You can treat type 1 diabetes (T1D) with daily doses of insulin, but that only relieves its symptoms. It doesn’t offer a cure. But a new treatment can help slow the onset of the disease. Doctors can now prescribe teplizumab (Tzield) to people over the age of 8 who are in the early stages of T1D and don’t yet have symptoms.
The Stages of T1D
Experts believe that a mistake in your immune system causes T1D. Instead of just attacking invaders that cause disease, it destroys the special cells in your pancreas that make insulin. This important hormone helps your body turn blood sugar into energy. When your body doesn’t have enough insulin, blood sugar levels in your bloodstream rise. That can cause severe, and sometimes fatal, health issues.
T1D doesn’t happen suddenly. It comes on slowly and in stages:
Stage 1: In this early stage, immune cells have just begun to destroy insulin-making cells. You won’t have any T1D symptoms, and a blood test may show that your blood sugar levels are normal.
Stage 2: At this stage, you still don’t show symptoms, but your blood sugar levels will be high. Special tests will show that your immune system is attacking insulin cells.
Stage 3: At this point, many insulin-making cells have been destroyed. Your blood sugar levels are high and you show signs of T1D.
T1D is usually not diagnosed until stage 3. But new screening tools can help change that. Once doctors know who has the disease, they have a chance to slow down the onset of symptoms.
A Drug That Can Delay T1D
The FDA has approved teplizumab (Tzield) to postpone the progress of T1D.
How does teplizumab work?
This drug affects your immune system. It weakens the rogue immune cells that want to destroy healthy insulin-making cells. That lets your body keep making enough insulin to stay healthy.
How long can teplizumab delay T1D?
A clinical trial showed that teplizumab can delay stage 3 T1D for about 2 years.
Who can take teplizumab?
This drug can be prescribed to people who are at least 8 years old and who are in stage 2 of T1D. Teplizumab hasn’t been tested on younger kids. It’s not clear yet if it’s safe for them to take or if would work well for them.
To confirm that you’re in stage 2, your doctor will run some tests. The results will need to show that:
- Your blood sugar is higher than normal.
- You have at least two persistent types of autoantibodies (immune proteins) in your blood.
Your doctor will also have to rule out type 2 diabetes before they suggest that you take teplizumab.
How is teplizumab taken?
You’ll get it through an IV (in your vein) once a day for 2 weeks. Each session lasts around 30 minutes.
What are the side effects?
The most common issues you could have with teplizumab include:
- Skin rash
- Headache
- Fewer white blood cells (which your body needs to fight infections)
Teplizumab can sometimes also trigger an extreme reaction from your immune system, a condition that’s called cytokine release syndrome (CRS.) If so, you could have:
- Fever and chills
- Fatigue
- Nausea and vomiting
- Diarrhea
- Coughing
- Low blood pressure
- Joint and muscle pain
- Shortness of breath
- Feeling dizzy or confused
- Swelling
- Trouble swallowing
You’ll need to let your doctor know if you have any of these symptoms. While most people get better within a week or two, CRS can get worse very quickly. At times, it can be fatal, so it’s important to seek treatment right away. - Fever and chills
You’ll need to let your doctor know if you have any of these symptoms. While most people get better within a week or two, CRS can get worse very quickly. At times, it can be fatal, so it’s important to seek treatment right away.
Who shouldn’t take teplizumab?
You shouldn’t take this drug if you have a serious or chronic infection. It’s also not safe to take if you’re pregnant. Doing so may harm your baby.
How much does it cost?
A 14-day course of teplizumab costs about $193,900. Right now, insurance companies will cover the cost of the drug if you meet certain guidelines and have a relative who has T1D. There are manufacturer’s programs that can help cover some of the cost.
What Are the Benefits to Delaying the Onset of T1D?
When you slow down T1D, there are a lot of benefits for both you and your child. Among them:
It gives you more time to prepare. There’s no cure for T1D: It’s a condition you have for life. It’s most often diagnosed in kids and young adults, which means decades of tracking blood sugar levels, planning meals, and taking insulin every day.
If you can delay stage 3, you and your child have more time to learn how to prepare for and manage T1D. Plus, you get the gift of time -- a little longer for you both to live without strict guidelines.
It lowers the chances of complications. T1D affects more than your blood sugar. It can cause severe problems that affect your feet, eyes, teeth, skin, nerves, heart, and kidneys. Close to half of all people with T1D develop a severe complication over the course of their lives. Keeping blood sugar within a healthy range for a few more years can help lower the chances of having these issues.
It’s better for your mental health. T1D puts you at risk for stress, anxiety, and depression. Diabetes distress -- feeling overwhelmed by daily diabetes care -- is also common. Mental health issues can make it harder to follow your T1D treatment plan. They can also make diabetes symptoms worse.
You’ll have fewer costs in the long run. Despite teplizumab’s high cost, being able to delay T1D could save you money. You’ll put off years of paying for insulin, diabetes-related supplies, doctor visits, and any diabetes-related emergencies.
Now that there’s a way to keep T1D from getting worse for a while, early screening for the disease may become more common. Your chances of getting T1D are higher if you have a parent, brother, or sister who has it, although many people don’t have a family history. If you believe you or your child could be at risk for T1D, talk to your doctor.
Show Sources
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SOURCES:
FDA: “FDA Approves First Drug That Can Delay Onset of Type 1 Diabetes,” “Highlights of Prescribing Information: TZIELD.”
CDC: “What is Type 1 Diabetes?” “Diabetes Distress.”
Type 1 Diabetes TrialNet.org: “Stages of Type 1 Diabetes.”
Diabetes UK: “First Ever Treatment to Delay Type 1 Diabetes Is Licensed in the US,” “Stress and Diabetes."
Diabetes Care: “Staging Presymptomatic Type 1 Diabetes: A Scientific Statement of JDRF, the Endocrine Society, and the American Diabetes Association.”
The Lancet: “Teplizumab approval for type 1 diabetes in the USA.”
Yale Medicine: “3 Things to Know About Teplizumab, the New Diabetes Drug.”
University of Michigan Institute for Healthcare Policy & Innovation: “Patients with type 1 diabetes spend about $2,500 a year in health care costs.”
National Institutes of Health: “Drug delays type 1 diabetes onset.”
Cleveland Clinic: “Cytokine Release Syndrome,” “Type 1 diabetes.”
Clinicaltrials.gov: “Teplizumab for Prevention of Type 1 Diabetes In Relatives "At-Risk."
Tzield.com: “Provention Bio Compass.”
Juvenile Diabetes Research Foundation: “FDA Approves Tzield™—A Watershed Moment for the T1D Community.”
American Journal of Managed Care: “Limiting Teplizumab Coverage to First-Degree Relatives Is a Mistake, Says Dr Kevan Herold.”
