Type 1 diabetes management: Room for improvement

Abstract

Aims/Hypothesis Optimal diabetes care and risk factor management are important to delay micro‐ and macrovascular complications in individuals with type 1 diabetes (T1D). Ongoing improvement of management strategies requires the evaluation of target achievement and identification of risk factors in individuals who do (or do not) achieve these targets. Methods Cross‐sectional data were collected from adults with T1D visiting six diabetes centers in the Netherlands in 2018. Targets were defined as glycated hemoglobin (HbA1c) <53 mmol/mol, low‐density lipoprotein‐cholesterol (LDL‐c) <2.6 mmoL/L (no cardiovascular disease [CVD] present) or <1.8 mmoL/L (CVD present), or blood pressure (BP) <140/90 mm Hg. Target achievement was compared for individuals with and without CVD. Results Data from 1737 individuals were included. Mean HbA1c was 63 mmol/mol (7.9%), LDL‐c was 2.67 mmoL/L, and BP 131/76 mm Hg. In individuals with CVD, 24%, 33%, and 46% achieved HbA1c, LDL‐c, and BP targets respectively. In individuals without CVD these percentages were 29%, 54%, and 77%, respectively. Individuals with CVD did not have any significant risk factors for HbA1c, LDL‐c, and BP target achievement. In comparison, individuals without CVD were more likely to achieve glycemic targets if they were men and insulin pump users. Smoking, microvascular complications, and the prescription of lipid‐lowering and antihypertensive medication were negatively associated with glycemic target achievement. No characteristics were associated with LDL‐c target achievement. Microvascular complications and antihypertensive medication prescription were negatively associated with BP target attainment. Conclusion Opportunities for improvement of diabetes management exist for the achievement of glycemic, lipid, and BP targets but may differ between individuals with and without CVD.

Plasma protein biomarkers trailblaze as early predictors of type 1 diabetes

“… 3 Moreover, children with T1D are prone to suffering from life-threatening complications due to poor metabolic control. 4 Therefore, it is imperative to discover biomarkers that can identify early-stage disease in most, if not all, individuals, in order to delay β-cell loss and improve prognostic outcomes. Although islet-specific autoantibodies have proven valuable in predicting future T1D onset, it should be noted that not all autoantibody-positive individuals progress to clinical T1D.…”

Beneficial effects of automated insulin delivery over one‐year follow‐up in real life for youths and adults with type 1 diabetes irrespective of patient characteristics

“…Several reports have clearly showed that commercially available AID systems facilitate PwT1D to reach these glycaemic goals by adjusting in real‐time basal insulin and delivering autocorrection boluses, as reviewed recently 6,7 . Altogether, these improvements in glucose control provide important conditions to minimize the daily burden of this chronic disease and to prevent diabetic complications 8 . However, it has been underlined that some participants were still unable to reach these glucose targets, largely because by the necessity to inform the system on levels of carbohydrate (CHO) consumption before meals and on expected changes in physical activity.…”

“…6,7 Altogether, these improvements in glucose control provide important conditions to minimize the daily burden of this chronic disease and to prevent diabetic complications. 8 However, it has been underlined that some participants were still unable to reach these glucose targets, largely because by the necessity to inform the system on levels of carbohydrate (CHO) consumption before meals and on expected changes in physical activity. This confirms that individual and psychosocial factors are important parameters for optimal diabetes management and sustained use of AID systems.…”