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Low-Dose Antithymocyte Globulin: A Pragmatic Approach to Treating Stage 2 Type 1 Diabetes

Timothy P Foster1, Laura M Jacobsen1,2, Brittany Bruggeman1

  • 1Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL.

Diabetes Care
|December 20, 2023
PubMed

Insights

Low-dose antithymocyte globulin (ATG) may delay progression in stage 2 type 1 diabetes. Some children remained diabetes-free for years, showing improved glycemic control and reduced insulin needs post-treatment.

Area of Science:

  • Immunology
  • Endocrinology
  • Pediatrics

Background:

  • Type 1 diabetes (T1D) is an autoimmune disease characterized by pancreatic beta-cell destruction.
  • Antithymocyte globulin (ATG) has shown potential in preserving beta-cell function in new-onset stage 3 T1D.
  • The efficacy of low-dose ATG in preventing progression from stage 2 to stage 3 T1D remains unevaluated.

Purpose of the Study:

  • To evaluate the efficacy of low-dose antithymocyte globulin (ATG) in delaying the progression of type 1 diabetes from stage 2 to stage 3.
  • To assess the impact of ATG on glycemic control, beta-cell function, and insulin requirements in children with stage 2 T1D.

Main Methods:

  • A small cohort of 6 children (aged 5-14 years) with stage 2 T1D received off-label, low-dose ATG.
  • Key parameters monitored included HbA1c, C-peptide levels, continuous glucose monitoring data, and insulin dosage.
  • Follow-up duration ranged from 18 to 48 months.

Main Results:

  • 50% of subjects (3 out of 6) remained diabetes-free for 1.5, 3, and 4 years post-treatment.
  • The remaining 3 subjects progressed to stage 3 T1D within 1-2 months but demonstrated significantly improved metabolic control at 18 months.
  • Progressors showed near-normal HbA1c, high time-in-range, low insulin needs, and robust C-peptide response to a mixed meal.

Conclusions:

  • Low-dose ATG shows promise in preserving beta-cell function and delaying T1D progression in stage 2.
  • These preliminary findings warrant larger, prospective studies to confirm ATG's role in early-stage T1D management.
  • Further research is needed to optimize ATG dosing and treatment protocols for stage 2 T1D.
Abstract

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