A new immunotherapy drug, teplizumab, has been approved for use on the NHS in the UK for individuals aged eight and above diagnosed with early-stage Type 1 diabetes. This treatment aims to slow the progression of the autoimmune disease, potentially reducing the reliance on insulin injections.
Type 1 diabetes occurs when the body's immune system mistakenly attacks and destroys insulin-producing beta cells in the pancreas. Unlike Type 2 diabetes, which is often linked to lifestyle factors, Type 1 diabetes has unclear causes, with genetics, viral infections, and environmental triggers believed to play a role. Patients diagnosed with Type 1 diabetes eventually become dependent on insulin injections or pumps for survival.
Katie Duggan, a 34-year-old solicitor, was initially diagnosed with gestational diabetes during her second pregnancy. Despite maintaining a healthy weight and lifestyle, her blood sugar levels remained high, leading to further tests that revealed she was in the early stages of Type 1 diabetes. "My blood tests found that I have four antibodies for type 1 diabetes, which meant I was developing the condition," Duggan stated. Pregnancy hormones had exacerbated her blood sugar control, a situation separate from the known link between gestational diabetes and Type 2 diabetes.
Teplizumab works by targeting the immune cells responsible for attacking beta cells. In a UK trial, children and adolescents with recently diagnosed Type 1 diabetes who received the drug maintained their insulin levels for longer compared to a placebo group, suggesting the drug can slow disease progression. Previous research indicates that immunotherapy can delay the progression of Type 1 diabetes by an average of three years when administered early.
Identifying individuals in the early stages of Type 1 diabetes, which can occur months or years before classic symptoms like thirst, frequent urination, and fatigue appear, remains a challenge. A new blood test that detects islet autoantibodies, markers indicating an immune system attack on beta cells has begun, is being used to screen children in a study led by Birmingham University. Initial results from this study, published in The Lancet Diabetes and Endocrinology, identified a significant number of children at increased risk or in early stages of developing Type 1 diabetes.
Following her pregnancy, Duggan's blood sugar levels normalized, and she came off insulin. However, due to her early Type 1 diagnosis, she continued to monitor her levels with a sensor. When her blood sugar began to spike again, she was recommended immunotherapy. After a 14-day course of intravenous treatment, her time 'in range'—the duration her blood sugar levels remained within a safe 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.
Researchers are also exploring other avenues, including islet cell transplants and lab-grown beta cells derived from stem cells. While islet cell transplants are available on the NHS, donor cell availability is limited. Early research on lab-grown beta cells has shown promising results, with some patients able to produce their own insulin again and even discontinue insulin therapy. However, transplants can trigger immune responses, necessitating lifelong immunosuppressant drugs with potential side effects. Immunotherapy might offer a way to protect transplanted cells without these drugs.
Additionally, an artificial pancreas device, available on the NHS, continuously monitors blood sugar levels and administers insulin via a pump. Studies have shown this device significantly increases the time patients spend within their target blood sugar range and improves sleep quality by eliminating the need for nighttime monitoring and treatment. The ultimate goal for many in the field remains an 'insulin-free future' for individuals with Type 1 diabetes.