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Exciting News Type 1 Diabetes

Over 100 years ago Dr. Fred Banting and his colleagues found a way to make insulin into an injectable form. In 2016, the American Diabetes Association (ADA)reported 3 Stages of Type 1 diabetes. The FDA approved the first and only disease – modifying therapy to delay the onset of Type 1 diabetes (T1D) in those with Stage 2 T1D in November 2022.

Nearly 60,00 people in the US are diagnosed with T1D yearly.T1D is due to the destruction of the insulin secreting cells in the pancreas called beta cells. Insulin is a hormone that acts like a key to open the cells to allow glucose to enter cells to allow the body to get energy. If the body does not produce insulin, glucose builds up in the blood. Over time, high levels of blood glucose can cause damage to organs such as the eyes, nerves, heart, kidneys and blood vessels.

The cause of T1D is not entirely known, but there are risk factors. There is an increased risk factor in developing T1D for people with first-degree family members which would be children of parents with T1D or a sibling with T1D or secondary relatives (aunts, uncles, nephews or nieces). However, 85% of people diagnosed with T1D have no family members with a history of T1D. The diagnosis often catches people by surprise. Also, anyone at any age can develop the disease with or without a family history.

Certain autoimmune or viral conditions can increase the risk. Any condition in which antibodies are produced that attack the body is called an autoimmune condition.

Antibodies are the cells in the body that normally attack and destroy anything foreign. Autoantibodies are proteins that appear in the blood stream when T1D begins, even in early stages before there are symptoms. Examples of an autoimmune condition are Celiac disease, Grave’s Disease, Addison’s Disease, multiple sclerosis, Rheumatoid arthritis and Lupus. Common viruses which can increase risk are Coxsackie virus, Rotavirus, mumps, CMV, and Covid 19.

These symptoms can occur suddenly and can be deadly if untreated. Diabetic Ketoacidosis (DKA) is a diagnosis people can get when first diagnosed. Elevated blood

glucose cannot get into the cells without insulin. The body then breaks down fat for energy. Ketones are released into the blood stream and spilled out into the urine. Approximately 25% of children with new onset T1 present with DKA.

ADA Stages of Type 1 Diabetes

Screening for Autoantibodies would be indicated if the risk factors are present such as first-degree family history of T1D and / or autoimmune disease diagnosis.

When 2 or more autoantibodies are found with screening, the risk for developing T1D in the next 5 years becomes close to 50%. That increases to 75% when 3 or more autoantibodies are present. This is the time to educate the patient and the family about the disease and monitoring the blood glucose.

To learn more about the screening process there are websites which include TrialNet.org, ASK (Autoimmune Screening for Kids), and PLEDGE (screen for type1.com), T1DETECT and JDRF. Any screening needs follow-up with physicians and health care professionals that are familiar with the significance of lab findings and the disease. If you are at risk for developing T1D or have a family history of the condition, it is worth asking about autoantibody testing with your healthcare professional to see if you have the markers for the condition.

Now for the great news! The FDA has approved the use of TEPLIZUMAB or Tzield which is a therapy for Stage 2 T1D (screened for 2 or more autoantibodies) to delay Stage 3 by three years. Teplizumab changes the autoimmune response by altering T cells that abnormally target and destroy the insulin producing beta cells of the pancreas. This makes it possible for the body to continue making insulin for a longer period of time. Some research shows a delay for greater than 7 years and counting.

With the use of this therapy, a T1D diagnosis doesn’t have to come as a total shock and the risk for DKA can be minimized. The drug is given intravenously once a day over 30 minutes for a total of 14 consecutive days. It is currently for those 8 years old or older. Side effects include headache, nausea, fatigue, fever, temporary low white blood cell count, elevated liver enzymes and rash. In the research, the mild side effects resolved within a few weeks.

Tzield has a patient support program called COMPASS to help answer questions and help navigate insurance coverage, reimbursement and access to financial assistance options. Call 1-844-778-2246 or email compass@preventionbio.com. The health care provider and the patient will need to fill out a Start Form.

As stated earlier, the exact cause of T1D is unknown. There are risk factors, but many are still not known. With the knowledge of the Stages of Type 1 and the screening available, people with 2 or more autoantibodies can delay the onset of Stage 3 for at least three or more years with the use of Tzield. It is up to the individual if screening is the right choice for them. However, having the knowledge from the screening can help the patient and their families prepare for the condition and help prevent DKA.

 


 

About the author:

Dianna Morrow is a Certified Rehab Registered Nurse and a Certified Diabetes Care and Education Specialist at Encompass Health Rehabilitaion of York, PA. She has been a member of the Joint
Commission Disease Specific Diabetes Protocol team since 2011 and is currently the lead facilitator of the group at Encompass Heath.

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