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Type 1 Diabetes

Can Type 1 Diabetes Be Delayed? The Teplizumab Story

· 3 min read · Reviewed by GlucIQ Clinical Review Workflow
#teplizumab#prevention#cluster:prevention

For decades, the story of type 1 was: it appears, and you manage it for life. There was no “wait, maybe we can slow this down.”

That changed. A treatment called teplizumab — a 14-day course of infusions — was shown to delay type 1 diabetes in people at high risk. It’s the first disease-modifying treatment ever approved for the condition.

Here’s what it is, what it does, and who it’s for.

What teplizumab does

Type 1 happens when your immune system attacks the cells that make insulin. Teplizumab is an antibody that briefly calms the attacking immune cells — a kind of “immune system time-out.”

It doesn’t cure anything. It doesn’t fix the cells that are already gone. But it can slow the attack down.

What the trial found

In the landmark trial, people at high risk (relatives of people with type 1 who had early markers of the disease) got either teplizumab or a placebo.

The result: teplizumab delayed the diagnosis of type 1 by about two years (Herold et al., 2019). Two years is not nothing — it’s two more years without daily injections, two more years before the burden begins, two more years of beta cells hanging on.

Who is this for?

This is the part that matters: it’s not for everyone with type 1. It’s for people at high risk — specifically, relatives of someone with type 1 who have:

  • Two or more diabetes autoantibodies (blood markers of the immune attack), and
  • Early signs their glucose is starting to change.

Screening programs can now find these people before symptoms. If you’re a parent of a child with type 1 and you have other kids, this screening question is worth asking your care team.

The honest limits

  • It delays, it doesn’t prevent. Most people in the trial still developed type 1 eventually — just later.
  • It’s a 14-day infusion course. Not a pill, not one visit.
  • It has side effects — rash, low blood counts, and a temporarily weakened immune system. It’s a real treatment, not a magic bullet.
  • Earlier work showed it also preserved insulin-making ability in newly diagnosed people (Herold et al., 2013) — so research continues on who benefits most.

What this means for the future

Teplizumab is proof of concept: type 1 is no longer a “wait and see” disease. We can now detect it early and do something about it. That’s a door that was closed for a century.

If someone in your family has type 1, and you have other children, ask your care team about autoantibody screening. The earlier you know, the more options exist.

References

  • Herold KC, et al. An Anti-CD3 Antibody, Teplizumab, in Relatives at Risk for Type 1 Diabetes. N Engl J Med. 2019. DOI: 10.1056/NEJMoa1902226
  • Herold KC, et al. Teplizumab (anti-CD3 mAb) treatment preserves C-peptide responses in patients with new-onset type 1 diabetes. Diabetes Care. 2013. DOI: 10.2337/dc12-0933