Exploring the BANDIT trial and what it means for the future of type 1 diabetes treatment

For over a century, insulin has been the mainstay of type 1 diabetes (T1D) care. But researchers are searching for therapies that go beyond blood sugar control—treatments that actually preserve the body’s own insulin production.

One promising candidate is baricitinib (Olumiant), a drug known as a JAK inhibitor. Already used in autoimmune diseases like rheumatoid arthritis, baricitinib works by calming the overactive immune system that destroys insulin-producing cells in T1D.

The BANDIT Trial: Testing Baricitinib in T1D

The BANDIT trial, a phase II study in Australia, explored whether baricitinib could protect pancreatic beta cells in people recently diagnosed with T1D.

• Participants: 91 patients aged 10–30, all diagnosed within 100 days.

• Treatment: Daily baricitinib 4 mg vs. placebo, for 48 weeks.

• Goal: To see if baricitinib could maintain C-peptide levels (a marker of natural insulin production) and reduce the need for injected insulin.

Key Findings: Baricitinib Works—But Only While You Take It

• At 48 weeks:

  • Patients on baricitinib had higher C-peptide levels than placebo (0.65 vs. 0.43 nmol/L/min).

  • They needed less daily insulin (0.41 vs. 0.52 U/kg).

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  • Blood sugar control (time in range, glucose stability) improved significantly.

• After stopping treatment:

  • By weeks 72 and 96, benefits faded.

  • C-peptide levels dropped and no longer differed significantly from placebo.

  • Early glucose control advantages disappeared.

• Safety:

  • No new safety concerns.

  • The drug was well tolerated, even in younger patients.

Why This Matters: A Glimpse of the Future

These results highlight an important fact: baricitinib only protects beta cells while being taken. Once discontinued, the immune system resumes attacking insulin-producing cells.

Still, this is an exciting milestone. For the first time, we have an oral disease-modifying drug that can:

• Delay insulin dependence in newly diagnosed patients.

• Provide relief from the daily burden of T1D management.

• Potentially reduce long-term complications by preserving natural insulin, even temporarily.

As Dr. Michaela Waibel, lead researcher, said:

“There’s no insulin like your own. Preserving it, even for a short time, could make a big difference.”

What’s Next?

The findings raise important questions for future studies:

• Should baricitinib be taken long-term to sustain benefits?

• Could it be started earlier, in people at high risk of T1D, to prevent full disease onset?

• Will larger trials confirm that it reduces complications and improves outcomes long-term?

Phase III clinical trials are expected soon, and if successful, baricitinib could become the first approved oral therapy for type 1 diabetes within the next 5 years.

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Takeaway for Patients and Families

Right now, insulin remains the cornerstone of type 1 diabetes management. But research like the BANDIT trial shows that new therapies are on the horizon.

• Baricitinib offers a glimpse of a future where people with T1D may rely less on insulin injections.

• Early intervention may be key—treating before the disease fully develops could one day prevent or delay type 1 diabetes.

• Families can stay hopeful: the next generation of T1D treatments is closer than ever.

✅ Bottom Line: JAK inhibitors like baricitinib show real potential in type 1 diabetes. While benefits fade after stopping treatment, future research may confirm their role in long-term disease modification and prevention.

Frequently Asked Questions (FAQ) on JAK Inhibitors and Type 1 Diabetes

1. What are JAK inhibitors?

JAK inhibitors are a class of medications that block Janus kinase (JAK) enzymes, which play a role in the body’s immune response. By calming down an overactive immune system, these drugs are used to treat autoimmune conditions such as rheumatoid arthritis, alopecia areata, and certain skin disorders.

2. How does baricitinib work in type 1 diabetes?

In T1D, the immune system attacks insulin-producing beta cells in the pancreas. Baricitinib reduces this immune attack, helping to preserve the body’s natural insulin production for as long as the treatment continues.

3. Is baricitinib approved for type 1 diabetes?

Not yet. Baricitinib is currently FDA-approved for rheumatoid arthritis, alopecia areata, and atopic dermatitis. Its use in type 1 diabetes is still experimental and being studied in clinical trials.

4. Does baricitinib cure type 1 diabetes?

No. Baricitinib does not cure T1D. In clinical trials, it temporarily preserved natural insulin production, but the benefits faded after the medication was stopped. Researchers are exploring whether long-term use could delay or reduce insulin dependence.

5. What are the potential benefits of baricitinib for people with type 1 diabetes?

• Preserves some natural insulin production (while on treatment).

• Reduces daily insulin requirements.

• Improves blood sugar stability.

• May lower risk of long-term complications if started early.

6. Are there risks or side effects?

So far, baricitinib has been well tolerated in T1D trials, with no new safety concerns. Like other immune-modulating drugs, it may increase the risk of infections, so close monitoring is required.

7. When could baricitinib become available for type 1 diabetes?

If ongoing phase III clinical trials are successful, baricitinib could be approved for type 1 diabetes within the next five years.