Scientists have shown that a new treatment can slow down the immune attack that causes Type 1 diabetes, delaying the point at which someone is diagnosed with the condition.
The findings are the first to show that a diagnosis of Type 1 diabetes can be delayed in some people for a median (a way of calculating the average) of two years. The results were announced today at the American Diabetes Association's Scientific Sessions and published in the New England Journal of Medicine.
The trial was run by TrialNet – an international network of scientists dedicated to the prevention of Type 1 diabetes – and funded by JDRF. It began in 2011 and involved 76 people, aged 8-49 years, who didn’t yet have Type 1 diabetes but were at high risk of developing the condition in the future.
Half of the volunteers received a daily dose of a drug called Teplizumab for 14 days, and the other half received a dummy drug (known as a placebo).
72% of participants in the placebo group went on to develop Type 1 diabetes during the course of study, compared to 43% of participants who were treated with the drug. The median time for people in the placebo group to develop clinical Type 1 diabetes was just over 24 months, while the median time in those taking Teplizumab was 48 months.
The results suggest that the treatment was able to slow down the immune system’s destruction of insulin-producing beta cells in the pancreas, so that volunteers could keep on making enough of their own insulin for longer, delaying a diagnosis of Type 1 diabetes.
TrialNet scientists have previously discovered that the immune attack behind Type 1 diabetes has different stages, and they can track these stages before someone reaches a diagnosis of the condition.
This gives us a window of opportunity to disrupt the immune attack before it progresses too far. This way, we could protect the beta cells in order to prevent, or at least delay, a diagnosis of Type 1 diabetes.
Scientists can use blood samples to look for signs that the immune attack is underway, suggesting that someone is at high risk of developing Type 1 diabetes in the future. People at high risk can then be placed on clinical trials – like this one testing Teplizumab.
Reprogramming the immune system
In this latest trial, researchers tested the drug Teplizumab: a type of immunotherapy. Scientists have already studied Teplizumab in people recently diagnosed with Type 1 diabetes. They found that Teplizumab could exhaust the killer immune cells responsible for the attack, so that they became less effective at attacking the pancreas. This meant more beta cells could survive for longer.
In this latest study, the TrialNet team wanted to see if they could act even earlier in the development of Type 1 diabetes, when the majority of someone’s beta cells are still intact.
Dr Elizabeth Robertson is Director of Research at Diabetes UK. She said:
“Today’s news from TrialNet is incredibly exciting. We’re delighted to see that it is possible to delay a diagnosis of Type 1 diabetes in some people, through research that tackles the root cause – the immune attack against the insulin-producing beta cells in the pancreas.
“This now opens up possibilities for the future, with further research needed to fully understand the effects and for whom treatments like this could benefit.
“But the discovery that this drug could potentially provide some people with extra years free from Type 1 diabetes and the harm it causes is a significant moment, and an important step towards a future where we can prevent the condition entirely.”
Teplizumab appeared to slow the immune system’s attack, but not stop it entirely - which is why we saw a delay in diagnosis, rather than complete prevention.
The scientists now plan to follow the volunteers who were treated with Templizumab.
In those who didn’t develop Type 1 diabetes, they want to look for specific changes in their immune system, to learn more about how the drug works and why it might be more effective for some and not others.
In those who did develop Type 1 diabetes, the scientists also want to know if the treatment could provide some benefits. For example, could it make their blood glucose levels easier to manage?
What does Teplizumab do?
Teplizumab is a type of drug therapy called a monoclonal antibody. ‘Monoclonal’ means that they are all copies of one type antibody, and they are made in the laboratory. Antibodies recognise and bind to specific molecules in the body. In the case of Teplizumab, it recognises a molecule found on T cells called CD3. You can find out more about T cells, and the other immune cells involved in Type 1 diabetes, on our immunotherapy spotlight page.