For more than a century, a type 1 diabetes diagnosis has carried the same sentence: insulin injections for life, starting the moment the immune system finishes destroying the cells that make it. On Tuesday, England and Wales took the first real step past that.
The National Institute for Health and Care Excellence recommended teplizumab for routine use on the NHS, clearing the way for the first treatment that goes after the cause of type 1 diabetes rather than managing its aftermath. Sold as Tzield and made by Sanofi, the drug does not cure anything. What it does is buy time — on average close to three years before the disease turns symptomatic, the trial evidence shows. Experts called the decision a “landmark” moment.
About 400,000 people in the UK live with type 1 diabetes, a lifelong autoimmune condition in which the body turns on the insulin-producing beta cells in the pancreas. Teplizumab, given as a single course, trains the immune system to ease off that attack, slowing the slide toward the point where blood sugar can no longer be controlled without lifelong insulin. It is cleared for children aged eight and over and for adults who are in the early, still-symptomless stage of the disease.
Helen Knight, director of medicines evaluation at NICE, framed the recommendation as a break from decades of treating only the symptoms.
“This is a genuinely exciting recommendation. For the first time, we have a treatment that can give people diagnosed at an early stage of type 1 diabetes precious extra time before they need to manage the full demands of the condition. The evidence shows teplizumab can delay the onset of symptomatic diabetes by an average of nearly three years.”
Helen Knight, director of medicines evaluation, NICE
For the charity that pushed for this, the significance is hard to overstate. Insulin has been the only answer since it was isolated in the early 1920s, and every advance since — better pens, pumps, continuous monitors — refined management without touching what drives the disease.
“Today’s landmark approval of teplizumab marks the start of a new age of type 1 diabetes treatment. For the first time in 100 years, we are moving beyond insulin, with a medicine that targets the root cause of the condition.”
Dr Elizabeth Robertson, director of research, Diabetes UK
The catch sits in the numbers. NICE estimates that around 1,100 people could be eligible for teplizumab in the first year, falling to roughly 820 in the years after. Against a population of 400,000, that is a sliver — and not because the drug is being rationed. It is because teplizumab only works in a narrow window, during stage 2 of the disease, when the immune attack is under way but symptoms have not yet appeared. Almost no one knows they are in that window.
- ~400,000 people in the UK live with type 1 diabetes
- ~1,100 estimated eligible in the first year, dropping to ~820 after
- Nearly 3 years — average delay in symptomatic onset, per NICE’s evidence review
- Ages 8 and over, in stage 2 (pre-symptom) disease, given as a one-off course
That is why the approval lands as much as a challenge as a victory. To find people in stage 2, you have to look before anything is wrong — by screening for the autoantibodies that signal the immune attack has already begun. The UK does not yet run that screening at scale. Two studies are trying to close the gap: the Early Surveillance for Autoimmune Diabetes (Elsa) study, funded by Diabetes UK and Breakthrough T1D, is screening children aged two to 17, while the separate T1DRA study covers adults between 18 and 70. Without a national programme behind them, most eligible patients will never be identified in time.
One family that was identified shows what is at stake. Elena Boichak, from Newbury, learned her son Dima had stage 2 type 1 diabetes after enrolling him in the Elsa study at the age of nine.
“As a mother, the most valuable thing teplizumab has given us is time. Every month and every year that Dima can continue being a child without insulin injections, carb counting and the daily burden of type 1 diabetes is incredibly precious.”
Elena Boichak, parent, Newbury
The road here was not smooth. The UK’s medicines regulator, the MHRA, licensed teplizumab in August 2025, but a NICE committee initially declined to recommend it for the NHS that same month, citing uncertainties about who would benefit and whether the price matched the gain. Tuesday’s reversal followed further evidence and what NICE described as a balance between clinical benefit and value for the taxpayer. It arrives amid a wave of research reshaping how the condition is understood, from drugs that protect blood vessels to the search for ways to slow the disease itself.
For now, teplizumab’s reach will be defined less by the drug than by how many people the system catches early — a reminder that the hardest part of prevention is often knowing where to look. Robertson put the ambition plainly: a future “where type 1 diabetes can be prevented altogether.” The medicine to start chipping at that finally exists. The screening to make it count does not — not yet.
