Special Report: Type 1 diabetes and the concept of remission

In episode 5 of the Special Report: Advances in Type 1 Diabetes Management, Contemporary Pediatrics explored how disease-modifying therapies were reshaping expectations for type 1 diabetes, including the possibility of partial remission and delayed insulin dependence. Moderated by Herbert Bravo, MD, the discussion focused on immune-based treatments that targeted the autoimmune foundation of the disease rather than glucose control alone.

Bravo opened by reflecting on discussions from a recent population screening symposium, where the concept of remission in type 1 diabetes was increasingly emphasized. He asked whether patients requiring only minimal insulin after diagnosis represented a form of remission similar to what was observed in other autoimmune diseases. Marian Rewers, MD, PhD, explained that type 1 diabetes remained an autoimmune condition throughout life, even when metabolic control was stable. While autoimmunity persisted, metabolic dysfunction emerged later, creating an opportunity for therapies that modified immune activity and preserved beta-cell function.

Rewers described how immune-modulating treatments had demonstrated the ability to delay progression to insulin dependence. He highlighted the approval of teplizumab in November 2022¹ as the first disease-modifying therapy shown to delay the onset of stage 3 type 1 diabetes by an average of 2 to 3 years when administered during stage 2 disease. He noted that approximately 1,000 children and adults in the United States had received this therapy, following years of randomized clinical trials, including a pivotal publication in 2019. These data provided evidence that immune intervention could preserve C-peptide and endogenous insulin production.²

The discussion also addressed treatment after clinical diagnosis. Rewers explained that while immune-modifying therapy rarely eliminated the need for insulin, it could significantly reduce insulin requirements and improve glycemic stability, representing a form of partial remission. Bravo noted that even patients who eventually required insulin often needed lower doses if treated early. Rewers cautioned that responses varied, with some patients maintaining preserved C-peptide for 5 to 10 years, while others derived limited benefit, underscoring the need to better identify likely responders.

Finally, the experts discussed emerging research extending these therapies to younger children and to patients shortly after stage 3 diagnosis. Rewers referenced ongoing trials evaluating safety in children as young as 2 years and expedited regulatory review for post-diagnosis use within 12 weeks of onset. Together, the discussion emphasized that disease-modifying therapy had moved from theory to clinical reality, marking a major shift toward altering the natural history of type 1 diabetes rather than simply managing its consequences.

Our experts

Herbert Bravo, MD, is a pediatrician and the president and founder of the Society for Innovation in Pediatrics. He is also the co-founder of The Pediatric Lounge Podcast.

Marian Rewers, MD, PhD, is a professor of Pediatrics and Medicine at the University of Colorado School of Medicine and executive director of the Barbara Davis Center for Diabetes.

Editor's note:

Herbert Bravo, MD, reports disclosures for Society For Innovation in Pediatrics, Sanofi, and Barbara Davis Center.

References:

1. Campbell P. FDA approves teplizumab for delay of type 1 diabetes in patients 8 years and up. Contemporary Pediatrics. Published November 18, 2022. Accessed December 18, 2025. https://www.contemporarypediatrics.com/view/fda-approves-teplizumab-for-delay-of-type-1-diabetes-in-patients-8-years-and-up
2. Fitch J. Teplizumab effectiveness in adolescents with newly diagnosed type 1 diabetes. Contemporary Pediatrics. October 18, 2023. Accessed December 18, 2025. https://www.contemporarypediatrics.com/view/teplizumab-effectiveness-in-adolescents-with-newly-diagnosed-type-1-diabetes