What’s the new consensus for type 1 diabetes?
A draft consensus report on the management of type 1 diabetes in adults from the American Diabetes Association (ADA) and European Association for the Study of Diabetes is now available. In our latest ‘The long and the short of it’, Professors Pratik Choudhary and Emma Wilmot take a closer look.
“This is a meaty document,” says Pratik Choudhary. And with good reason. Drawn up by an international, 14-person writing group convened by the ADA and EASD, the draft consensus report has had to gets to grips with rapidly changing treatments and technologies, covering the gamut of topics necessitated by this complex condition: self-management education and training, insulin therapies, hypoglycaemia, psychosocial care, islet transplantation, and much, much more.
So how did they do?
“This really screams psychosocial aspects, personalised care, individualised targets,” says Emma Wilmot approvingly. “I love the fact that they have ‘time in range’ in there, which we know is very much the new language of the diabetes clinic, alongside glycaemic variability. One of the other things, I think, in terms of psychosocial aspects, is really looking into diabetes-related distress, depression, etc. And the recognition that all parts of the diabetes team have a role to play in recognising and supporting that.”
No document of this kind could emerge without controversy. And a number of big bear traps lie in wait for any report in this field. For instance, the report left Pratik asking whether HbA1c is now a thing of the past, superseded by glucose management indicator (GMI). Education is another tricky area, with Pratik asking whether today’s educational approaches are always fit for purpose in a digital age. And both Pratik and Emma would both like to have seen stronger, more in-depth recommendations around monitoring and insulin delivery technologies – particularly on closed loop - and question the relatively greater emphasis given to adjunct therapies, at least in relation to their role to glycaemic control.
“Of course, if we’d written the document it would have been different. But really, it’s a great document – it has all the real bits in it. There are some bits we’d have liked to see more of but we understand that some of the evidence for some of those things isn’t quite there yet. We just hope people will go out and read this and form their own opinions on what it shows.”
For more on the topics raised in this presentation, why not enroll on the following EASD e-Learning courses: