New Research Explores Treatments to Protect the Kidneys and Preserve Insulin Production in Type 1 Diabetes

When someone develops type 1 diabetes, their immune system has already begun attacking the insulin-producing beta cells in the pancreas. Early intervention with certain therapies aims to slow or delay this process. A recent analysis of the TrialNet Anti-CD3 Prevention study examined how teplizumab—an antibody therapy—affects the body's remaining insulin production in people with stage 2 type 1 diabetes.

The research tracked insulin secretion, insulin sensitivity, and other metabolic measures over 12 months in both treated and untreated participants. Among those who received teplizumab, insulin secretion actually increased over the year, while it declined in the placebo group. However, the response wasn't uniform: some people progressed rapidly to stage 3 disease despite teplizumab, while others maintained better insulin production. This variation suggests that understanding who will benefit most from early treatment remains an important research goal.

People with type 1 diabetes face increased risk of kidney disease over time. The ATTEMPT trial tested whether dapagliflozin, a medication commonly used in type 2 diabetes, could offer protection when added to insulin therapy in young people ages 12–21 with type 1 diabetes.

Over 22 weeks, young people who received dapagliflozin alongside their insulin showed measurable improvements. Their measured kidney filtration rate—a key indicator of kidney function—decreased by 8.8 ml per minute per 1.73 m², compared to those on placebo. HbA1c, a measure of average blood sugar control, decreased by 0.47%, and time spent in the healthy glucose range (70–180 mg/dl) increased by 9%. Participants also experienced modest weight loss of about 2.8 kg. Importantly, adverse events were similar between groups, with careful monitoring for diabetic ketoacidosis (a serious but rare condition).

These results suggest that adding dapagliflozin to insulin may offer kidney-protective benefits in young people with type 1 diabetes, though longer-term studies are needed to understand sustained effects.

Most approved therapies for type 1 diabetes focus on the very early stages of the disease. Breakthrough T1D, a major research funder, recently awarded a grant to study SAB-142 as a potential adjunct therapy in the PRISE-hATG trial. This research aims to advance treatment options beyond the first 100 days after diagnosis, a period when much of the initial beta cell destruction occurs.

By exploring interventions later in the disease course, researchers hope to identify additional windows of opportunity to slow progression and preserve remaining insulin production in people who may have been diagnosed after the earliest intervention period.

Across these studies, a consistent theme emerges: people respond differently to the same treatment. In the teplizumab analysis, participants labeled as 'slow progressors' maintained their insulin secretion much better than 'rapid progressors,' regardless of treatment. Similarly, in the dapagliflozin trial, people with higher baseline kidney filtration rates showed greater improvements.

This variation underscores why type 1 diabetes is increasingly understood as a disease with multiple subtypes. Future treatment approaches may need to identify which people are likely to progress quickly and tailor therapy accordingly. Ongoing research into immune markers, metabolic measures, and genetic factors aims to personalize treatment decisions and maximize benefits for each individual.

Origin: Minichart (News report). Evidence: News report, corroborated with 3 indexed studies. Type1Cure is an information and intelligence hub, not a medical advice service. This article summarizes published research and does not provide diagnosis, treatment, or personal medical guidance. Always talk to your own care team before changing anything about your Type 1 diabetes management.