Teplizumab (Tzield) for the delay of type 1 diabetes

Type 1 diabetes (T1D) is a chronic autoimmune disease that disproportionately affects children and adolescents and is associated with substantial medical and psychosocial burden. Despite advances in insulin delivery systems and continuous glucose monitoring, most patients do not achieve optimal glycemic control and remain at risk for diabetic ketoacidosis, long-term microvascular and macrovascular complications, and premature mortality. Increasing evidence demonstrates that T1D is a progressive disease characterized by years of asymptomatic autoimmunity and gradual pancreatic beta-cell loss, creating an opportunity for early disease-modifying intervention. This review summarizes the genetic and immunologic foundations of T1D, the disease classification system, and emerging strategies aimed at preserving endogenous insulin production. Particular focus is given to teplizumab (Tzield), an anti-CD3 monoclonal antibody that is the first FDA-approved therapy shown to delay progression from stage 2 to stage 3 T1D in individuals ages 8 years and older. Disease-modifying immunotherapies such as teplizumab represent a paradigm shift in T1D management, with the potential to delay disease onset and reduce long-term complications.