Despite newer products with improved pharmacokinetic/pharmacodynamic (PK/PD) profiles, the type 1 diabetes treatment market has been gradually declining in value driven by falls in the US, and factors contributing to this are expected to continue, including net pricing pressures following the launches of biosimilars, saturation with multiple maturing insulins and limited or uncertain prospects of non-insulin therapies. That said, if very early-stage transformative technologies succeed, such as glucose-responsive insulins, they could recast the market, but there is a lack of good clinical data on these to date. Novel weekly insulins offer potential improvements in adherence and a reduction in treatment burden, though concerns over safety are hampering approval in the US. A potential driver of growth is in the prevention space, with Sanofi’s acquisition of Tzield providing more resources to drive screening for eligible patients.