Innovations in Care for Type 1 Diabetes: Tzield

Medically reviewed by Dr. Naomi Fogel, Medical Director of Lurie Children's Diabetes Program, Dr. Laura Levin and Dr. Mary McCauley, Attending Physicians in Lurie Children's Endocrinology Division

Diabetes care has changed dramatically in recent years, moving beyond insulin alone to new therapies that can detect risk earlier and even slow the disease's progression. Tzield (teplizumab) is an FDA-approved infusion therapy that works by slowing the immune system's attack on insulin-producing cells. Our expert, Dr. Naomi Fogel provides background on the stages of type 1 diabetes, what parents need to know about these advances and whether they might be right for your child.

Stages of Type 1 Diabetes 

Type 1 diabetes (T1D) is an autoimmune disorder in which the immune system is inappropriately attacking the part of the body that makes insulin: beta cells in the pancreas. We now understand that this process occurs in stages and starts before any elevation in blood sugars are seen.

An individual is in stage 1 of type 1 diabetes if two or more positive autoantibodies (signs of immune system activation) are present; blood sugars remain in normal range. One is in stage 2 T1D if two or more antibodies are present with elevations in blood sugars. A person with stage 3 T1D has positive antibodies along with frankly high blood sugars which cause symptoms such as increased thirst and urination. When people are diagnosed with T1D, they are usually already in stage 3 of the disease. 

With understanding that the underlying immune destruction can be occurring before blood sugar changes are seen, it is now recommended that those who are at risk for developing T1D undergo screening to assess risk. This includes those who had family members with T1D, or those who have a personal or strong family history of autoimmune disorders such as thyroid disease or celiac disease. This screening is completed by obtaining a blood test measuring autoantibodies as well as blood sugar levels.    

Stage 2 Type 1 Diabetes 

If an individual is found to be in stage 2 of T1D, there is treatment available to delay the onset of stage 3 clinical diabetes. Teplizumab (Tzield) is designed to slow down the immune destruction of the insulin-producing cells. This prolongs the amount of time it takes to reach stage 3 of diabetes and can delay starting insulin.

Currently, this treatment is approved for patients age 1 year and older who are in stage 2 type 1 diabetes. Lurie Children’s is excited to offer this innovative treatment to those who may qualify.  

Stage 3 Type 1 Diabetes

If your child has recently been diagnosed with type 1 diabetes, you're likely navigating a whirlwind of emotions, information and treatment decisions. We want to share some hopeful news: a groundbreaking treatment option is now available right here at Lurie Children's Hospital.
 
Teplizumab (Tzield) therapy is also now approved for patients ages 8-17 years who have been diagnosed with stage 3 diabetes within the last 8 weeks and have continued evidence of insulin production.  

Teplizumab (Tzield) goes beyond insulin management and can actually slow down the progression of type 1 diabetes in newly diagnosed patients. Let us be clear: this isn't a cure. Your child will still need insulin and ongoing diabetes management. But what Tzield can do is help preserve your child's remaining insulin-producing cells, making diabetes significantly easier to manage over time. 

How is Tzield different from insulin? 

This is an important distinction that many families ask about. Here's how these two treatments work differently: 

Insulin management:

• Replaces the insulin your child's body can no longer make 
• Requires daily injections or pump use for life 
• Manages blood sugar levels after the immune system has already destroyed insulin-producing cells 
• Essential for survival, but doesn't slow the disease itself 

Tzield (disease-modifying therapy):

• Works by actually slowing down your child's immune system attack on insulin-producing beta cells 
• Given as an intravenous infusion for twelve days shortly after diagnosis; this is then repeated in 6 months to complete the treatment course 
• Helps preserve whatever insulin production your child still has 
• Does NOT replace insulin—instead it helps preserve any remaining insulin production by the body, which can help improve long term outcomes over time 

Think of it this way: insulin keeps your child healthy day-to-day, while Tzield helps protect what's left of their body's natural ability to produce insulin. Together, they can make diabetes significantly more manageable for your family in the years ahead.  

Who is this treatment for? 

Tzield is now approved for children and teens ages 8-17 years who have been diagnosed with stage 3 type 1 diabetes, marking the first disease-modifying therapy beyond insulin for newly diagnosed patients. If you're reading this shortly after your child's diagnosis, you're in the right window to explore this option with your care team. Early intervention is key. 

What does treatment look like? 

Here's what you can expect if you and your care team decide Tzield is right for your child: 

• 12 daily outpatient infusion sessions, which may be done in the infusion clinic at a Lurie Children’s site; some days of the infusion may be completed at home as well, at the discretion of you and your care team. There are options to discuss with your team about the best method of delivering the medication, which can be done through a standard intravenous catheter or a PICC line.  
• The medication is most often given over a 30-minute time period. The visit may take up to 1-2 hours including preparation for infusion and monitoring vitals. Medications are given before the infusion to help prevent common side effects, which may include fever, nausea and vomiting, or rash.  

Our team will work with you to make the schedule as manageable as possible while your child receives this important treatment.  

What can families expect? 

Based on clinical trials, Tzield has been shown to preserve remaining insulin production of those with recently diagnosed type 1 diabetes, which means: 

• Better blood sugar control over time 
• Potentially less insulin needed 
• Reduced risk of diabetes-related complications down the road 
• More stable glucose levels, which can mean fewer scary highs and lows 

Every child's experience with diabetes is unique, and results will vary. But many families who have pursued this treatment report that it makes daily diabetes management more predictable and less overwhelming. 

Why Lurie Children's?

We're proud to be one of only a handful of hospitals in the Chicago area that will offer this cutting-edge treatment. This is now available at our main campus infusion center and at NM Central DuPage Hospital. This means you won't need to travel outside our system or across the city to access this innovative therapy. We're committed to bringing the most advanced diabetes care directly to the families we serve. 

What about cost and insurance? 

We know this is likely one of your first questions, and it's an important one. Our financial counselors and care coordinators will work directly with your family to navigate insurance coverage and explore all available options. Additionally, Tzield provides support fornavigating insurance coverage and providing co-pay assistance through their Compass program. 

What should you do next? 

If your child was recently diagnosed with type 1 diabetes, here are your next steps: 

1. Talk to your Lurie Children's endocrinologist about whether Tzield might be right for your child. 
2. Ask questions! Our team is here to help you understand all your options. 
3. Consider the timing—remember, Tzield is most effective for those newly diagnosed.  
4. Think about screening the rest of your family for their diabetes risk, which allows for early detection and intervention. 

Looking Ahead 

Type 1 diabetes research is moving faster than ever before, and treatments that were unimaginable just a few years ago are now becoming reality. At Lurie Children's, we're committed to staying at the forefront of diabetes care, ensuring that families in Chicago and beyond have access to the most advanced treatment options available. We're here to support you through every step of your child's diabetes journey, from diagnosis through treatment and beyond. 

If you have questions about Tzield or want to discuss whether it might be appropriate for your child, please reach out to your diabetes care team. If you are interested in screening your child for their risk of developing T1D, or if you feel your child may qualify for treatment with teplizumab, please call to schedule an appointment with us at 1.800.KIDS DOC 

Learn more about our Pediatric Diabetes Program

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