What are the current treatment guidelines for Type 1 Diabetes Mellitus (T1DM)?

From the Guidelines

The latest guideline for treating type 1 diabetes recommends treating most adults with continuous subcutaneous insulin infusion or multiple daily doses of prandial and basal insulin, with a preference for insulin analogs over human insulins to minimize hypoglycemia risk. This approach is based on the most recent evidence from the 2025 standards of care in diabetes 1. The guidelines suggest that adults with type 1 diabetes should be treated with either continuous subcutaneous insulin infusion or multiple daily doses of prandial (injected or inhaled) and basal insulin.

Some key points to consider in the treatment of type 1 diabetes include:

• The use of insulin analogs (or inhaled insulin) is preferred over injectable human insulins to minimize hypoglycemia risk 1.
• Early use of continuous glucose monitoring is recommended to improve glycemic outcomes and quality of life and to minimize hypoglycemia 1.
• Automated insulin delivery systems should be offered to all adults with type 1 diabetes 1.
• Patients should receive education on how to match mealtime insulin doses to carbohydrate intake and fat and protein intake, as well as how to modify the insulin dose based on concurrent glycemia, glycemic trends, sick-day management, and anticipated physical activity 1.

The treatment plan and insulin-taking behavior should be reevaluated at regular intervals (e.g., every 3–6 months) and adjusted to incorporate specific factors that impact choice of treatment and ensure achievement of individualized glycemic goals 1. Overall, the goal of treatment is to minimize both hyperglycemia and hypoglycemia while reducing long-term complications through tight glucose control.

From the FDA Drug Label

In two clinical studies (Studies A and B), adult patients with type 1 diabetes (Study A, n=585, Study B n=534) were randomized to 28 weeks of basal-bolus treatment with Insulin Glargine or NPH insulin. In another clinical study (Study C), patients with type 1 diabetes (n=619) were randomized to 16 weeks of basal-bolus treatment with Insulin Glargine or NPH insulin. In these 3 adult studies, Insulin Glargine and NPH insulin had similar effects on HbA1c (Table 9) with a similar overall rate of severe symptomatic hypoglycemia [see Adverse Reactions (6. 1)].

The latest guideline for treating type one diabetes is not explicitly stated in the provided drug label. However, the label does provide information on the effectiveness of Insulin Glargine in treating type 1 diabetes, which includes:

• Basal-bolus treatment: Insulin Glargine can be used as a basal insulin in a basal-bolus treatment regimen.
• Similar effects to NPH insulin: Insulin Glargine has similar effects on HbA1c and severe symptomatic hypoglycemia compared to NPH insulin.
• Administration: Insulin Glargine can be administered once daily at bedtime. 2

From the Research

Treatment Guidelines for Type 1 Diabetes

The latest guidelines for treating type 1 diabetes recommend the following:

• Insulin is the primary treatment in all patients with type 1 diabetes mellitus (T1DM) 3
• Typically, patients with T1DM will require initiation with multiple daily injections at the time of diagnosis, which can include short-acting insulin or rapid-acting insulin analogue given 0 to 15 min before meals together with one or more daily separate injections of intermediate or long-acting insulin 3
• The target glycated hemoglobin A1c (HbA1c) for all children with T1DM is recommended to be < 7.5% (< 58 mmol/mol) 3
• For nonpregnant adults with T1DM, a glycemic target of glycated hemoglobin < 7% (53 mmol/mol) is appropriate 4

Insulin Regimens

Different insulin regimens can be used to manage type 1 diabetes, including:

• Multiple daily injections of basal/bolus insulin 4
• Continuous subcutaneous insulin infusion (CSII) 4, 5
• Basal-bolus therapy (BBT) with a long-acting basal insulin and a rapid-acting insulin at mealtimes 5
• A twice-daily regimen with NPH and detemir insulins during initial treatment of youth with type 1 diabetes mellitus 6

Insulin Types

Different types of insulin can be used to manage type 1 diabetes, including:

• Rapid-acting insulin analogues (e.g. aspart, glulisine, lispro) 4, 7
• Basal insulin analogues (e.g. glargine, degludec) 4, 7
• Faster-acting insulin aspart 4
• Ultrarapid-acting lispro 7
• Human insulin 3, 5

Monitoring and Education

Blood glucose monitoring is an integral part of effective insulin therapy and should not be omitted in the patient's care plan 3

• Patient education on insulin dosing based on carbohydrate counting, premeal blood glucose, and anticipated physical activity is paramount 4