Emerging therapies for type 1 diabetes: Immunotherapy and gene editing advances

Type 1 diabetes is a chronic autoimmune disease involving the specific destruction of pancreatic β-cells and consequent absolute insulin deficiency. Although exogenous insulin replacement aids in hyperglycemic management, it does not cure the disease and increases the risks of hypoglycemia. Recent breakthroughs in disease-modifying therapies aim to delay, halt, or reverse disease progression via immune modulation or cell replacement. This narrative review systematically summarizes key therapeutic advances from 2023 to 2025. In immunotherapy, anti-CD3 monoclonal antibodies such as teplizumab have become the first Food and Drug Administration-approved agents to delay clinical onset in high-risk individuals. Inhibitors targeting pathways such as Janus kinase-STAT and engineered cell therapies such as chimeric antigen receptor-Tregs have also demonstrated potential for preserving residual β-cell function. For gene therapy and cell replacement, clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated protein 9 (Cas9) editing has generated "hypoimmune" stem cell-derived β-cells, with early clinical trials reporting instances of insulin independence without immunosuppression. Encapsulation technologies further provide a physical immune barrier for transplanted cells. Collectively, these advances mark a paradigm shift from symptomatic control to addressing core disease mechanisms through immune repair and functional restoration. Although challenges in long-term efficacy, safety, and accessibility persist, the ongoing development of combination strategies and precision medicine contributes to long-term remission and potentially a cure within reach.