Cases of type 1 diabetes —  an autoimmune condition where the body attacks insulin-producing beta cells — are rising faster than ever, climbing about 42% since 1990. That’s a huge increase in a disease that’s expensive, incurable, and still shortens lifespan by more than a decade.

But the number of new and emerging treatments is surging too, and experts say we’re in the most promising era of type 1 diabetes treatments in history, with new medications that slow the disease’s progression, advanced insulin delivery systems, inhalable options, and drugs that improve insulin resistance. It’s a shift in the management of a chronic lifelong disease for patients who are often diagnosed in childhood. “These patients are living much longer than they used to with an improved quality of life,” said Kupper A. Wintergerst, MD, a pediatric endocrinologist and executive director of the Wendy Novak Diabetes Institute.

Experts attribute the rise in type 1 cases to a few factors. Genetics play a role in who will get type 1 diabetes, increasing a patient’s risk by about 40%. And in people with an increased risk, certain environmental factors may serve to nudge them toward getting the disease. For example, infections in early childhood like mumps, rubella, and influenza B as well as childhood obesity and certain environmental factors like antibiotics overuse, vitamin D deficiency, and the hygiene hypothesis — which suggests that kids who aren’t exposed to enough microorganisms in childhood may end up with an overactive immune system — may also be playing a role.

Additionally, certain chemicals found in foods and drinking water, including PFAS, dioxins, and arsenic, may jolt inflammation in the body. Once these chemicals build up in the bloodstream, it triggers a chronic inflammatory state, which contributes to the immune system mistakenly attacking and destroying its own insulin-producing beta cells in the pancreas. Over time, this lack of beta cells causes the body to stop making insulin, which starts to raise blood sugar. Researchers are responding with new treatment strategies that leverage a slowed progression of the disease while also more accurately monitoring and regulating blood sugars, which all work to extend lifespan. The number of patients living past 65 has tripled in the last four decades.

Type 1 diabetes is usually diagnosed in childhood, though it can develop in adulthood, too. A new medication, called teplizumab (Tzield), has been shown to slow the disease’s progression, potentially staving off the disease for two or three years. It’s now for patients either before they’re diagnosed or early after a diagnosis. Once patients have tested positive for two or more type 1 diabetes-related autoantibodies, they’re considered eligible for the medicine. They may also have abnormal blood sugar levels but don’t yet have other symptoms of type 1 diabetes like excessive thirst, frequent urination, slowed wound healing, and excessive hunger.