Insulin and Abatacept in Recently-diagnosed Type 1 Diabetes

The goal of this clinical trial is to test whether the combination of two safe immune therapies called abatacept and nasal insulin can preserve pancreas function in recently-diagnosed type 1 diabetes. When type 1 diabetes is first diagnosed, the pancreas is still able to make small amounts of insulin, which helps control glucose levels. Preserving pancreas function can make glucose control easier and reduce the need to use injected insulin.Participants will be asked to inject abatacept under their skin once per week and inhale nasal insulin or nasal placebo using a spray for 10 consecutive days initially and twice per week thereafter. The treatment period is for 48 weeks, with another 48-week follow-up period.

Inclusion Criteria:Age between 6 and 21 years and weight at least 20kg at Visit 1Diabetes mellitus diagnosed according to ADA criteria (53) within 100 days of Visit 2Presence of at least one antibody against insulin (if <10 days since starting insulin therapy), GAD, IA2 or ZnT8Random C-peptide >0.3nmol/l, measured by a NATA-accredited pathology laboratory within 2 weeks of Visit 2Willing to use CGM for the duration of the studyDemonstrated ability to record home glucose measurements and insulin doses, as judged by the study doctorWilling to forego other forms of experimental treatment during the studyFully vaccinated against Covid-19, as recommended by the Australian Technical Advisory Group on ImmunisationUp to date with other vaccinations recommended by the Australian Technical Advisory Group on ImmunisationWilling to postpone any live vaccine immunisations for 3 months after treatmentExclusion Criteria:Clinical or laboratory evidence of active infection other than localised skin infection, including viral hepatitis, EBV, CMV or tuberculosisImmunodeficiency or chronic use of immunosuppressive drugs other than topical or inhaled glucocorticoidVaccination with live or dead virus within 4 weeks of Visit 2History of malignancyPregnant or lactating, or of child-bearing potential not using an effective method of contraceptionAny pathology of the nasal passages that would preclude safe application of the nasal sprayAny condition that would interfere with study conduct or participant safety