Patients with Type 1 prediabetes have a new treatment that can delay the onset of full diabetes for as long as three years. Preventing progress to T1D, or even brittle or labile diabetes, is not just a convenience in avoiding injections, but can save lives of people who cannot have good glucose control. Some could at any moment pass out from either insulin shock or ketoacidosis with coma. Teplizumab is administered as an intravenous infusion over 30 minutes once daily for 14 consecutive days.
New diabetes treatment could change the future of the disease
A new drug created to treat diabetes buys patients more time before they have to use insulin to manage their condition, according to medical experts.
“Tzield” or “teplizumab” is the drug that essentially delays diabetes.
by EL Ramos · 2023 · Cited by 26 —Teplizumab, a humanized monoclonal antibody to CD3 on T cells, is approved by the Food and Drug Administration to delay the onset of clinical type 1 diabetes (stage 3) in patients 8 years of age or older with preclinical (stage 2) disease. Whether treatment with intravenous teplizumab in patients with newly diagnosed type 1 diabetes can prevent disease progression is unknown.
Type 1 Diabetes Drug, Teplizumab, Has Additional Benefits, New Study Shows
Oct 20, 2023 — Teplizumab is a monoclonal antibody that modifies T cells to prolong the pancreas' ability to create insulin.
To that end, a study published in mid-October in the New England Journal of Medicine (NEJM) was promising, finding that two 12-day courses of teplizumab in children and adolescents diagnosed with diabetes less than six weeks earlier preserved their ability to make their own insulin.
There are different stages of type 1 diabetes. In stage 1, blood sugar levels are normal, but autoantibodies—markers of disease activity—to insulin-producing beta cells have started to appear in the bloodstream, setting the stage for the killing of beta cells and a progression to stages 2 and 3, explains Kevan Herold, MD, a Yale Medicine endocrinologist who was involved in the teplizumab trials and was an author of the latest NEJM study (called PROTECT).
American Diabetes Association Clinical Pharmacology Updates [paywalled]: Teplizumab: The First Treatment to Delay the Progression of Type 1 Diabetes
Each vial of teplizumab 1 mg/1 mL in 2-mL vials costs $13,850, and a 14-day supply of teplizumab costs $193,900. Insurance companies are covering the infusions with various required copayments. Programs are available to lower out-of-pocket costs to as low as $0.
We may expect costs to decrease with further R&D, but I am not going to guess when that could happen. If you talk to your Congresspersons about controlling costs for medications, put this one on your list.
Grab Bag
Bernie Sanders: American people are 'sick and tired' of being 'ripped off by drug companies'
Sanders is at the White House today. President Biden is scheduled to give a talk about the outrageous US prices for drugs like Ozempic and Wegouvy.
As cases of gestational diabetes and metabolic disorders increase during pregnancy, the prescription of metformin has become more common.
“As a result of antidiabetic treatment in the early postnatal period, we were able to identify alterations in the weight gain and hormonal status of the offspring, which were critically dependent on the metabolic state of the mother,” explains Lippert. Furthermore, sex-specific changes in hypothalamic AMPK signaling in response to metformin exposure were also observed. Together with the metformin-induced shift in the examined hormone levels, the results indicate that the maternal metabolic state must be taken into account before starting the treatment of gestational diabetes.
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Among other serious nastiness.
Personal Notes
I don’t understand it. I am off all of my diabetes medicines except glipizide, and that only on some days, when my blood glucose isn’t way down. I had 6 low glucose events recorded on my CGM in the last week, and 12 the week before. I have to plan for a certain amount of carbs every day to prevent more of them and respond to those that happen anyway—dark chocolate, crystallized ginger, ginger snaps, sometimes sourdough bread or soups with potatoes or lentils. When it goes really low, a whole potato. Right now I have the option of a slice of an apple pie that my wife just baked.
I am drinking big mugs of green tea, which seems to reduce my hunger, but not my weight so far.