulin and technology → hypoglycemia → complications |
| Survey the frontier | clinical trials → β-cell replacement → open questions |
| Center lived experience and safety | patient experience → psychosocial → red flags |
Pages¶
The canonical page list for this condition (per CONVENTIONS.md §5). All 17 pages passed the separate 2026-08-30 audit. Nine pages are draft after the 2026-10-15, 2026-10-22 and 2026-10-29 sweeps and await independent review. On 2026-10-29, complications and genetics were demoted from curated because new quantitative content was added (FINE-ONE finerenone; a Swedish parental-autoimmunity cohort).
| File | Scope | Status |
|---|---|---|
| overview.md | What T1D is, staging framework, burden, map of the topic | curated |
| staging-and-natural-history.md | Stage framework, progression rates and birth cohorts | draft |
| epidemiology-and-burden.md | Global models, adult onset, mortality and DKA | curated |
| immunopathogenesis.md | T cells, insulitis, β-cell stress and immune-response evidence | curated |
| genetics-and-environmental-triggers.md | HLA/non-HLA risk and environmental hypotheses | draft |
| screening-and-early-detection.md | Relative/population screening, monitoring, ethics and economics | draft |
| insulin-therapy-and-technology.md | Insulin, CGM, pumps, AID and TIR | draft |
| disease-modifying-immunotherapy.md | Teplizumab, immune/β-cell therapy and combinations | draft |
| beta-cell-replacement.md | Pancreas/islet transplantation and stem-cell islets | curated |
| hypoglycemia.md | Severe hypoglycemia, awareness, rescue and technology | curated |
| complications.md | Micro-/macrovascular disease, DCCT/EDIC and kidney therapy | draft |
| psychosocial-and-behavioral.md | Distress, eating, transition, caregivers and quality of life | draft |
| guidelines.md | ADA, ISPAD and NICE synthesis | draft |
| biomarkers.md | C-peptide, antibodies, genetics and progression scores | curated |
| clinical-trials-landscape.md | Prevention, replacement, technology and registered pipeline | draft |
| patient-experience-and-advocacy.md | Lived experience, organizations and access advocacy | curated |
| red-flags-and-safety-concerns.md | DKA, hypoglycemia, SGLT, driving and exercise safety | curated |
Literature layer¶
| Layer | Contents | Status |
|---|---|---|
| BIBLIOGRAPHY.md | 282 deduplicated records; 7 additions on 2026-10-29 (6 cited, 1 bibliography-only) | sweep pending audit |
| notes/ | 5 landmark paper notes | built |
| guidelines/REGISTRY.md | 30 guideline/consensus catalog records, including the 2026 transition consensus and NICE TA1176 | sweep pending audit |
| statistics/STATISTICS.md | Historical estimates plus 2025 T1D Index v3.0 portal figures and PROTECT PP results; headline figures rechecked unchanged on 2026-10-29 | unchanged this sweep |
| patient-voice/ | Method, 6 previously verified organizations, themes and updated annotated sources | unchanged this sweep |
Curation state¶
The 2026-08-30 independent audit remains the baseline. The 2026-10-15 sweep updated six wiki pages. The 2026-10-22 sweep added three PubMed records, NICE TA1176, and one newly posted trial, and demoted staging from curated to draft. Changed pages remain draft pending an independent auditor. Ten wiki pages retain their prior curated status. The 2026-10-29 sweep added FINE-ONE (finerenone in T1D with CKD), Czech general-population screening yield, a Swedish parental-autoimmunity cohort, the teplizumab/EBV-HLH case (full text read), and two trial registrations. Search queries, retraction checks, and source-access limits are in the 2026-10-29 sweep manifest. This sweep does not re-audit every older claim.