For the first time in 100 years, we are moving beyond insulin
For the first time in over a century, medicine has moved beyond merely compensating for type 1 diabetes to actually altering its course. The NHS in England and Wales has approved teplizumab, an immunotherapy that can delay the onset of the disease by up to three years in high-risk children and adults — not by replacing what the body has lost, but by persuading the immune system to stop destroying it. In a condition that has long demanded lifelong vigilance from the moment of diagnosis, three years of reprieve carries a weight that is as much human as it is clinical.
- For 105 years, insulin has been the only answer to type 1 diabetes — a treatment that sustains life but does nothing to slow the disease claiming it.
- Teplizumab breaks that stalemate by retraining the immune system before it finishes destroying the pancreatic cells that produce insulin, buying patients up to three years before symptoms emerge.
- The drug is approved for children aged eight and above and adults in the pre-symptomatic stage, administered as a simple 14-day intravenous course — but it only works if patients are found before the damage is done.
- NHS England has secured a confidential discounted price with Sanofi, yet the deeper challenge now is building the screening infrastructure to identify at-risk individuals early enough for the treatment to matter.
- For families, the approval signals not just a medical milestone but a reprieve — years of childhood and adolescence lived without the relentless arithmetic of insulin dependency.
For the first time in more than a century, the NHS in England and Wales will offer a drug that delays type 1 diabetes rather than simply managing it. Teplizumab, made by Sanofi, received approval from the National Institute for Health and Care Excellence, and those in the diabetes community are calling it the most significant advance since insulin was discovered 105 years ago.
Type 1 diabetes typically strikes during childhood or adolescence, when the immune system turns on the pancreatic cells that produce insulin. Until now, insulin replacement was the only recourse — lifesaving, but entirely compensatory. Teplizumab works differently: it is an immunotherapy that trains the immune system to stop attacking those cells, postponing the disease's onset by as long as three years in people identified as high-risk before symptoms appear. The treatment is a 14-day intravenous course, once daily for about 30 minutes, and then it is finished.
The human stakes are considerable. Three extra years before a type 1 diabetes diagnosis means time to reach developmental milestones, to move through adolescence without the daily weight of insulin injections, blood sugar monitoring, and carbohydrate counting. For families, it represents years of relative normalcy before the condition becomes inescapable. Diabetes UK's director of research called it the start of a new era — the first time in a century that medicine is addressing the root cause rather than the consequence.
Access, however, will hinge on early detection. The drug only works in people identified before the pancreas has largely ceased insulin production, meaning routine screening for at-risk individuals will be essential. Sanofi has agreed a confidential discounted price with NHS England, but the harder work ahead lies in finding eligible patients early enough — and ensuring that opportunity is distributed fairly across the country.
For the first time in more than a century, the NHS in England and Wales will offer a drug that does not simply manage type 1 diabetes but actually delays when it takes hold. Teplizumab, made by Sanofi and also known as tzield, received approval from the National Institute for Health and Care Excellence on Tuesday, marking what many in the diabetes community are calling the most significant advance in the disease since insulin was discovered 105 years ago.
Type 1 diabetes strikes millions of people worldwide, typically during childhood or adolescence. The disease occurs when the pancreas produces little to no insulin, the hormone that allows glucose to enter cells and fuel the body. Until now, insulin replacement was the only treatment available—a lifesaving intervention that does nothing to slow or stop the underlying disease, merely compensating for what the body no longer makes.
Teplizumab works differently. It is an immunotherapy that trains the immune system to stop attacking the pancreatic cells responsible for producing insulin. The drug does not cure type 1 diabetes, but it postpones its onset for as long as three years in people identified as high-risk before symptoms appear. Nice approved it for use in children aged eight and above and adults with early, pre-symptomatic type 1 diabetes—what clinicians call stage 2 disease. The treatment itself is straightforward: a 14-day course delivered intravenously, once daily for about 30 minutes, with doses that start low and gradually increase. After those two weeks, the treatment ends.
The human stakes are substantial. Children and teenagers facing a diagnosis of type 1 diabetes have historically known that managing the condition would dominate their lives from that point forward—multiple daily insulin injections, constant blood sugar monitoring, the relentless arithmetic of carbohydrate counting. Three extra years before that reality sets in means time to reach crucial developmental milestones, to grow into adolescence, to simply be young without the weight of lifelong medical management. For families, it means years of relative normalcy before the demands of the disease become inescapable.
Dr. Elizabeth Robertson, director of research at Diabetes UK, described the approval as marking the start of a new era. For the first time in a century, she said, the field is moving beyond insulin toward a medicine that addresses the root cause of the condition. Karen Addington, chief executive of Breakthrough T1D, called it an "incredible moment," emphasizing that families now have a treatment that can give their children years without the daily burden of managing a relentless condition. Helen Knight, director of medicines evaluation at Nice, noted that the decision balanced clinical benefit against value for taxpayers, calling it a "genuinely exciting recommendation."
Access will depend on early detection. The drug only works in people identified before symptoms emerge—before the pancreas has already largely stopped producing insulin. That means the NHS will need to identify at-risk individuals through screening, a process that is not yet routine. Sanofi has negotiated a confidential discounted price with NHS England, ensuring the drug will be available to eligible patients. But the real challenge ahead lies in finding those patients early enough for the treatment to make a difference, and in ensuring that access is fair and equitable across the country.
Notable Quotes
For the first time in 100 years, we are moving beyond insulin, with a medicine that targets the root cause of the condition.— Dr. Elizabeth Robertson, director of research at Diabetes UK
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.— Helen Knight, director of medicines evaluation at Nice
The Hearth Conversation Another angle on the story
Why does delaying the disease by three years matter so much? Insulin still works.
Insulin keeps you alive, but it doesn't give you your life back. Three years is the difference between childhood and adolescence—between being a kid and becoming a teenager. It's time before the daily math of managing blood sugar becomes your constant companion.
So this drug actually stops the disease from progressing?
Not entirely. It slows it. The immune system is still attacking the pancreas, but teplizumab teaches it to stop. Eventually, in most people, the disease will still emerge. But you get years of reprieve.
Why has nothing like this existed before?
Type 1 diabetes is an autoimmune disease—your own body attacking itself. For a century, we only knew how to replace what was lost. Understanding how to talk to the immune system, to redirect it, that's much newer science. This is the first time we've had a drug that actually works that way.
Who gets access to it?
Children eight and older and adults who are identified early, before symptoms show up. That's the catch—you have to know you're at risk before you get sick. The NHS will need to screen for it, and that's not something they've been doing systematically.
What happens after the 14 days of treatment?
You're done. No ongoing medication. The immune system has been retrained. Some people will go years without developing symptomatic diabetes. Others will eventually progress, but they've had that gift of time.
Is this a cure?
No. But it's the first time we've been able to change the course of the disease itself. That's the breakthrough.