Core Concepts
Immunologic interventions show promise in preserving beta-cell function in type 1 diabetes.
Abstract
The content discusses the efficacy of two immune therapies, baricitinib and teplizumab, in preserving beta-cell function in individuals with new-onset type 1 diabetes. Both drugs, although not leading to significant improvements in A1c levels or reducing the need for exogenous insulin, show potential in maintaining residual beta-cell secretion. The trials, published in The New England Journal of Medicine, highlight the importance of these interventions in managing type 1 diabetes.
Baricitinib Study:
Baricitinib preserved beta-cell function in new-onset type 1 diabetes.
No significant improvements in A1c levels observed.
Participants continued to require exogenous insulin.
Lower glucose level variations with baricitinib.
Adverse events were similar between the drug and placebo groups.
Teplizumab Study:
Teplizumab led to higher stimulated C-peptide levels.
No significant differences in insulin doses, A1c, or hypoglycemic events.
Some patients experienced adverse effects like headache and gastrointestinal symptoms.
Two patients had severe cytokine release syndrome with teplizumab.
Expert Opinion:
Clinicians see potential in these treatments for type 1 diabetes.
Immunologic interventions may help minimize long-term complications.
Questions remain about the acceptance and safety of these therapies.
Stats
"The primary outcome, mean C-peptide level determined by area under the curve during a 2-hour mixed meal tolerance test at week 48, was 0.65 nmol/L/min with baricitinib vs 0.43 nmol/L/min with placebo — a significant difference (P = .001)."
"Participants randomly assigned to receive teplizumab had significantly higher stimulated C-peptide levels than did those assigned to placebo at week 78, with a difference of 0.13 pmol/mL (P < .001)."
Quotes
"As clinicians, we need to learn how best to combine therapies to preserve β cells and to control type 1 diabetes."