It is well known that type 1 diabetes is a chronic autoimmune disease in which the breakdown of normal tolerance to the cell allows the activation of T cell to multiple antigens. This induces a progressive destruction of cells and a state of chronic insulin deficiency. Multiple genetic and environmental risk factors have been evaluated for better understanding the mechanisms causing type 1 diabetes with the aim of improving prediction and possibly prevention of cell impairment and failure. Meanwhile, it remains of paramount importance to reach the best metabolic and glycemic control from the very beginning of diabetes in children and adolescents; new technologies have improved the day-to-day diabetes care and there is hope that a closed-loop device will allow a more physiological insulin delivery. There is also hope for finding a cure for diabetes by teaching stem cells to produce insulin, by implementing cell and pancreas transplantation and by applying gene therapy.