A new drug in the field of diabetes is giving providers hope for the future of diabetes prevention. If you’re the parent of a child with type 1 diabetes (T1D), it could be meaningful to you too. A study of the drug published in the New England Journal of Medicine showed that it delayed the onset of type 1 diabetes for up to an average of two years.
The drug is named teplizumab and is sold under the brand name Tzield®. It was approved by the FDA in November 2022 for use in people ages 8 and older who have stage 2 (pre-clinical) type 1 diabetes.
As an endocrinologist who treats children with T1D, and having T1D myself, I’m encouraged by what I’ve learned about this drug and what impact it could have on future patients.
What does this drug mean for the general population? Below are questions I’ve been hearing about teplizumab and what we know about this medication so far.
1. What is teplizumab and how does it work?
Teplizumab is an immune therapy medication. It works by binding to certain immune system cells in people who are in stage 2 of T1D. (See question #2 below for more on the staging of T1D.)
The drug is given through an intravenous infusion. Patients need to have an IV placed and they receive a one-hour infusion for 14 days in a row.
2. What are the stages of type 1 diabetes?
To understand how teplizumab works, it helps to be familiar with the stages of T1D:
- Stage 1: Most people won’t know they are in this stage. They have normal blood sugar levels and no symptoms. If tested, they would test positive for at least two diabetes-related antibodies.
- Stage 2: A person in stage 2 will have some abnormal blood sugar levels but may not know it. They generally still have no symptoms. They would test positive for two or more diabetes-related antibodies.
- Stage 3: This is when most people are diagnosed. They have high blood sugar levels and other symptoms of diabetes (increased thirst, increased urination, and weight loss) are usually present at this point.
Teplizumab is for those who are in stage 2. There is no universal screening for type 1 diabetes at this time, therefore a limited number of people know they are in stage 2 T1D.
3. What did the study of teplizumab show?
The trial involved patients who received either teplizumab or a placebo. Over more than four years of follow-up, results showed that those in the teplizumab group had a delay in onset of stage 3 T1D as compared to those who received a placebo.
The delay was first reported as a median of 24 months, and has since been updated to 32.5 months. To be more specific, in the first year after teplizumab, 8 people who received placebo developed stage 3 T1D whereas 0 people who received teplizumab developed stage 3 T1D.
4. Who is able to receive teplizumab?
The FDA has approved teplizumab for use in those ages 8 and older who are in stage 2 T1D. Studies are in progress to investigate the ability to use teplizumab in kids under age 8.
In general, only those who have been screened for T1D will know if they are in stage 2.
5. How can people get screened for type 1 diabetes?
Currently there are three ways to get screened for T1D:
- Through your pediatrician’s office. For first-degree relatives of a person with diabetes, insurance will often cover screening. Your pediatrician can order this screening for your child. It involves going to a lab for a blood draw and then that gets sent off for analysis.
- Through TrialNet. This screening is also for first-degree relatives of someone who has diabetes. It is available in person at a TrialNet location, or through a lab test kit or in-home test kit that TrialNet will send to you.
- Through the ASK Research Program. This free screening is offered to detect type 1 diabetes and celiac disease. It’s available to all U.S. children ages 1–17 with or without a family history of these conditions.
6. Who should get screened?
You might want to consider type 1 diabetes screening in the following instances:
- If you have a first degree relative who has type 1 diabetes, you may want to consider being screened.
- If you have a child with type 1 diabetes, you may want to consider screening for the child’s siblings.
7. What would be the benefit of delaying the onset of type 1 diabetes using teplizumab?
Delaying the onset of T1D means the body has that much longer in a state with normal blood sugars and without the long-term complications that come with having diabetes. Some of those complications are severe and can even be life-threatening, including diabetic ketoacidosis (DKA).
Delaying onset could also give families time to go through diabetes education to learn the important skills needed for managing diabetes in children.
8. What could the success of teplizumab mean for diabetes prevention in the future?
To me, this drug is the tip of the iceberg in terms of what will come next in diabetes prevention research now that we have found something that can slow down the immune system. So now we can ask more questions: Does it act by itself? Can we add other medications to it? Can we use it repeatedly to possibly prevent diabetes forever?
These are all questions that we don’t know the answers to yet. But it’s exciting that we’re even to the point where we can ask those questions and researchers can embark on the next level of investigation into preventing this disease.
The Cincinnati Children’s Division of Endocrinology is ready to administer teplizumab to any patients who qualify.
To address the increasing cases of early-stage diabetes that are identified through screenings in pediatric patients, we’ve created a Diabetes Prevention Clinic to follow patients with stage 1 and stage 2 type 1 diabetes.
Call our Division of Endocrinology at 513-636-3005 to learn more about teplizumab or our Diabetes Prevention Clinic.