Type 1 diabetes update: Immune therapy, screening, and new technology

Three recent developments in type 1 diabetes care were particularly relevant for pediatricians, according to Brittany S. Bruggeman, MD: an immune therapy approved for clinical disease, expanded screening recommendations, and automated insulin delivery (AID) technology becoming the standard of care.

Bruggeman, a pediatric endocrinologist and type 1 diabetes physician scientist at the University of Florida in Gainesville, was discussing the developments in an interview with Contemporary Pediatrics during the American Academy of Pediatrics 2026 National Conference & Exhibition.

Teplizumab (Tzield) was approved by the FDA in 2026 for clinical type 1 diabetes, marking the first immune therapy available at the onset of symptomatic disease.¹ Because patients retained functioning beta cells at diagnosis, the therapy prolonged endogenous insulin secretion, according to Bruggeman.

"I think another thing pediatricians may not know is that when you're diagnosed with type 1 diabetes, you do still have remaining beta cells left that are functioning," Bruggeman said.

Teplizumab did not eliminate the need for insulin, but it could potentially stabilize blood glucose levels and reduce insulin doses. The approval also opened new research avenues, including therapies given alongside or in place of teplizumab. The greatest change for newly diagnosed patients and families was hope, she said, because no prior therapy had addressed the primary disease process after diagnosis.

The American Diabetes Association (ADA) recommended screening with islet autoantibodies, which appeared in the bloodstream years before clinical symptoms, for individuals with relatives who had type 1 diabetes and for those at higher genetic risk.² Because higher genetic risk was difficult to determine in the office, Bruggeman's group interpreted it to include children with other autoimmune conditions, particularly Hashimoto thyroiditis and celiac disease. Screening was available through commercial laboratory blood tests, with fingerstick kits used primarily in research settings.

Identifying children with no symptoms allowed for metabolic monitoring, which substantially reduced rates of diabetic ketoacidosis at diagnosis. Screening also identified children in the presymptomatic phase who could receive teplizumab to delay onset of clinical disease.

The ADA also recommended that all individuals with type 1 diabetes be offered an AID system, in which an insulin pump communicated with a continuous glucose monitor to titrate insulin delivery up or down in response to glucose levels. AID systems were not a cure but offered major benefit, particularly overnight, when they kept glucose levels steady, according to Bruggeman. The systems also buffered glucose fluctuations associated with exercise and eating.

"So I have parents now who are able to sleep, who before were up all night checking their child's blood sugar and having to make adjustments overnight at 2 AM," Bruggeman said.

Between endocrinology visits, general pediatricians could help address the psychosocial burden of a disease that families managed continuously, during meals, sleep, sports, and daily activities. According to Bruggeman, pediatricians could provide space for families to discuss the impact of type 1 diabetes and facilitate referrals for mental health support, given the risk of diabetes burnout, depression, and anxiety that accompanied chronic disease.

References

1. Ramos EL, Dayan CM, Chatenoud L, et al. Teplizumab and β-cell function in newly diagnosed type 1 diabetes. N Engl J Med. 2023;389(23):2151-2161. https://doi.org/10.1056/NEJMoa2308743

2. American Diabetes Association Professional Practice Committee for Diabetes. Diagnosis and classification of diabetes: Standards of Care in Diabetes—2026. Diabetes Care. 2026;49(suppl 1):S27-S49. https://doi.org/10.2337/dc26-S002