Bridging Pubertal Changes and Endotype Based Therapy in Type 1 Diabetes.

The intersection of puberty with the onset of type 1 diabetes (T1D) presents unique pathogenic, clinical and psychosocial challenges, necessitating nuanced management strategies that account for developmental changes and the disease's heterogeneity. The distinction between pre-pubertal (T1DE1) and pubertal (T1DE2) T1D onset underscores the need for tailored approaches to monitoring and therapy during this critical period. Patients, with severe β-cell loss and heightened metabolic demands during puberty, require more intensive glycaemic management and screening for growth delays and pubertal disruptions.