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  • Taking a Step Closer to Ending Type 1 Diabetes
    Type 1 is the form of diabetes that most often appears in children. Those youths represent approximately 244,000 of the nearly 2 million people with type 1 diabetes in the US. The disease involves an error on the part of the immune system, where it actively destroys beta cells. As the body's singular source of insulin production, an attack on them will result in a serious insulin deficiency. The blood glucose level will rise above normal levels from this circumstance, and the individual will develop type 1 diabetes. A new medication is helping open the path to disease prevention by interrupting the errant immune response at a critical stage of its progression.

    The diagnosis of type 1 diabetes will often be based on the clinical symptoms that suggest insulin deficiency, which include hyperglycemia, polyuria, polydipsia, and weight loss. However, as of 2015, three distinct steps have been classified within type 1 diabetes, with the earlier stages more likely to be asymptomatic. The trio of stages are defined by the progression of the autoimmune response with beta cell decline and rising blood sugar levels:
    • Stage 1 is the beginning of the disease, where testing is able to identify if two or more type 1 diabetes-associated islet autoantibodies are present in an individual. The patient is normoglycemic at this stage.
    • Stage 2 is the step where beta cell levels have dropped and dysglycemia has developed, in addition to the presence of two or more autoantibodies.
    • Stage 3 is the category where most type 1 diabetes is diagnosed. Patients will often experience the typical symptoms that accompany insulin deficiency.
    With type 1 diabetes, lifetime treatment with insulin is required. If insulin levels are not maintained, a patient may experience the serious complication of ketoacidosis. The options for taking insulin include administering injections multiple times a day with subcutaneous insulin or using an insulin pump that dispenses a background supply of insulin, with the addition of possible additional bolus insulin with meals or for blood sugar level correction. Close attention must be paid to the timing and dose of insulin therapy, physical activity, and food intake.

    A new, first-ever therapy has recently been approved that can interrupt the progression of type 1 diabetes stages. A development like this is a significant advancement in treating diabetes. The new approval is for Tzield (teplizumab-mzwv) injection. The intravenous drug is indicated to delay the onset of stage 3 type 1 diabetes in adult and pediatric patients aged eight years or older who have stage 2 type 1 diabetes. The drug is taken one time a day for two weeks. It is a monoclonal antibody that modifies the T-cells that in a diabetic patient are working incorrectly to destroy the beta cells needed to produce insulin. In this manner, the progression of diabetes is interrupted. Patients in the clinical trial that led to the drug's approval experienced an average onset to stage 3 of two years. Though teplizumab only offers a potential delay and not a cure, extra time for patients to live without more advanced disease is a boon for all those affected by type 1 diabetes. Researchers anticipate the continued development of more effective treatments that get even closer to the goal of curing diabetes.

    As the treatment landscape for diabetes continues to shift and grow, providers can stay aligned with the components of diabetes care, treatment goals, and tools to evaluate quality of care as designed by the American Diabetes Association by referring to the free ADA Standards of Care App. Also, stay informed about emergent drug information, including treatment options for diabetes mellitus, by updating or registering your profile to receive email alerts and other critical drug information updates from PDR. You can also stay current by using the official PDR app, mobilePDR, available for free from your favorite app stores.