Post-Treatment Monitoring

Currently, the treatment with teplizumab to prevent/slow progression from Stage 2 type 1 diabetes to Stage 3 type 1 diabetes is a one-time therapy. Once the 14-days of treatment have been completed, surveillance and monitoring the patient’s metabolic stability is now required. The median delay from Stage 2 to Stage 3 type 1 diabetes is 32 months and following these patients over time is imperative.

Surveillance will involve periodic evaluation of insulin secretion and glucose stability. This can be performed by OGTT every 6 months, A1C every 3 to 6 months, or using CGM as frequently as the patient desires. The concern with CGM surveillance is the consideration that patients may implement a low CHO diet to reduce glucose spikes and therefore rendering the CGM and A1C less relevant to evaluating progression to Stage 3 as compared to the OGTT. However, the OGTT is a cumbersome test and adherence with having it done at a frequency of every 6 months needs to also be considered.

Patient and caregiver education regarding the signs and symptoms of hyperglycemia and when to seek emergent care is critical to prevent severe and life-threatening hyperglycemia crisis (DKA).