Consensus report issued on management of type 1 diabetes in adults

The report from the American Diabetes Association and European Association for the Study of Diabetes offers guidance on diagnosis, management, and treatment, among other topics. Their recommendations are evidence-based where possible but represent the consensus opinion of the authors.

Clinicians caring for patients with type 1 diabetes should aim for effective delivery of exogenous insulin that maintains glucose levels as close as safely possible to the target range while preventing diabetes complications, according to the American Diabetes Association and the European Association for the Study of Diabetes.

The groups also recommend checking islet cell antibodies in all adult patients with suspected type 1 diabetes by direct measurement of individual antibodies, starting with glutamic acid decarboxylase (GAD).

These recommendation are part of a consensus report by the two organizations that highlights major areas of care for clinicians managing adults with type 1 diabetes, focusing primarily on current and future glycemic management strategies and metabolic emergencies. The report states that continuous glucose monitoring is the standard for most adults with type 1 diabetes. Other considerations for insulin therapy include minimizing all episodes of hypoglycemia (particularly severe ones, defined as blood glucose below 54 mg/dl [3 mmol/L] requiring outside assistance), preventing (and appropriately treating) episodes of diabetic ketoacidosis, effectively managing cardiovascular risk factors, helping to minimize diabetes-related distress, and promoting psychological well-being, the report said.

Optimal management of blood pressure (<140/90 mmHg in lower-risk patients, <130/80 mmHg in higher-risk) and use of lipid-lowering agents are vital, according to the report. The authors noted that routine screening for coronary artery disease is not recommended in asymptomatic patients with type 1 diabetes if risk factors for atherosclerotic cardiovascular disease are treated but said that patients should be investigated for coronary artery disease if they have atypical cardiac symptoms, signs or symptoms of associated vascular disease, or abnormalities on electrocardiogram. Antiplatelet agents, such as aspirin, should be considered in patients with proven cardiovascular disease.

Regarding the optimal schedule of care, the report called for a detailed evaluation at the initial visit and more targeted patient-centered care at follow-up visits. Visits should be scheduled at least annually, but more frequent visits are better for most patients, including those with recent diagnoses, those whose diabetes goals are not being met, those who need cardiovascular risk management, and those who need more education and support, the report said. “Additional visits can also be useful when the therapeutic regimen changes, for example, when the insulin regimen is modified or when a new device is started,” the authors noted.

Other topics covered in the report include diagnosis, aims of management, diabetes self-management education and support, insulin therapy, hypoglycemia, behavioral considerations, psychosocial care, diabetic ketoacidosis, pancreas and islet transplantation, adjunctive therapies, special populations, inpatient management, and future perspectives. The report was published Sept. 30 by Diabetes Care and Diabetologia.