Teplizumab for delaying the onset of type 1 diabetes in people 8 years and over at risk of developing the condition [ID6259]

Diabetes mellitus is a chronic metabolic disorder characterised by elevated blood glucose levels (hyperglycaemia) resulting from a lack of the hormone insulin or resistance to its action. Type 1 diabetes results from the body’s own immune system destroying the cells that make insulin *1.

If not managed effectively diabetes mellitus can lead to kidney failure blindness foot problems and damage to the nervous system *2.

People with diabetes are also more at risk of cardiovascular disease *3.Type 1 diabetes progresses across the following three stages *4:• Stage 1 type 1 diabetes: presence of 2 or more pancreatic islet autoantibodies but a normal concentration of blood glucose.

Clinical symptoms are not present at Stage 1.• Stage 2 type 1 diabetes: 2 or more pancreatic islet autoantibodies and dysglycaemia (abnormalities in blood glucose levels) without reaching thresholds for hyperglycaemia.

Clinical symptoms are not present at Stage 2.• Stage 3 (symptomatic) type 1 diabetes is defined by overt hyperglycaemia accompanied by clinical symptoms. In Stage 3 people with type 1 diabetes will usually require lifelong insulin therapy as treatment. Pancreatic islet autoantibodies can be measured using a blood sample.

Dysglycaemia can be assessed in different ways including an oral glucose tolerance test or measurement of HbA1c.In 2021-22 there were 9760 people newly diagnosed with type 1 diabetes in England and Wales *5. Most people with type 1 diabetes are diagnosed in stage 3. There is no national screening programme to identify people with stage 1 or 2 type 1 diabetes.

Type 1 diabetes can present at any age peaking in presentation around age 12-years *6.

Type 1 diabetes is slightly more common in males than females *6.NICE’s clinical guideline on the diagnosis and management of type 1 diabetes in adults (NG17) states that diabetes is typically diagnosed when people present with hyperglycaemia. The type of diabetes can be assessed using diabetes-specificautoantibodies and if needed non-fasting serum C-peptide.

The management of type 1 diabetes in adults includes structured education dietary management physical activity self-monitoring of blood glucose levels insulin therapy hypoglycaemia control control of cardiovascular risk and treating complications.NICE’s clinical guideline on the diagnosis and management of type 1 and 2 diabetes in children and young people (NG18) highlights symptoms of stage 3 type 1 diabetes including: hyperglycaemia (random plasma glucose more than 11 mmol/litre)polyuria polydipsia weight loss and excessive tiredness.

The management of type 1 diabetes in children and young people includes education dietary management exercise self-monitoring of blood glucose levels insulin therapy psychosocialsupport and hypoglycaemia control.There are no guidelines for the management of people with stage 2 type 1 diabetes but established clinical management will likely include monitoring blood glucose psychosocial support and education about diabetes care.References*1.

NHS Diabetes. Accessed May 20242. Diabetes UK Complications of diabetes. Accessed May 20243. Diabetes UK Diabetes and heart disease. Accessed May 20244.

Besser et al. (2022) ISPAD clinical practice consensus guidelines 2022: Stages of type 1 diabetes in children and adolescents. Accessed September 20245. NHS Digital National Diabetes Audit 2021-22 Report 1: Care Processes and Treatment Targets Detailed Analysis Report. Accessed May 20246. NHS Digital.

National Diabetes Audit 2019-20 Type 1 Diabetes. Accessed September 2024