Drug that delays the onset of type 1 diabetes, recommended by NICE

A drug that can delay the onset of type 1 diabetes for up to three years has been made available to NHS patients in England and Wales, after the National Institute for Health and Care Excellence (NICE) recommended it today (23 June).

England and Wales are now the first countries in Europe to recommend teplizumab, which is the world’s first disease-modifying immunotherapy treatment that targets the root cause of type 1 diabetes and can slow its progression.

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Helen Knight, director of medicines evaluation at NICE, said: ‘This is a genuinely exciting recommendation. For the first time, we have a treatment that can give people diagnosed at an early stage of type 1 diabetes precious extra time before they need to manage the full demands of the condition.’

She highlighted that teplizumab can delay the onset of symptomatic diabetes ‘by an average of nearly three years’ according to current evidence.

Teplizumab, which is made by Sanofi and branded as tzield, has been recommended for children aged 8 and older and adults who have type 1 diabetes in its early, pre-symptomatic stage.

According to NICE, teplizumab represents a significant step forward, and gives people at high risk of developing symptomatic diabetes the chance to delay its onset.

By delaying the onset of symptomatic type 1 diabetes, people will benefit from extra time before taking on the demands of lifelong diabetes management, and children and young people in particular can have more time to reach key developmental milestones before that point.

NICE estimates that around 1,100 people could be eligible for teplizumab in the first year, decreasing to a steady state of approximately 820 eligible patients annually from year three onwards.

Teplizumab will be available to NHS patients in England within 90 days of publication of NICE final guidance, while patients in Wales will be able to access it within 60 days.

In Northern Ireland, there is a process for reviewing and adopting NICE guidance. Diabetes UK are working with local systems to understand what happens next.

In Scotland, decisions about new treatments are made by the Scottish Medicines Consortium, who say they expect to publish advice in early 2027.

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Lucy Common, clinical nursing advisor at NICE, emphasised that early, pre-symptomatic diagnosis can have a significant impact on individuals and their families. ‘This recommendation matters enormously for patients and their loved ones,’ she said.

‘Having time before the onset of stage 3 diabetes is not just a clinical benefit; it can make a meaningful difference to people’s lives, their mental wellbeing, and the wellbeing of the families and carers who support them. It is encouraging to see a treatment that has the potential to be made available across the NHS.’

The evidence for teplizumab comes from a clinical trial called TN-10, which followed 76 children aged eight and over and adults who had been diagnosed with stage 2 type 1 diabetes and had a close family member with the condition.

Of the 76 participants, 44 received teplizumab and 32 received a placebo. Teplizumab delayed the onset of symptomatic diabetes by approximately 32 months, or nearly three years.

In type 1 diabetes, the immune system mistakenly attacks the insulin-producing cells in the pancreas, eventually destroying them.

Teplizumab is an immunotherapy that works by helping to regulate the immune system and slowing the damage to the pancreas and delay the onset of the disease.

Teplizumab is given through a drip into a vein once a day for 14 days in a row. Each infusion takes at least 30 minutes.

The dose starts low and is gradually increased over the first few days of treatment. Once the 14-day course is complete, treatment does not start again. It is a one-time course.

Patients will need to visit hospital every day during the treatment period, including at weekends. The NICE committee recognised that this may be difficult for some people, for example because of the cost or practicalities of travelling to hospital each day.

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The drug manufacturer, Sanofi, has agreed a commercial arrangement with NHS England, meaning teplizumab will be available to the NHS at a confidential discounted price.

Dr Elizabeth Robertson, director of research and clinical at Diabetes UK, said: ‘For the first time in 100 years, we are moving beyond insulin, with a medicine that targets the root cause of the condition.

‘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.’

According to Diabetes UK, almost 6 million people in the UK are living with diabetes. Of those, they estimate that 8% have type 1 diabetes.

The charity highlights that the key to unlocking treatments like teplizumab is early detection. That means testing for type 1 diabetes autoantibodies.

A person can find out if they or their child has autoantibodies by taking part in screening studies. Diabetes UK are co-funding the ELSA study that’s screening children aged 2-17 across the UK, and the T1DRA study screens adults aged 18-70.

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