In the preinsulin era, survival following the diagnosis of type 1 diabetes was dismal; 50% of patients died within the first 20 months of diagnosis and fewer than 10% survived 5 years.1 The introduction of insulin therapy in 1922 significantly changed survival as mortality from diabetic ketoacidosis (DKA) decreased substantially. However, in the middle of the 20th century, there was still a 20-year reduction in life expectancy for those diagnosed with type 1 diabetes; 50% of individuals with youth-onset disease failed to reach the age of 55 years.2 A half century later, in the current era, intensive insulin therapy has become the standard of care and advances in insulin delivery and glucose monitoring assist in the management of type 1 diabetes.3 Yet glycemic control remains suboptimal for the majority of patients with type 1 diabetes,4 and acute and chronic diabetes complications persist, reducing life expectancy for many patients.