Dr Kevan Herold Talks Barriers, Solutions in T1D Treatment


Differentiating type 1 and type 2 diabetes care is a major issue that needs better understanding, said Kevan Herold, MD, professor of immunobiology and medicine at Yale School of Medicine

Despite being one of the most common chronic diseases in children, type 1 diabetes (T1D) is often overlooked, said Kevan Herold, MD, professor of immunobiology and medicine at Yale School of Medicine.


What are some existing barriers in T1D treatment?

The drug [teplizumab] is currently approved with this 14-day infusion thing. It's awkward; I would agree about that. Obviously, in the future, it'd be better to have easier ways to deliver preventive therapies. That's a barrier, just the way you have to give the drug.

I think many people don't even think about diabetes. It happens to be one of the most common chronic diseases of childhood; in every school in the country, there is someone with diabetes, and there's probably more than one in most schools. But people don't think about it. They think, "Oh, it's not going to affect me," or something. But I think awareness of this is an issue, and I think the idea that we can do something about this is an issue.

Lastly, I think there needs to be—getting back to your last question—some appreciation of what time without the disease means. I think if you were to ask someone who has the disease, "What would you give for 3 months without diabetes?" They'll tell you, "I'll give anything." And I think people don't quite get that yet.

How can these barriers be reduced or overcome?

The pediatric endocrinologists need to understand this. General practice physicians need to understand this. That there's something to do about this—this is not just a doomsday issue now. So that's number one, and understanding what diabetes is and who gets it and what it's about. Frankly, I'm surprised that we actually have to talk about this in 2023, but differentiating it from what older individuals are getting, type 2 diabetes, that's important, too. I don't think there's broad public awareness of that. So that's a barrier. I think companies need to understand why this is so important to families and people and what the benefits are of not having the disease.

The question also that invariably comes up is, if we delay the diagnosis for 2 years—I mean we talked about what the immediate sort of benefits in terms of lifestyle are—does it mean you're gonna get less heart disease or kidney disease or eye disease? And we don't know. We don't know what the long-term benefits are about immune therapy before the diagnosis; that's still something that has to be addressed. So that sort of data would be helpful going forward.

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