The type 1 diabetes market is dominated by three major players: Eli Lilly, Novo Nordisk, and Sanofi. In the US, sales have been impacted negatively by significant list price reductions, with more moderate declines in Japan and relative stability across the major European markets. Headwinds are expected to continue in the insulin segment, including ongoing net pricing pressures from biosimilar/follow-on competition, near-saturation of insulin use in type 1 diabetes, and growing insulin pump adoption that will erode basal usage. With limited prospects for major insulin technology advances, drug developers are pivoting toward alternative approaches, with anticipated approvals Sanofi’s Tzield (teplizumab) in recently diagnosed stage 3 type 1 diabetes and vTv Therapeutics’ cadisegliatin.