A novel immunotherapy drug, teplizumab, has been approved for use in the UK, marking a significant step in managing early-stage Type 1 diabetes. The treatment aims to halt the progression of the autoimmune disease, which occurs when the body's immune system mistakenly attacks and destroys insulin-producing beta cells in the pancreas.
Katie Duggan, a 34-year-old solicitor from Manchester, experienced a surprising diagnosis of Type 1 diabetes. Initially believed to have gestational diabetes during her second pregnancy, further tests revealed she was in the early stages of Type 1. "My blood tests found that I have four antibodies for type 1 diabetes, which meant I was developing the condition," Duggan stated. She described the diagnosis as a shock, especially as she maintained a regular exercise routine and a healthy diet.
"Living with type 1 diabetes is relentless. It requires continuous decision-making and attention without ever being able to switch off," explained Lucy Chambers, head of research communications at Diabetes UK. Patients typically must monitor blood-sugar levels constantly and calculate insulin doses, adjusting for various factors including diet, exercise, hormones, illness, and stress.
Teplizumab, administered as an injection, works by targeting the immune cells responsible for attacking beta cells. Clinical trials have indicated that it can preserve insulin production in newly diagnosed patients. In one UK trial, children and adolescents treated with teplizumab maintained their insulin levels for longer compared to a placebo group, suggesting a slowed progression of their Type 1 diabetes. Previous research indicates that immunotherapy, when given in the early stages of the disease, can delay its progression by an average of three years by retraining the immune system to spare beta cells.
"These drugs retrain the immune system so it doesn’t attack beta cells – so people can still produce some of their own insulin – but they need to be administered before too many beta cells are destroyed," Chambers noted. While patients receiving immunotherapy may still require insulin, preserving some natural insulin production could eventually reduce the overall burden of self-management and potentially prevent the condition entirely.
Identifying individuals in the early stages of Type 1 diabetes, which can occur years before classic symptoms like excessive thirst, frequent urination, and fatigue, remains a challenge. Current testing is often limited to those with a strong family history. However, new diagnostic approaches are emerging, including blood tests that detect islet autoantibodies, which signal the immune system's attack on beta cells. Such a test is currently being used in a study by Birmingham University to screen children.
Duggan's experience highlights the potential benefits of early detection and treatment. Although her blood sugar levels normalized after her daughter's birth, allowing her to stop insulin temporarily, her early Type 1 diagnosis enabled her to use a continuous glucose monitoring sensor. "I hadn’t had any obvious symptoms so without the sensor I’d have been none the wiser," she said. When her blood sugar began to rise, she was recommended immunotherapy. After a 14-day course of intravenous treatment, her time in the target blood sugar range increased from 70% to 90%. "It’s blindingly obvious that immunotherapy made a difference. I feel so much better and have more energy," Duggan reported.
Looking further ahead, research is also exploring lab-grown beta cells derived from stem cells as a potential 'cure.' While islet cell transplants are available, donor cell scarcity is an issue. Early data from a treatment using lab-grown cells has shown that some individuals with Type 1 diabetes could produce insulin effectively again, with some even discontinuing insulin injections. However, transplant recipients often require lifelong immunosuppressants, which carry risks. Researchers hope immunotherapy might mitigate this need by protecting transplanted cells.
In the interim, advanced technologies like the artificial pancreas, which automates blood sugar monitoring and insulin delivery, are significantly improving patients' quality of life. A Cambridge University study found these devices provide patients with several additional hours per day within their target blood sugar range and improve sleep quality. The ultimate goal remains an 'insulin-free future,' as stated by Professor David Hodson.