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Could There be a Way to Prevent Type 1 Diabetes?

Aug 24, 2021
 
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Oluwatayo Ishola, PharmD. Candidate, South College, School of Pharmacy

According to two new studies, researchers have seen tremendous progress in delaying the onset of type 1 diabetes and slowing down the disease’s progression.

While new methods and strategies have been employed to help prevent and manage type 1 diabetes, there is still no cure for the disease. The two new ways are preserving insulin-producing pancreatic beta-cell function immediately after a patient is diagnosed, and delaying type one diabetes onset in patients at a higher risk of disease development. Though not a cure, both methods help to improve the quality of life significantly in patients. Some benefits include better blood glucose control, a lower risk of developing low blood sugar, and a decreased risk of disease-related adverse effects overall.

 

The first study dealt with preserving beta-cell function through combination therapy in new patients. The study that was conducted for this trial was a randomized, double-blind study. The study was also placebo-controlled. Therefore, nobody knew who was given the drug and the placebo until after the experiment’s conclusion.

This study included 308 patients who were between the ages of 18 and 45. The inclusion criteria in this trial were a diagnosis of type 1 diabetes within 20 weeks and residual beta-cell function. The 308 patients were split up into four groups of 77 each; one group was given a placebo, one group liraglutide, another group monoclonal anti-IL-21 plus liraglutide, and the last group was assigned monoclonal anti-IL-21 by itself.

The decrease in mixed meal tolerance test (MMTT) stimulated C-peptide concentration from baseline to week 54 was significantly smaller with combination treatment than with placebo or with anti-IL-21 or liraglutide alone. At week 54, all the active treatments achieved a greater decrease in A1c than placebo. The results of this trial show that combination therapy has the potential to save beta-cell function in patients with a recent type 1 diabetes diagnosis.

The purpose of the second study was to see if the onset of type 1 diabetes can be delayed in an individual. This study included 76 patients who were between the ages of 8 and 49. The criteria for inclusion in this study was a positive result for at least two types one diabetes autoantibodies. The 76 patients were split up into a placebo group and a treatment group. The treatment group underwent a 14-day infusion course of teplizumab. Half of the treatment group were diabetes-free at a median follow-up on day 923. They also showed improvements in the function of their beta cells. In the placebo group, only 22 percent of the patients were diabetes-free at the median follow-up. The results of this study showed that one course of teplizumab delayed the need for insulin in patients at high risk for developing type 1 diabetes for approximately three years.

Practice Pearls:

  • Combination therapy with monoclonal anti-IL-21 and liraglutide has the potential to save beta-cell function in patients with a recent type 1 diabetes diagnosis.
  • Although a regimen consisting of monoclonal anti-IL-21 plus liraglutide aids in preserving beta-cell function in diabetes, more research needs to be done to prove the safety and efficacy of this treatment.
  • One course of teplizumab can delay the need for insulin in patients at high risk for developing type 1 diabetes for up to 3 years.

 

Miriam E. Tucker, Diabetes Prevention Moves Towards Reality as Studies Published. Medscape, 17 March 2021.

Matthias von Herrath, MD Stephen C Bain, MD. Anti-interleukin-21 antibody and liraglutide for the preservation of β-cell function in adults with recent-onset type 1 diabetes: a randomized, double-blind, placebo-controlled, phase 2 trial. The Lancet, 01 March 2021.

Emily K. Sims, Brian N. Bundy, Teplizumab improves and stabilizes beta-cell function in antibody-positive high-risk individuals. Science Translational Medicine, 03 March 2021.

 

Oluwatayo Ishola, PharmD. Candidate, South College, School of Pharmacy

 

 

 

See more about potential ways of preventing or delaying type 1 diabetes.