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."