The Most exciting news from the World of Type 1 Diabetes
By Dr Mimi Chen, Consultant Endocrinologist & Diabetologist at St Georges University Hospital, London.
The US Food and Drug Administration (FDA) has just approved Tzield (Teplizumab-mzwv) injection to delay the onset of stage 3 type 1 diabetes in adults and paediatric patients 8 years or older who currently have stage 2 type 1 diabetes.
What does this mean & why is this important
Type 1 diabetes (T1DM) commonly develops in childhood, with detection of 2 or more autoantibodies1against the cells which produce insulin (Beta cells).Patients requiredaily insulin injections lifelong to control their glucose level. There are 4 stages in the progression to type 1 diabetes. This is dependent onimmune activation and development of an autoimmune response towards beta-cells. This leads to destruction of insulin producing beta-cells, resulting in abnormal blood glucose control.
1 Autoantibodies: 2 or more (GAD65, IA-2, ZnT8)
|
Stage |
Blood glucose (BG) |
Diagnosis |
|
1 |
Normal |
No diabetes |
|
2 |
Impaired fasting BG or abnormal oral glucose tolerance test |
‘Pre-diabetes’ |
|
3 |
BG in diabetes range |
Diabetes diagnosis |
|
4 |
Persistent high BG |
Diabetes established |
People in stage 2 are at very high risk of developing type 1 diabetes, 60% in 2 years and 75% over 5 years. Earlier onset of type 1 diabetes may also lead to greater risk of diabetes related complications. Therefore, a delay in the onset of type 1 diabetes would produce multiple benefits.
Teplizumab is anti-CD3 monoclonal receptor-nonbinding antibody.It works by interrupting the immune process and therefore delay the progression from Stage 2 to 3, ie delay the development of frank type 1 diabetes.
First degree relatives of a person with type 1 diabetes have 15x greater risk of developing type 1 diabetes. High-risk individuals could be screened for autoantibodies (2 or more) and abnormal blood glucose readings (stage 2) as they could potentially benefit from treatment with Teplizumab. This will delay the progression to frank type 1 diabetes (Stage 3)
As Teplizumab has only just been approved in the US, and not available clinically globally, and its use would be by specialists at present. Nonetheless, this is a huge breakthrough in the management of type 1 diabetes and hugely encouraging for the patients and health care communities!