Teplizumab treatment for stage 2 type 1 diabetes: a real-world evaluation of metabolic and immunological outcomes – published online 15/01/2026
Kagan E. Karakus, Lexie Chesshir, Sonya Walker, Erin E. Baschal, Kristen A. McDaniel, Taylor M. Triolo, Andrea K. Steck, Brigitte I. Frohnert, Peter A. Gottlieb, Aaron W. Michels, Kimber M. Simmons
Teplizumab is approved to delay stage 3 type 1 diabetes, yet clinicians still need real-world evidence that treatment is both working and biologically on-target. In this issue, Karakus et al (https://doi.org/10.1007/s00125-025-06646-6) present results from a prospective observational cohort treated in routine clinical care, and report that teplizumab was feasible to deliver with expected, transient adverse events. In this cohort, metabolic measurements often improved or remained stable over follow-up, including OGTT categories, HbA1c and continuous glucose monitoring (CGM) time above 7.8 mmol/l, supporting translation of trial findings into everyday practice. The authors paired clinical outcomes with immune profiling and detected a disease-relevant effect: contraction of CD4 T cell receptors targeting preproinsulin, without a parallel change in Epstein–Barr virus-targeting T cells. Importantly, the magnitude of this preproinsulin-specific shift correlated with C-peptide, linking immune modulation to beta cell preservation. The authors conclude that these data move teplizumab from ‘does it work?’ to ‘how do we monitor and personalise it?’.
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