Diabetes is an endocrinological disorder characterised by chronic hyperglycaemia due to abnormalities in insulin secretion, insulin action or a combination of both. According to the International Diabetes Federation, 463 million people worldwide are living with diabetes; 700 million people will be affected by 2045. The severity of the disease is dependent on the type and the stage of progression; when not correctly managed, diabetes can lead to potentially life-threatening micro- and macrovascular complications.

Prior to the discovery of insulin in 1922, the life expectancy of children with diabetes was short and the prognosis was very poor. The advocated treatment for diabetes was ruthless starvation, an approach which resulted in a greatly reduced quality of life for malnourished patients. Modern insulin therapy has revolutionised the management of diabetes. However, the prevention, treatment, and curation of diabetes will require more sophisticated approaches that address the underlying pathophysiological mechanisms of disease.

Presently, a number of strategies are focusing on protecting pancreatic beta-cells and normalising serum glucose levels through immunomodulation. However, the novelty of immunotherapy raises the risk of unknown long-term complications, and recent studies have reported that immunomodulators currently in clinical circulation may represent a trigger for a specific type of drug-induced diabetes.

This review will highlight contemporary advances in the classification, aetiopathogenesis, diagnosis and treatment of diabetes, with special focus on immunomodulatory strategies for the prevention of pathology and the potential risk for modern immunomodulators to result in drug-induced diabetes.