medwireNews: The newly published ADA/EASD consensus report on the management of type 1 diabetes provides a comprehensive overview of the care required to help people with the condition live a full and healthy life.

The report is published in Diabetes Care and Diabetologia, and is being simultaneously presented at the virtual 57th EASD Annual Meeting. The authors presented their draft version at the ADA Scientific Sessions in June, and called for feedback, which was incorporated into the final version.

“What we’re hoping to do is to make everybody aware of what is necessary for people with type 1 diabetes – what not only saves their life, but allows them to live a long and healthy life,” joint lead author Anne Peters (Keck School of Medicine of USC, Los Angeles, California, USA) told medwireNews.

“I want to change the way the world thinks about people with type 1 diabetes.”

The writing team accounted for observational study findings as well as randomized trials, “given that the available evidence is incomplete,” and divided the report into 15 distinct areas of type 1 diabetes care.

These include core disease care areas such as diagnosis, overall aims of care, self-management education, glucose monitoring, insulin therapy, hypoglycemia, and diabetic ketoacidosis. The section on diagnosis includes an algorithm – based on age, autoantibodies, and C-peptide levels – to help distinguish between type 1, type 2, and monogenic diabetes.

The authors stress that care may differ at different times of a person’s life, and offer advice for specific populations such as pregnant women, and older people.

Other sections of the report focus on requirements for whole-person care, such as psychosocial support, other behavioral considerations such as nutrition, physical activity, driving, and religious fasting.

“Given the high prevalence and impact of psychosocial problems and psychological disorders in diabetes, screening and monitoring should be integral parts of diabetes care, not least because these psychological comorbidities tend to negatively affect diabetes outcomes and vice versa,” writes the team.

The report also covers adjunctive treatments, such as metformin and sodium-glucose cotransporter 2 inhibitors, and emergent treatments, such as stem-cell transplantation and immunotherapies.

Notably, diabetes technology does not have a dedicated section, with the individual technologies instead appearing within the relevant sections such as glucose monitoring and insulin therapy.

The authors observe that while most people with type 1 diabetes can benefit from technologies such as continuous glucose monitoring, “[t]he choice of the device should be based on individual preferences and circumstances.”

They also note that some people may choose to use DIY solutions to closed-loop delivery, and that these people should be supported in their choice.

The writing committee stresses that the majority of data on which they relied came from White European populations, “and may not be representative of other ethnic groups.”

This is one of several “huge” knowledge gaps, they say, emphasizing: “People with type 1 diabetes deserve better, higher quality research evidence on which to determine their optimal care.”

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Diabetes Care 2021; doi:10.2337/dci21-0043
Diabetologia 2021; doi:10.1007/s00125-021-05568-3