T1D (T1D) is one of the most frequent chronic disease in children and is associated to the risk of severe acute and chronic complications. There are about 550,000 children with T1D in the world; and about 86,000 children are diagnosed with T1D every year and its incidence is ever increasing. In this narrative review we will discuss current and future perspectives in T1D prevention strategies as well as their pitfalls. It is important to remember that for the first time one drug, in particular teplizumab (antibody anti-CD3) is going to be accepted for treatment in stage 2 of type 1 diabetes mellitus. This represent the onset of a new era.