Dr. Jwan Terengi explains Tzield, the first drug to delay type 1 diabetes onset. A single 14-day course postpones progression by a median of 25 months. It targets people in Stage 2, before symptoms appear, preserving insulin production and giving families time to prepare.
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Hi, I'm Dr. Jwan Terengi. I'm a board certified endocrinologist with special interest in autoimmune conditions and early prevention. In this video, I want to share one of them very important and exciting developments in the type 1 diabetes care. There's a new medication called Tzield, the first medication shown to delay the onset of or the clinical type 1 diabetes. This is a typical type 1 diabetes is a kind of diabetes that happens in children and adults as well, where you're dependent on insulin. You don't go on pills, your only option is insulin. And you may be getting the insulin in the form of injection or insulin pump or inhaled insulin, whatever it might be, but you're dependent on insulin. So in the past we had no option, but. But once you got diabetes you just go on insulin. But now we have a medication that can delay the onset. That means we need to test in the high risk population earlier to understand who's at high risk. When can we test them to diagnose it earlier so that we can delay the progression to full blown or full onset of type 1 diabetes. So my goal is simple to educate, prevent and delay the disease progression because timing matters and so does awareness. So let's dive in understanding the stages of type 1 diabetes. Type 1 diabetes doesn't develop overnight. It unfolds in three defined stages, long before insulin is ever acquired. Stage 1. This is when the immune system has just started attacking the pancreas, which is an organ right behind our stomach, right below our lungs. The person tests positive for multiple islet cell antibodies, but the blood sugars are still normal. No symptoms at this time. At stage two, autoantibodies are still present, but now we see signs of dysglycemia. That means the blood sugars have started going up a little bit, but it's not too high to be on insulin. So you might see slight dysglycemia or slightly high blood sugars. It could be in the form of impaired fasting glucose or it could be elevated A1C or abnormal oral glucose tolerance test. Now, most of the time in type one patients, we don't catch them at this stage because they're very asymptomatic, no symptoms at this time, so we don't catch it. Okay, then comes stage three. Stage three is clinical type 1 diabetes. In this case, the person has now experienced or experiencing complete full blown symptoms of polyuria, polydipsia, weight loss, fatigue, and they meet the diagnostic criteria for diabetes and insulin is required. Stage two is a key opportunity Zone where we now have a chance to intervene. So what is a typical progression timeline? Without treatment, people in stage two have high risk of progression. 60% of people will progress to clinical diabetes or go to stage three within two years. And 75% of people will go to full blown diabetes within five years. This progression is predictable and biologically active, even if it is silent. That's where TZ yield comes in. Now, what is Tzield? Tzield is also called teplizumab. Tzield is a monoclonal antibody that targets CD3 on T cells, essentially calming the autoimmune attack on the pancreas. In a pivotal trial, one 14 day course of Tzield delayed the onset of stage 3 diabetes by a median of 25 months, just over 2 years compared to placebo. It's not a cure, but it's a first treatment to delay the disease in a meaningful way. Imagine in teenagers or imagine in younger children. The drug is approved for eight years and older adults. Youth and adults. Now, who's eligible for Tzeald? Tzeald is currently Approved for people 8 years and older who meet all three of these criteria. Positive for two or more islet cell antibodies. And there's evidence of dysglycemia or abnormal glucose testing. No clinical symptoms yet. Because they're still in stage two, most people are only identified through screening, usually the family members of those with type 1 diabetes or participants in a research programs like trialnet. Routine screening of general population is not standard, at least yet. Now, who else can we test for? We can test for people with other autoimmune conditions because autoimmune disorders can occur as a spectrum. So if they have one autoimmune condition, they're at high risk for other autoimmune conditions as well. Now, why delaying the onset matters? Delaying the diagnosis of diabetes is more than just pushing back the date. It means you have better glycemic control from preserved insulin production, lower risk of severe hypoglycemia or diabetic ketosidosis at the time of diagnosis, and time for families to emotionally and practically prepare, and less psychological burden during critical life stages like adolescence. For someone newly diagnosed with stage two, delay can be a gift. Now let's try to understand the bigger picture. Let's zoom out for a moment. In US, about 283,000 youth under 20 live with diabetes. 86% of these are type 1. In adults, 95% of diabetes is type 2. Only 5% of it is type 1. The peak onset of age for type 1 diabetes is 10 to 14 years. That makes pediatric screening especially important and makes Tzield a valuable tool for right candidate. Happy to share this information with you. This is Dr. Range and I'm happy to share more information like this. TZ represents a breakthrough, a chance to shift the timeline of a disease we once thought was inevitable. If you or someone you love has a family history of type 1 diabetes, ask your doctor about screening and identify stage 2 early. That could give you and your family members a chance or options or more time. Thank you for watching. And again, I'm Dr. Renge committed to helping you stay informed, take action early, and delay what once felt to be unavoidable. Take care. Thank you.
