Diabetes Prevention Moves Towards Reality as Studies Published  

Miriam E. Tucker

March 17, 2021

Two newly published studies highlight recent success toward delaying the onset of type 1 diabetes in people at high risk and slowing progression in those with recent onset of the condition.

Both studies were initially presented in June 2020 at the virtual American Diabetes Association (ADA) 80th Scientific Sessions and reported by Medscape Medical News at the time.  

As yet, neither of the two strategies — preserving insulin-producing pancreatic beta-cell function soon after diagnosis or delaying type 1 diabetes onset in those at high risk — represent a cure or certain disease prevention.

However, both can potentially lead to better long-term glycemic control with less hypoglycemia and a lower risk for diabetes-related complications.

Combination Treatment Prolongs Beta-Cell Function in New-Onset Disease

The first study, entitled, "Anti-interleukin-21 antibody and liraglutide for the preservation of β-cell function in adults with recent-onset type 1 diabetes," was published online March 1 in Lancet Diabetes & Endocrinology by Matthias von Herrath, MD, of Novo Nordisk, Søborg, Denmark, and colleagues.

The randomized, placebo-controlled, double-blind phase 2 combination treatment trial involved 308 individuals aged 18-45 years who had been diagnosed with type 1 diabetes in the previous 20 weeks and still had residual beta-cell function.

Patients were randomized with 77 per group to receive monoclonal anti-IL-21 plus liraglutide, anti-IL-21 alone, liraglutide alone, or placebo. The antibody was given intravenously every 6 weeks and liraglutide or matching placebo were self-administered by daily injections.

Compared with placebo (ratio to baseline 0.61, 39% decrease), the decrease in mixed meal tolerance test (MMTT) stimulated C-peptide concentration from baseline to week 54 — the primary outcome — was significantly smaller with combination treatment (0.90, 10% decrease; estimated treatment ratio, 1.48; P = .0017), but not with anti-IL-21 alone (1.23; P = .093) or liraglutide alone (1.12; P = .38).

Despite greater insulin use in the placebo group, the decrease in A1c (a key secondary outcome) at week 54 was greater with all active treatments (–0.50 percentage points) than with placebo (–0.10 percentage points), although the differences versus placebo were not significant.

"The combination of anti-IL-21 and liraglutide could preserve beta-cell function in recently diagnosed type 1 diabetes," say the researchers.

"These results suggest that this combination has the potential to offer a novel and valuable disease-modifying therapy for patients with recently diagnosed type 1 diabetes. However, the efficacy and safety need to be further investigated in a phase 3 program," Herrath and colleagues conclude.

Teplizumab: 3-Year Data Continue to Show Benefit

The other study looked at delaying the onset of type 1 diabetes. Entitled, "Teplizumab improves and stabilizes beta cell function in antibody-positive high-risk individuals," the article was published online March 5 in Science Translational Medicine by Emily K. Sims, MD, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, and colleagues.

This trial of the anti-CD3 monoclonal antibody adds an additional year of follow-up to the "game-changer" 2-year data reported in 2019.

Among the 76 individuals aged 8-49 years who were positive for two or more type 1 diabetes-related autoantibodies, 50% of those randomized to a single 14-day infusion course of teplizumab remained diabetes-free at a median follow-up of 923 days, compared with only 22% of those who received placebo infusions (hazard ratio, 0.457; P = .01).

The teplizumab group had a greater average C-peptide area under the curve compared with placebo, reflecting improved beta-cell function (1.96 vs 1.68 pmol/mL; P = .006).

C-peptide levels declined over time in the placebo group but stabilized in those receiving teplizumab (P = .0015).

"It is very encouraging to see that a single course of teplizumab delayed insulin dependence in this high-risk population for approximately 3 years versus placebo," said Frank Martin, PhD, JDRF director of research.

"These exciting results have been made possible by the unwavering efforts of TrialNet and Provention Bio. Teplizumab, if approved by the FDA, could positively change the course of disease development for people at risk of developing T1D and their standard of care," he concludes.

The teplizumab study was funded by TrialNet. Herrath is an employee of Novo Nordisk, which funded the study involving its drug liraglutide. Sims has reported no relevant financial relationships.

Sci Transl Med. 2021;13:eabc8980. Abstract

Lancet Diabetes Endocrinol. Published online March 1, 2021. Abstract

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