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Pediatric experts will debate whether technology or immunomodulation is better for type 1 diabetes management


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3 minutes

Michael J. Haller, MD
Michael J. Haller, MD

A variety of technologies have been developed to aid in the management of type 1 diabetes, including continuous glucose monitors (CGMs), insulin pumps, and more; however, as advances in immunomodulation of the disease continue, clinicians and patients alike will have to consider the benefits and drawbacks of each approach.

On Saturday, June 24, two experts will debate Technology or Immunomodulation—The Best Course for Management of Type 1 Diabetes. The session will take place at 3:15 p.m. PT in Ballroom 20-D of the San Diego Convention Center.

“We are at a point in type 1 diabetes management where it is quite reasonable for people to think about using technology as a means to fully manage their disease while achieving good control and good quality of life,” said Michael J. Haller, MD, Professor and Chief of Pediatric Endocrinology, University of Florida. “In contrast, we are also finally at the point where we have immunotherapeutics that have benefits in terms of preserving beta-cell function.”

The debate going forward will be how to balance the relative risks, benefits, and personal choices when deciding to use technology, immunotherapy, or both for any given patient, Dr. Haller said.

Antoinette Moran, MD
Antoinette Moran, MD

Dr. Haller will present data and arguments in support of “Let’s Preserve Beta Cells.” He will be joined by Antoinette Moran, MD, Vice Chair of Faculty Development and the Marguerite and James Dugger Professor in Pediatrics, University of Minnesota, who will present the stance “Technology Is the Way Forward.”

One of the biggest recent advancements in support of beta-cell preservation was the November 2022 U.S. Food and Drug Administration (FDA) approval of teplizumab. The CD3-directed monoclonal antibody was approved to delay the onset of stage 3 type 1 diabetes in adults and children aged 8 or older.

In the trial leading to the agent’s regulatory approval, 45% of patients who received teplizumab were later diagnosed with stage 3 type 1 diabetes compared with 72% of patients who were assigned placebo. Mid-range time from randomization to stage 3 type 1 diabetes diagnosis was 50 months for teplizumab compared with 25 months for placebo.

“Any time without a requirement for insulin or cumbersome technologies can have a huge impact on quality of life,” Dr. Haller said.

In addition to teplizumab, there are other drugs that have demonstrated potential benefits in preserving beta-cells. For example, Type 1 Diabetes TrialNet is testing a low dose of the immunotherapy drug antithymocyte globulin to see if it can delay or prevent type 1 diabetes.

On the flip side of the argument, there are risks associated with immunosuppressive agents and challenges related to the side effects and logistics of these treatments. Teplizumab is a 14-day infusion, and the estimated price tag is close to $200,000.

Dr. Haller said most experts likely agree there will be a role for both technologies and immunomodulation going forward. Both should be discussed and offered to patients.

“I hope people will come away from the session with a good understanding of opportunities for patients progressing through the different stages of diabetes to utilize beta-cell-preserving therapies to prolong the function of their remaining beta-cells, while simultaneously considering the use of technology to optimize glycemic control and improve overall quality of life,” Dr. Haller said.

Equity issues exist for both options as well.

“Even though diabetes technologies are now considered standard of care, they are certainly not distributed equitably across all type 1 diabetes populations,” Dr. Haller said. “And the same can be said for immunotherapeutic options. We need to work harder to level the field for all.”