The National Institute for Health and Care Excellence has approved teplizumab for use on the NHS in England and Wales, making it the first drug in history capable of delaying the onset of type 1 diabetes. NICE granted the approval on Tuesday, and clinicians and patient groups have described it as the most significant development in treating the condition since insulin was first identified in 1921.

Teplizumab does not cure type 1 diabetes. What it does is buy time. Immunotherapy slows the disease's development before symptoms appear by preventing the immune system from attacking the pancreatic cells that produce insulin. In clinical evidence reviewed by NICE, the drug postponed onset by up to three years. It is approved for adults and children aged eight and above who have been identified as having early, pre-symptomatic type 1 diabetes, known clinically as stage 2.

The treatment is administered intravenously once a day over 14 consecutive days. The dose increases gradually across the course, and once completed, no further treatment is required. The infusion itself takes approximately 30 minutes per session.

The practical implications for patients are considerable. Type 1 diabetes requires lifelong insulin management, with continuous monitoring of blood glucose levels and careful adjustment of doses. Delaying that burden by several years is clinically meaningful in itself, but for children and teenagers it carries additional weight. Those diagnosed at an early stage will have more time to reach developmental milestones before taking on that responsibility. Parents of children identified at high risk will gain time they did not previously have.

Diabetes UK welcomed the decision as a turning point. Dr Elizabeth Robertson, the charity's director of research, said the approval marked the beginning of a new era in treatment, describing it as the first medicine in a century to address the root cause of the condition rather than simply compensating for what the body can no longer produce. She said the focus must now shift to ensuring fair and equitable access for all eligible patients. Karen Addington, chief executive of Breakthrough T1D, said the approval was an "incredible moment" for the type 1 community, and that families would now have a treatment capable of giving their children more years free from the daily demands of managing the disease.

Teplizumab is manufactured by the pharmaceutical company Sanofi and marketed under the name Tzield. Sanofi has agreed a commercial arrangement with NHS England under which the drug will be supplied at a confidential discounted price. Helen Knight, director of medicines evaluation at NICE, said the recommendation followed a rigorous and transparent assessment process, and that the decision reflected both the clinical evidence and the need to deliver value for NHS resources.

The approval, however, depends on something that remains underdeveloped in the UK: systematic early screening. Teplizumab only works before symptoms emerge, which means identifying those at stage 2 requires proactive testing, typically in relatives of people already living with type 1 diabetes. Diabetes UK has acknowledged that detection at this pre-symptomatic stage is the essential precondition for the drug to deliver its benefits at scale. Without broader screening infrastructure, access to teplizumab may in practice remain limited to those whose family history prompts earlier investigation. How the NHS moves to address that constraint will determine how far this approval translates into outcomes across the eligible population.