Dr Elizabeth Robertson, Diabetes UK's Director of Research and Clinical, shares her thoughts following the historic approval of the first type 1 diabetes immunotherapy on the NHS.
For more than a century, type 1 diabetes care has focused on patching the problem, by replacing insulin, rather than addressing its root cause. That is why NICE’s decision to approve teplizumab for use in the NHS is so significant, and a moment to celebrate with the whole type 1 community.
Our research was pivotal in showing that type 1 diabetes is caused by an immune attack on the insulin-producing cells in the pancreas, and now for the first time, we have a medicine that targets this attack.
We hope this will be the first of many type 1 diabetes immunotherapies - marking a fundamental shift in how we understand and treat the condition.
We now know that the immune attack on insulin-producing cells typically begins years before type 1 diabetes symptoms appear. By the time symptoms develop, much of the damage has already been done.
Teplizumab changes that trajectory, offering the chance to slow the immune attack and give people in the early stages of type 1 diabetes valuable extra years free from the relentless demands of insulin therapy.
However, this breakthrough also exposes a challenge. To benefit from teplizumab, type 1 diabetes must be detected early before symptoms begin.
Yet today, diagnosis usually happens only once the 4Ts appear - being tired, thirsty, thinner and going to the toilet more - often when someone is already seriously unwell. Without access to screening to find people in the early, symptomless stage, the window to intervene is lost.
We have a long history of funding research into the early detection of type 1 diabetes, including the ELSA study, one of the world’s largest childhood screening research programmes.
ELSA is screening children aged 2–17, to allow families to find out if their child is in the early stages of type 1 diabetes and might benefit from teplizumab. We’re also funding the UK Islet Autoantibody Registry to improve support for people with early-stage type 1 diabetes and connect them to clinical trials and new treatments like teplizumab.
Our research is generating the vital evidence needed for a national childhood type 1 diabetes screening programme, and we are continuing to invest in innovative type 1 treatments including other immunotherapies and beta cell therapies.
But scientific breakthroughs must be backed by a healthcare system ready to act. We want a future where everyone with early-stage type 1 diabetes can access immunotherapies, and Diabetes UK is calling for national services to detect and treat type 1 early.
To help us get there, we have launched our Type 1 Tipping Point campaign to ensure the UK is ready to adopt innovations like screening and immunotherapies, and to invest in the research needed to bring forward curative therapies quickly and fairly, without widening existing health inequalities.
This moment has been decades in the making, built on long-term investment in research and close partnership between charities, the NHS and industry. Now, we have an opportunity to go further, towards a future where type 1 diabetes can be detected early in everyone at risk, delayed, and one day prevented entirely.
