Disease-modifying therapies targeting islet autoimmunity are now a reality. Teplizumab was recently approved to prevent progression from Stage 2 to Stage 3 T1D and other more promising therapies are under development. The treatment paradigm is now evolving from one of insulin replacement for end-stage beta cell failure to early diagnosis and beta cell preservation using immunotherapy. This will have a major impact on endocrine practice: endocrinologists are now expected to recommend screening to at-risk populations, monitor those who screen positive and facilitate access to disease-modifying therapy. In this talk I will summarise the current state of T1D screening in Australia, how to interpret test results and how to monitor for disease progression. I will then provide an overview of the clinical trial landscape and the approach to using teplizumab and other available therapies to delay disease progression, improve glycaemia and decrease insulin requirement.