April 09, 2024
Type 1 diabetes accounts for 5% to10% of all diabetes, and the only available therapy for patients with type 1 diabetes has been insulin for the past 100 years. However, now there is a new immune-modulating therapy available to slow the rate of islet cell loss for people with early stages of type 1 diabetes.
Ana L. Creo, M.D., of Pediatric Endocrinology and Metabolism at Mayo Clinic in Rochester, Minnesota, explains how type 1 diabetes is now classified into three stages:
- Stage 1: two or more positive diabetes autoantibodies but normal blood glucose levels.
- Stage 2: two or more positive diabetes autoantibodies and asymptomatic dysglycemia (fasting glucose, 100-125 mg/dL; two-hour glucose, 140-199 mg/dL; or A1C 5.7% to 6.4%).
- Stage 3: two or more positive diabetes autoantibodies and symptomatic hyperglycemia, with clinical disease defined by standard glycemic criteria.
Alaa Al Nofal, M.D., M.B.A., a pediatric endocrinologist at Mayo Clinic in Rochester, Minnesota, says, "Given the progress in clinical and research domains, we recommend screening for early stages of type 1 diabetes in people who have a first-degree relative with type 1 diabetes, especially offspring of adults with type 1 diabetes. While the risk of type 1 diabetes in children is around 1 in 300, having a first-degree relative increases the risk to 1 in 20, which is 15 times higher than the risk in the general population.
"If a person is found to have positive type 1 diabetes autoantibodies, healthcare professionals recommend referral to a specialized diabetes center for further evaluation and type 1 diabetes staging, as well as consideration for disease-modifying therapy."
Screening for type 1 diabetes can be achieved through national screening programs or local clinical lab evaluation. Screening can identify appropriate participants for clinical trials as well as candidates for FDA-approved therapy that slows the progression to stage 3 type 1 diabetes.
According to findings published in The New England Journal of Medicine in 2023, teplizumab is an anti-CD3 antibody approved for people 8 years and older with stage 2 type 1 diabetes. Teplizumab given as a 14-day infusion slowed the onset of stage 3 disease by a median of two years in a total of 76 participants randomized to teplizumab or placebo.
"Half of the participants receiving teplizumab remained entirely disease-free at 48 months. While further large-scale efficacy studies are needed, hopefully this will be one of several agents targeting the root cause of type 1 diabetes in the future, thus changing the paradigm of future diabetes management," says Dr. Creo.
For more information
Ramos EL, et al. Teplizumab and β-cell function in newly diagnosed type 1 diabetes. The New England Journal of Medicine. 2023;389:2151.
Refer a patient to Mayo Clinic.