Glycaemic management in diabetes: old and new approaches

Ceriello, A. et al | 2021 | Glycaemic management in diabetes: old and new approaches | The Lancet Diabetes & Endocrinology | DOI:https://doi.org/10.1016/S2213-8587(21)00245-X

Summary

HbA1c is the most used parameter to assess glycaemic control. However, evidence suggests that the concept of hyperglycaemia has profoundly changed and that different facets of hyperglycaemia must be considered. A modern approach to glycaemic control should focus not only on reaching and maintaining optimal HbA1c concentrations as early as possible, but to also do so by reducing postprandial hyperglycaemia, glycaemic variability, and to extend as much as possible the time in range in near-normoglycaemia. These goals should be achieved while avoiding hypoglycaemia, which, should it occur, should be reverted to normoglycaemia. Modern technology, such as intermittently scanned glucose monitoring and continuous glucose monitoring, together with new drug therapies (eg, ultra-fast insulins, SGLT2 inhibitors, and GLP-1 receptor agonists), could help to change the landscape of glycaemia management based on HbA1c in favour of a more holistic approach that considers all the different aspects of this commonly oversimplified pathophysiological feature of diabetes.

Glycaemic management in diabetes: old and new approaches [abstract only]

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Adult-Onset Type 1 Diabetes: Current Understanding and Challenges

Adult-Onset Type 1 Diabetes: Current Understanding and Challenges David Leslie, R. et al | 2021 | Diabetes Care | 44| 11| P. 2449-2456 |  DOI: 10.2337/dc21-0770

Abstract

Recent epidemiological data have shown that more than half of all new cases of type 1 diabetes occur in adults. Key genetic, immune, and metabolic differences exist between adult- and childhood-onset type 1 diabetes, many of which are not well understood. A substantial risk of misclassification of diabetes type can result. Notably, some adults with type 1 diabetes may not require insulin at diagnosis, their clinical disease can masquerade as type 2 diabetes, and the consequent misclassification may result in inappropriate treatment. In response to this important issue, JDRF convened a workshop of international experts in November 2019. Here, we summarize the current understanding and unanswered questions in the field based on those discussions, highlighting epidemiology and immunogenetic and metabolic characteristics of adult-onset type 1 diabetes as well as disease-associated comorbidities and psychosocial challenges. In adult-onset, as compared with childhood-onset, type 1 diabetes, HLA-associated risk is lower, with more protective genotypes and lower genetic risk scores; multiple diabetes-associated autoantibodies are decreased, though GADA remains dominant. Before diagnosis, those with autoantibodies progress more slowly, and at diagnosis, serum C-peptide is higher in adults than children, with ketoacidosis being less frequent. Tools to distinguish types of diabetes are discussed, including body phenotype, clinical course, family history, autoantibodies, comorbidities, and C-peptide. By providing this perspective, we aim to improve the management of adults presenting with type 1 diabetes.

This Perspective piece published in the journal Diabetes Care , based on that workshop, the participants outline the evidence for a new viewpoint, suggesting future directions of research and ways to alter disease management to help adults living with type 1 diabetes. They also outline a roadmap for addressing these deficiencies (Fig. 1). A cornerstone of this roadmap is a renewed emphasis on the careful consideration of the underlying etiology of diabetes in every adult presenting with diabetes.

Image source: David Leslie et al, 2021. Image shows the roadmap to better understand, diagnose and care for adults with T1D.


The full article is available from Diabetes Care [paper]

Habit and diabetes self-management in adolescents with type 1 diabetes

Cummings, C. et al | 2021| Habit and diabetes self-management in adolescents with type 1 diabetes| Health Psychology | .https://doi.org/10.1037/hea0001097

Objective The development of habit (i.e., behavioral automaticity, the extent to which a behavior is performed with decreased thresholds for time, attention [effort], conscious awareness, and goal dependence), for goal-directed health behaviors facilitates health behavior engagement in daily life. However, there is a paucity of research examining automaticity for Type 1 diabetes self-management in adolescence. This study examined if greater perceived automaticity for diabetes self-management was associated with increased daily self-management, decreased daily self-regulation failures in glucose checking, and more optimal daily glycemic levels in adolescents with Type 1 diabetes.

Method: Adolescents aged 13–17 and diagnosed with Type 1 diabetes (n equal to 79) completed the Self-Report Behavioral Automaticity Index, a measure of automaticity of diabetes self-management (i.e., automaticity of glucose checking, carbohydrate counting, and insulin dosing), and a measure of perceived self-management at baseline. One to 3 months later, a subsample of teens (n equal to 42) also completed a daily diary for a 7-day period including perceptions of daily self-management, daily self-regulation failures in glucose checking, and daily glucose levels.

Results: Greater overall automaticity of diabetes self-management was associated with greater baseline and daily self-management, fewer daily self-regulation failures in glucose checking, and lower average daily mean blood glucose levels but not more optimal daily variations in blood glucose levels.

Conclusions: Greater automaticity for diabetes self-management may support more optimal daily diabetes self-management in adolescence. Further research is needed to clarify the benefits and mechanisms of automaticity and explore possible interventions. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

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NHS England: More people with diabetes set to benefit from blood sugar monitors as NHS roll-out succeeds

NHS England | November 2021 | More people with diabetes set to benefit from blood sugar monitors as NHS roll-out succeeds

Half of NHS Type 1 diabetes patients in England are now benefiting from the use of “life-changing” flash monitors that allow them to check their glucose levels more easily and regularly, paving the way for more people to benefit.

Health service chief executive Amanda Pritchard, patient groups and senior clinicians have welcomed the milestone, showing that the NHS is ahead of target to roll-out the monitors, as the independent health advisory NICE, confirmed it was beginning to consult on expanding access to the convenient and effective kit.

The most recent figures show that around 125,000, or half, of patients living with Type 1 diabetes are now using these monitors to help control their condition.

The insight from the successful roll-out by NHS England has helped to inform the case for potential wider use of these technologies to benefit patients living with Type 1 diabetes, and potentially those living with Type 2 diabetes, as the health service continues to improve care for people with both forms of the condition.

The NHS Long Term Plan included a target to ensure 20 per cent of people with Type 1 diabetes were benefiting from flash monitors by March 2021.

Data for March shows the NHS significantly exceeded that goal, with the actual percentage of those benefiting hitting more than 45 per cent – double the target, with uptake by July hitting half of eligible people.

Eligible patients are currently able to access the monitors on prescription from their local GP or diabetes team, helping them to better manage their blood sugar levels.

The wearable gadgets have a sensor that easily attaches to the back of the arm, allowing patients to check their glucose quickly and easily with a simple one-second scan.

The monitors link to an easy-to-use app on your phone, where patients can access the data gathered by the device.

Unlike conventional blood glucose monitors they allow you to view patterns over time, not only showing current and previous levels but also where they’re headed (Source: NHS England).

More people with diabetes set to benefit from blood sugar monitors as NHS roll-out succeeds