Living with Type 1 diabetes (T1D) is a 24/7 balancing act. Every meal, activity, and decision is shaped by the need to manage blood sugar and avoid dangerous highs and lows. “Staying in range” is only part of the story. Behind it lies a constant mental and physical burden that touches every part of life. Today’s treatments help manage the disease. Could something better be around the corner?
Type 1 Diabetes (T1D) disrupts the flow of daily life. You don’t drive your kids to school because you fear losing control of your car. You plan school and work and socializing around insulin injections and blood sugar monitoring. You post notes around your house so your family knows what to do if they find you passed out. T1D is not just a condition — it’s a constant companion that never takes a day off.
Today, an estimated 9.5 million people around the world — including nearly 2 million children and adolescents — live with T1D, and diagnosis rates are rising, fast. The Type 1 Diabetes Index estimates that by 2040, more than 14.7 million people will have T1D.[i] This means millions more people waking each day to a routine that demands vigilant planning and an ever-present awareness of risk.
For all those living with T1D and their loved ones, the common care mantra is “staying in range”: injecting insulin to keep your blood glucose within a narrow window to avoid hypoglycemia (too little blood glucose) or hyperglycemia (too much blood glucose). This manual management aims to mimic the normal pancreatic function of someone without T1D. But this daily balancing act barely scratches the surface of the full burden of T1D. Staying in range requires near-constant decision-making — calculating carbohydrates, adjusting insulin for activity, reacting to fluctuations — and even with the latest tools, perfect balance remains elusive.
What disease management misses
Dr. Marlon Levy
Senior Vice President, VCU Health Sciences; CEO, VCU Health System
Dr. Marlon Levy, senior vice president of Virginia Commonwealth University (VCU) Health sciences, CEO of VCU Health System, and a career transplant surgeon, has witnessed the burden of T1D up close in his patients’ lives over decades of practice. “A diabetic patient can live a very full, active life, but there is no doubt diabetes is a cruel disease,” he shared. “It is extremely difficult, even with the most careful management, to stay in range all the time.”
Even with hypervigilance and dedicated daily management using existing glucose self-monitoring tools, such as continuous glucose monitoring and automated insulin delivery systems, life-altering dangers loom daily for those living with T1D. One of the more frightening complications for T1D are severe hypoglycemic events (SHEs). SHEs can occur for anyone living with T1D and may be sudden. Those who have lived with T1D for a long time or who cannot sense that their blood sugar is falling dangerously low (impaired awareness of hypoglycemia, or IAH) may be at an increased risk for SHEs. Untreated, such episodes can lead to unconsciousness, seizures, and, in some cases, death.
Despite advancements in care, those with T1D remain at higher risk for kidney disease, vision loss, cardiovascular disease, nerve problems, and other serious complications.[ii],[iii],[iv] Given the high risk of such long-term complications and co-occurring health challenges, global studies indicate that premature death for those living with T1D is still significantly higher than for those without it, despite significant advancements in care.[v] The Type 1 Diabetes Index estimates that more than 173,000 people worldwide lost their lives to diagnosed and undiagnosed T1D in 2025 alone.[i]
The burden is not just physical. Unsurprisingly, researchers have found a connection between the daily demands of T1D and mental health challenges. T1D can interrupt schooling, interfere with career ambitions, and strain relationships.[vi]
Envisioning an evolution in T1D treatment
What if care could evolve beyond just management and move toward redefining what is possible? “The Holy Grail for a chronic condition,” explained Dr. Levy, “is being able to live one’s life as if the disease didn’t exist or was part of the past, not part of the present.”
In 30 years of practice, Dr. Levy has performed pancreas transplants for people living with T1D and has seen the difference such treatments can provide. He shared, “Patients describe it as miraculous. To have a life restored, to have promise restored, to have hope restored, there’s no other way to describe it.” But pancreas transplants are not widely accessible and carry the risks that may be associated with other forms of organ transplant, leaving such life-changing outcomes in limited supply.
The team at Vertex Pharmaceuticals is working toward advancements in T1D treatment with the hopes of having a transformative impact. And that starts by thinking bigger and focusing on the underlying biology of the disease.
There is inspiration to be found in recent decades of medical research, marked by transformational breakthroughs in the way we treat other chronic conditions. Consider hepatitis C, a virus that attacks the liver. Around 50 million people globally have chronic hepatitis C virus infection, which carries the risk of chronic liver disease that can lead to death. Today, direct-acting antiviral medicines can cure more than 95% of people with hepatitis C.[vii]
“In hepatitis C, we’ve seen a transformation,” Dr. Levy noted, “the ability to eradicate the virus and restore life to what it was before illness struck.”
Similarly, advances in HIV treatment have turned a once-fatal illness into a manageable condition, allowing people to live long, healthy lives.[viii]
Looking forward
Building upon learnings from patients who received pancreatic transplants, the focus of future T1D treatments is aimed at harnessing and applying developments in cell therapy research. This work is being done in the hopes of progressing innovative changes in the treatment of T1D, like moving beyond just managing the disease.
Researchers are exploring ways to replace the insulin-producing beta cells destroyed in T1D, protect them from immune attack, and avoid the need for life-long immunosuppressive drugs. If successful, such approaches could make the automatic glucose regulation of a healthy pancreas possible again, easing both the physical and emotional burden of the disease.
Dr. Levy does not hesitate to share his optimism for a paradigm shift in T1D treatment. “It’s a real blessing to be living in this moment and to work in this area where the pace of understanding how to improve the lives of T1D patients is multiplying rapidly.”
This article was sponsored by Vertex Pharmaceuticals.
Dr. Marlon Levy has not received compensation for this interview. Virginia Commonwealth University is a Vertex Pharmaceutical clinical trial site.
[i] Breakthrough T1D, Life for a Child, International Diabetes Federation, ISPAD, & Beyond Type 1. (2022). Type 1 Diabetes Index [Data simulation tool]. Retrieved July 31, 2025, from https://www.t1dindex.org/
[ii] Jansson Sigfrids, F., & Groop, P. H. (2023). Progression and regression of kidney disease in type 1 diabetes. Frontiers in nephrology, 3, 1282818. https://doi.org/10.3389/fneph.2023.1282818
[iii] Sheehy, D. F., Quinnell, S. P., Vegas, A. J. (2019). Targeting Type 1 Diabetes: Selective Approaches for New Therapies. Biochemistry, 58, 4, 214–233. https://doi.org/10.1021/acs.biochem.8b01118
[iv] American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2014 Jan;37 Suppl 1:S81-90. doi: 10.2337/dc14-S081. PMID: 24357215.
[v] Secrest, A. M., Washington, R. E., & Orchard, T. J. (2018). Mortality in Type 1 Diabetes. In C. C. Cowie (Eds.) et. al., Diabetes in America. (3rd ed.). National Institute of Diabetes and Digestive and Kidney Diseases (US).
[vi] van Duinkerken, E., Snoek, F. J., & de Wit, M. (2020). The cognitive and psychological effects of living with type 1 diabetes: a narrative review. Diabetic medicine : a journal of the British Diabetic Association, 37(4), 555–563. https://doi.org/10.1111/dme.14216
[vii] World Health Organization. Hepatitis C Fact Sheet. Updated July 2023. https://www.who.int/news-room/fact-sheets/detail/hepatitis-c
[viii] U.S. Department of Health & Human Services. HIV Treatment Overview. https://www.hiv.gov/hiv-basics/staying-in-hiv-care/hiv-treatment/hiv-treatment-overview
