EASD blog – Day 2 (21st February 2020)
On the second day of the ATTD conference and, indeed, scattered throughout the programme, were several sessions on the use of SGLT-2 inhibitors in type 1 diabetes. This new class of drug has and is continuing to prove very beneficial in the management of type 2 diabetes, but not as much has been published on the use of these drugs in people with type 1 diabetes. The EASD’s e-learning platform already boasts a seven-module course on SGLT-2 inhibitors, including one specifically on the use of the drug in type 1. (Please click here to test your knowledge in this area.)
However, as our course co-authors recognise, there are still issues that need to be addressed when considering this adjunct therapy. Professor Stephanie Amiel from the UK uses Sergio Leone’s epic Spaghetti Western-genre film “The Good, the Bad and the Ugly” to dissect what she considers to be the pros and cons of their use in type 1 diabetes, recognising the “good” in the urinary calorie loss and subsequent weight loss profiles, the “bad” in the increased rates of genital mycotic infection (particularly in women) and the “ugly” in the increased rates of diabetic ketoacidosis (DKA) that have been observed.
Another session that encouraged a very good attendance was the one on “Enablers and Barriers in Managing Diabetes”. Fear of hypoglycaemia was addressed by Professor Frank Snoek from the Netherlands. His take-home messages were stark.
- Fear of hypoglycaemia is prevalent and pervasive
- It has adverse effects on well-being, relationships, social functioning and glycaemic control
- Hypoglycaemia and related fears should be monitored and discussed with the patient
- Education about hypos and continuous glucose monitoring (CGM) where available can be offered as preventative strategies
- Referral for psychological treatment should be considered for those in need
However, as with many sessions at the ATTD conference, there is a rallying call for more research, this time into effective treatments for the fear of hypoglycaemia.
Unmet technological needs in paediatric diabetes were also addressed at an interesting session that covered unmet needs in minority people in Europe, across the Arabic region, Africa and Asia, and in minority peoples in North and South America.
Following the results of a simple survey across the Middle East and North Africa, certain themes coalesced about why technology uptake was not as high as it might be. Over half of the healthcare professional respondents felt that the current devices need to be simplified in order to encourage uptake and, to address this, a similar percentage indicated a need for the provision of structured training programmes. Fifty-two percent felt that there were inherent difficulties in keeping patients motivated to use technology to manage their diabetes, some of which stems from a lack of acceptance in some communities, highlighting the need for greater cultural awareness. Important issues surrounding lack of secure IT infrastructure and issues with storage and access to sensitive patient data were also flagged up.
This session was run in conjunction with the International Society for Paediatric and Adolescent Diabetes (ISPAD), an organisation which, like ATTD, supplies healthcare professionals working in the arena with expert opinion guidelines. It ended with another call for more research and ideas for where such research is required, giving everyone in the audience food for thought as Day 2 drew to a close.
The opinions expressed in this article are those of Dr Eleanor D. Kennedy.
Want to know more about these topics?
SGLT-2 inhibitors and type 1 diabetes
To promote better understanding of how to mitigate the issues of mycotic infection and DKA, our e-learning platform also offers an additional module: a four-way debate with some of the leading researchers in this field, which gives tips and tricks for using SGLT inhibitors in type 1 diabetes (click here).
In 2020, the EASD e-learning team will be producing a new course on the topic of hypoglycaemia. The course will range from the physiology and consequences of hypoglycaemia and severe hypoglycaemia to the fear this complication provokes and its prevention and treatment.
By clicking here to register on our site, when this exciting new course launches you will be able to access it and test your knowledge in this important area of diabetes management.
ISPAD and Ramadan
One recent addition to ISPAD’s offering is “Fasting During Ramadan by Young People with Diabetes”, an important issue for those working with Muslim communities. As we approach the start of Ramadan in April, the e-learning team has been busy creating two new modules to join our four existing Ramadan-focused modules. One of these will be on ISPAD’s new guidelines and is led by Professor Asma Deeb, the statement’s lead author. If you are interested in keeping abreast of this and other important areas relating to Ramadan fasting by people with diabetes, please click here to access our existing courses and to register on our site for the additional modules that will launch soon.