NHS approves first drug that can delay type 1 diabetes

For the first time, the NHS will offer a treatment that can delay the onset of type 1 diabetes rather than simply detect it earlier.

NICE has approved teplizumab for use in England and Wales, making it the first treatment available on the NHS that can slow the progression of type 1 diabetes before insulin is needed.

The treatment is intended for adults and children aged eight years and older who have been identified as having stage 2 type 1 diabetes.

Unlike insulin, teplizumab is not a daily treatment. Eligible patients receive a single course of intravenous infusions over 14 consecutive days, usually in a hospital or specialist clinic setting. Each infusion takes around 30 minutes, with the dose gradually increasing during the treatment course.

The drug works by modifying part of the immune system involved in the attack on insulin-producing beta cells. After the treatment course is completed, patients continue to be monitored through follow-up appointments and blood tests.

Clinical studies found teplizumab delayed progression to symptomatic, insulin-dependent type 1 diabetes by a median of 48.4 months compared with 24.4 months in people who received a placebo. In practice, that means the treatment delayed diagnosis by around two years on average, with some participants experiencing substantially longer delays.

While the treatment will not be relevant to most people already living with type 1 diabetes, many experts believe the approval marks the beginning of a major shift in how the condition is identified and treated.

Teplizumab at a glance

What is it?	Immune-modifying treatment
Who can receive it?	8+ years old with stage 2 T1D
How is it given?	14 daily intravenous infusions
Average delay achieved	Around 2–3 years
NHS approved?	Yes, in England & Wales
Already have type 1 diabetes?	Not currently available

Why do some reports say two years and others three years? The original study found a median delay of around two years compared with placebo. However, longer-term follow-up showed some people experienced substantially longer delays, which is why many organisations and news reports now describe teplizumab as delaying type 1 diabetes by around two to three years.

How does teplizumab work?

Teplizumab is an immunotherapy designed to target the autoimmune process behind type 1 diabetes.

Rather than lowering blood sugar levels or replacing insulin, the drug acts on T-cells involved in the immune attack that destroys insulin-producing beta cells in the pancreas.

By slowing that process, teplizumab can help preserve beta cell function for longer and delay progression to the stage where insulin treatment becomes necessary.

The treatment was first approved in the United States in 2022 and received UK regulatory approval from the MHRA in 2025. The latest NICE decision means eligible patients in England and Wales will now be able to access the treatment through the NHS.

Who can receive the treatment?

Teplizumab is not intended for everyone with type 1 diabetes.

Most people are diagnosed with type 1 diabetes after symptoms appear, meaning only a relatively small proportion of people are currently expected to qualify for treatment.

To be eligible, a person must:

• Be aged eight years or older
• Have stage 2 type 1 diabetes
• Meet the criteria set out by specialist diabetes teams
• Not yet require insulin treatment

Because the treatment is aimed at people before symptoms develop, identifying those at risk becomes particularly important.

This is likely to increase interest in type 1 diabetes screening programmes that look for diabetes-related autoantibodies before a diagnosis occurs. In England, one example is the ELSA study, which is helping researchers identify people at risk of developing type 1 diabetes before symptoms appear. Screening is not commonplace and only Italy currently has a national type 1 screening programme for children and young people.

Understanding stage 2 type 1 diabetes

Stage 2 type 1 diabetes means the autoimmune process has already started, but symptoms have not yet developed and insulin is not yet needed.

People are usually identified through blood tests that detect diabetes-related autoantibodies and changes in blood sugar levels before a traditional type 1 diabetes diagnosis.

Most people diagnosed with type 1 diabetes today are diagnosed at stage 3, when symptoms have already developed and insulin treatment is required.

This is why many people living with type 1 diabetes may never have heard the term "stage 2" before. Until recently, there were very few treatment options available even if someone was identified at this earlier stage.

How much does the treatment cost?

NHS England has secured teplizumab through a confidential commercial agreement with Sanofi, meaning the price paid by the NHS has not been disclosed.

However, Sanofi's published NHS list price is £10,939.12 per vial.

Because treatment is personalised and delivered through a series of intravenous infusions over 14 consecutive days, the total undiscounted cost of a full course is likely to run into many tens of thousands of pounds per patient.

Despite the high cost, NICE concluded that teplizumab provides sufficient clinical benefit to be recommended for eligible patients through the NHS.

Is teplizumab already used in other countries?

Yes. While NHS availability is new, teplizumab has already been approved in several countries including the United States, Canada, China, Israel and Brazil.

The drug was first approved in the United States in 2022 and the UK became the first country in Europe to authorise teplizumab in August 2025. A European Union-wide approval followed in January 2026.

Teplizumab is sold as Tzield outside Europe and Teizeild in the EU.

More than a delay

The significance of teplizumab goes beyond the delay itself.

For people already living with type 1 diabetes, a delay of two or three years may not sound dramatic at first. However, many researchers believe the treatment demonstrates something that was not previously possible: altering the course of type 1 diabetes before symptoms appear.

That transition from monitoring risk to actively delaying progression is why many diabetes organisations view the approval as a landmark moment.

Until now, advances in type 1 diabetes have largely focused on improving life after diagnosis through better insulin delivery, CGMs and hybrid-closed loop (HCL) systems.

Teplizumab takes a different approach.

It is the first NHS-approved treatment shown to alter the course of type 1 diabetes before symptoms appear.

Diabetes UK described the decision as the start of a new era in type 1 diabetes treatment.

Karen Addington, Chief Executive of Breakthrough T1D UK, described the approval as an "incredible moment" and said: "For the first time, we have an immunotherapy that can delay the onset of symptomatic type 1 diabetes."

She added that for families facing a future diagnosis, additional years without the daily demands of managing type 1 diabetes could make a meaningful difference.

Could teplizumab help people who already have type 1 diabetes?

No. The NHS approval only covers people with stage 2 type 1 diabetes who have not yet developed symptoms or started insulin treatment.

Researchers are studying whether immune-based therapies could help preserve insulin production after diagnosis, but teplizumab is not currently approved for people who already have type 1 diabetes.

That means the vast majority of people currently using insulin, CGMs and hybrid-closed loop systems will not be eligible for treatment under the current NHS recommendation.

What happens next?

Following the NICE recommendation, NHS England must now make the treatment available within 90 days. NHS Wales is required to provide access within 60 days.

Initially, only a relatively small number of people are expected to qualify. Estimates suggest around 1,100 people could be eligible during the first year, with approximately 800 additional people becoming eligible each year thereafter.

However, experts believe those numbers could increase as awareness grows and more people are identified before symptoms develop.

The approval may also encourage further investment in screening programmes and research into additional immune-based treatments.

What could this mean for the future of type 1 diabetes?

Teplizumab is not a cure and it does not prevent type 1 diabetes completely.

People who receive the treatment are still expected to develop type 1 diabetes eventually. The goal is to delay that progression rather than stop it altogether.

Even so, many researchers see this approval as the beginning of something bigger.

For decades, the focus of diabetes technology has been on improving management after diagnosis. Today's insulin pumps, CGMs and hybrid-closed loop systems have transformed life for many people with type 1 diabetes, but they do not change the underlying disease process.

Teplizumab is the first approved treatment that attempts to intervene before symptoms appear.

However, teplizumab is unlikely to be the last treatment of its kind.

Researchers are already investigating several other immune-based therapies that aim to slow, modify or interrupt the autoimmune attack responsible for type 1 diabetes.

One of the best-known examples is abatacept (Orencia), a treatment already used for rheumatoid arthritis. Clinical studies have suggested it may slow progression through the early stages of type 1 diabetes and help preserve insulin-producing beta cells.

Another candidate is golimumab (Simponi). Originally developed for inflammatory conditions such as ulcerative colitis and rheumatoid arthritis, the drug has shown encouraging results in preserving insulin production in people recently diagnosed with type 1 diabetes.

Researchers are also studying rituximab, which targets B-cells involved in the autoimmune response. Some scientists believe combination approaches involving drugs such as rituximab and abatacept may ultimately prove more effective than a single therapy alone.

Other research is exploring regulatory T-cell therapies, immune-modifying vaccines, stem-cell derived beta cell replacement and encapsulated islet cell technologies.

The long-term goal is not simply to delay type 1 diabetes by a few years, but to preserve insulin production for much longer periods or potentially prevent progression altogether in some people.

Many scientists believe the future may involve combinations of therapies that target different parts of the immune system, rather than relying on a single treatment.

That means today's announcement may be remembered not only because teplizumab became available on the NHS, but because it marked the moment type 1 diabetes treatment began moving beyond monitoring risk and towards actively changing the course of the disease.

For now, teplizumab offers something that has never previously been available through the NHS: extra time.

For people already living with type 1 diabetes, today's approval will not change daily management. But for future generations identified before symptoms develop, it could represent the first step towards a very different future for type 1 diabetes.