The Grapevine

Immunotherapy Drug Found To Delay Onset Of Type 1 Diabetes

The World Health Organization (WHO) estimated that 1.6 million people worldwide had died due to direct causes related to diabetes in 2016. Closer home, data published by the National Center for Health Statistics ( NCHS) in September 2018 pointed out that 1 in 7 Americans have diabetes.

The count included people with both type 1 and type 2 diabetes and the latter is more common. However, 1.25 million Americans have the type 1 variety and 40,000 more are expected to be diagnosed on year.

Type 1 Diabetes TrialNet, the world’s largest international network of scientists and healthcare professionals dedicated to researching novel ways to prevent and live with diabetes, has made a monumental discovery. A drug, teplizumab, is the first of its kind to help delay the onset of type 1 diabetes in high risk adults and children for a period of two years or more. 

The results of the study funded by the National Institute of Health (NIH) were published in The New England Journal of Medicine on June 9. It was also presented at the American Diabetes Association Scientific Sessions in San Francisco recently.

How does it work? Teplizumab is an antibody drug that was designed to attack a molecule called CD3 found on the surface of T cells in the pancreas before it could even lead to diabetes. T cells are supposed to protect the body’s immunity, but in diabetes they attack the body’s beta cells that produce insulin instead. Hence, teplizumab will come in handy in destroying them. 

Type 1 Diabetes Type 1 diabetics who undergo treatment immediately following a diagnosis are more likely to live longer than those who wait. Photo courtesy of Shutterstock

The drug was tested on people with a 75 percent risk of developing diabetes within five years. TrialNet has a database of thousands of relatives of people diagnosed with type 1 diabetes in centers spread around the world, from North America, Europe to Australia.  For the purpose of the study, 76 participants were enrolled and 55 of them were below 18 years of age.

Participants were assigned to two groups - 44 were placed in the group receiving teplizumab and 32 were put in the group to be given placebo medication. Both groups were given the treatment intravenously for a period of 14 consecutive days. Follow-ups were done at six month intervals by giving them oral glucose tolerance tests to check the level of progression to type 1 diabetes.

The first year was the most telling as 41 percent of participants in the placebo group developed clinical diabetes. The following year, 72 pecent of the placebo group had cases of type 1 diabetes diagnosed, while it took 4 years to diagnose 43 percent of the group taking the drug. This time delay is the achievement of the study since it has never been done before. 

“The median time to the diagnosis of type 1 diabetes was 48.4 months in the teplizumab group and 24.4 months in the placebo group; the disease was diagnosed in 19 (43 percent) of the participants who received teplizumab and in 23 (72 percent) of those who received the placebo treatment,” said the researchers, led by Dr Kevan. C. Herold, Yale University.  

The two-year delay might seem insignificant, but as Mark Atkinson, a pathologist at the University of Florida said,“You have to think of mom or dad having 2 years less of getting up at night.” He also said that for the possibility of reducing risk of long-term complications, two weeks of participating in such a study is a small price to pay.  

Nevertheless, there are limitations that need to be looked into with further research. There is suspicion that age could be the reason behind the fast progression to type 1 diabetes in some patients, for it is known to develop faster in children. The other limitations of the study is the small number and absence of ethnic inclusivity.

The study’s participants being related to people with type 1 diabetes is another obstacle, so the application becomes limited since 85 percent of diagnoses happened to people without family history of diabetes.