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. Meanwhile, pubertal T1D patients, though benefiting from relatively preserved β-cell function, still face heightened risks of insulin resistance and comorbidities such as obesity that demand vigilant monitoring and individualised interventions. Key actionable recommendations include implementing systematic screening protocols for growth impairment, menstrual abnormalities, and early markers of microvascular complications. Advanced technologies such as continuous glucose monitors and automated insulin delivery systems to reduce the glycaemic burden before and during puberty warrant robust investigation. The integration of behavioural interventions that enhance self-regulation and family-centred care into routine diabetes management can yield valuable insights into improving adherence and glycaemic control.