Type 1 diabetes (T1D) starts long before symptoms appear. Today, we can detect early-stage T1D by testing for autoantibodies in the blood. Autoantibodies tell us that beta cells have been damaged by the immune system.
Soon, we may be able to spot the immune attackers themselves. This would allow us to recognize T1D earlier, giving us more time to try to prevent harm to beta cells. It would also let us track the progression of T1D more closely.
In addition, it would help researchers evaluate new immune therapies — like those described below — in clinical trials. The test, called BASTA, could show whether the drugs are working.
BASTA testing needs only a small blood sample, which is especially helpful for use with children. Researchers are continuing to develop this test, which could, one day, become a routine part of T1D clinical trials.
Detecting T1D in its earliest stages can help prevent serious complications, such as diabetic ketoacidosis, and improve long-term health. What’s more, intervening during these early stages may slow the progression toward a clinical diagnosis of T1D.
Slowing T1D progression can delay the need for insulin therapy. This gives people more time to prepare and more time free of the daily burden of managing T1D.
Teplizumab (Tzield®) is the first drug approved to slow the progression of T1D. Approved in 2022, it’s now indicated to delay the onset of Stage 3 T1D in adults and children aged 1 year and older with Stage 2 T1D. Tzield is also approved to help preserve natural insulin production in children aged 8 to 17 years who have been recently diagnosed with Stage 3 T1D.
Today, several new approaches to delay Stage 3 T1D are in development. Read on to learn more about them.
Baricitinib treatment
Researchers are testing whether the drug baricitinib (Olumiant®) can delay the development of T1D in a clinical trial called BARICADE-DELAY. The trial is now recruiting participants ages 1-35 years in 5 states and 16 other countries worldwide and is expected to last about 5 years.
Baricitinib is used daily in pill form to treat certain cases of rheumatoid arthritis and alopecia. Because it can calm overactive immune responses, scientists believe it could slow the immune attack on beta cells that leads to T1D. Baricitinib is also being tested in recent-onset T1D.
Anti-thymocyte globulin (ATG) treatment
ATG is an immune-suppressing drug that may protect beta cells and slow the development of T1D. It’s also being used in people with recent-onset T1D to help them continue making their own insulin.
In Florida, a clinical trial recently began comparing ATG with Tzield. It’s now enrolling people with Stage 2 T1D between the ages of 4 and 34. ATG is used to treat aplastic anemia and to help organ or bone marrow transplants succeed. It is usually given as an infusion by a healthcare professional every day for up to 2 weeks.
Golimumab treatment
Scientists are also preparing to study a drug called golimumab in early-stage T1D. Golimumab is used to reduce inflammation in conditions like rheumatoid and psoriatic arthritis. In the upcoming clinical trial, golimumab will be delivered by injection. People ages 2-45 years will be eligible for the study, which will take place in Massachusetts.
Short-chain fatty acid (SCFA) supplements
SCFAs are produced by beneficial microbes that live in our digestive systems. People living with T1D have fewer of these bacteria and lower SCFAs levels than others. Scientists believe that lower levels of SCFAs may be linked to T1D progression.
In a recent study, people with T1D took oral SCFA supplements for 6 weeks. At the end of the study, both their immune responses and the microbes in their guts had changed. In lab experiments, samples of these microbes slowed the development of T1D in mice.
We don’t know yet whether SCFA supplements can slow T1D progression in people. Future clinical trials could explore this possibility.
Want to learn more?
New trials launch regularly, offering more opportunities to participate in T1D clinical research. You can find more information about these trials through the links above and at ClinicalTrials.gov.
