For the first time in 100 years, a drug that delays the onset of type 1 diabetes has been approved for use on the NHS in England and Wales, marking the biggest breakthrough in treating the disease since the discovery of insulin. The immunotherapy, teplizumab, postpones the early stages of the condition for up to three years, according to the National Institute for Health and Care Excellence (Nice), which gave the green light on Tuesday.
How teplizumab works
Teplizumab, also known as tzield and manufactured by Sanofi, trains the immune system to stop attacking pancreatic cells. It is administered through a drip into a vein once a day for 14 consecutive days, with each session lasting about 30 minutes. The dose starts low and gradually increases. Once the course is complete, no further treatment is needed.
The drug does not cure type 1 diabetes but delays its progression from stage 2 (pre-symptomatic) to stage 3 (symptomatic), giving patients years free from the need for insulin therapy. Nice approved teplizumab for adults and children aged eight and above with early, pre-symptomatic type 1 diabetes.
Significance of the approval
Dr Elizabeth Robertson, director of research at Diabetes UK, described the approval as a landmark moment. “For the first time in 100 years, we are moving beyond insulin, with a medicine that targets the root cause of the condition,” she said. “This is an extraordinary moment for celebration in the type 1 diabetes community, and represents a shift towards a future where type 1 diabetes can be prevented altogether.”
Karen Addington, chief executive of Breakthrough T1D, called the approval an “incredible moment”. She added: “For the first time, we have an immunotherapy that can delay the onset of symptomatic type 1 diabetes. If it were your child or someone you love, you would want to do everything possible to give them more years without the daily burden of managing this relentless condition.”
Impact on patients
By delaying the onset, patients gain extra time before facing the demands of lifelong diabetes management. Children and teenagers, in particular, can reach key developmental milestones without the burden of insulin therapy. The only other treatment, insulin, was discovered 105 years ago and does not alter the disease course—it simply replaces what the body cannot produce.
The approval follows a commercial agreement between Sanofi and NHS England, ensuring the drug is available at a confidential discounted price. Helen Knight, director of medicines evaluation at Nice, said the decision was “rigorous, transparent and based on the best available evidence, striking a balance between clinical benefit and value for taxpayers”.
Looking ahead
Robertson emphasised the importance of early detection: “Detecting type 1 diabetes early, before symptoms appear, is key to unlocking these benefits and our focus now is ensuring fair and equitable access for everyone who is eligible.”
