International Consensus Offers Guidance for
Monitoring Autoantibody Positive Individuals in Early-Stage
Type 1 Diabetes
Data Shows Continuous Glucose Monitoring Helps
Classify Patient Risk of Type 1 Diabetes
ORLANDO,
Fla., June 24, 2024 /PRNewswire/ -- New
developments for early risk monitoring of Type 1 Diabetes (T1D)
were presented as part of the American Diabetes Association's®
(ADA) 84th Scientific Sessions in Orlando, FL. An international consensus
provided insights into how health care professionals can improve
patient care for individuals with autoantibodies in early stage
type 1 diabetes and new research highlighted the benefits of
continuous glucose monitoring (CGM) metrics in predicting disease
progression and risk.
This comes at a time when more than 2 million
Americans live with type 1 diabetes, including about 304,000
children and adolescents. Type 1 diabetes can frequently present
with preventable life-threatening complications such as diabetic
ketoacidosis. Despite recommendations from the ADA for screening of
all types of diabetes every three years for adults 35 years and
older and adults with overweight under 35 years with an additional
risk factor, 22.8% US adults have undiagnosed diabetes, including
type 1 and type 2 diabetes.
"Early screening and risk monitoring has become critical in the
care and delay of type 1 diabetes, to reduce the risk of
complications with the disease such as diabetic ketoacidosis," said
Robert Gabbay, MD, PhD, ADA's chief scientific and medical
officer. "The studies and guidance statement presented at this
year's annual meeting will help pave the way for a new era of
treatment for individuals with type 1 diabetes."
Monitoring Guidance Provides Clear, Actionable Advice for
Healthcare Professionals
Presented as a symposium, researchers from Schneider Children's
Medical Center of Israel and Riley
Children's Health at Indiana University
Health presented a new consensus statement for monitoring
autoantibody positive individuals in early stage type 1 diabetes.
The guidance provides clear, actionable advice for healthcare
professionals in primary and specialty care on how to follow up
during the early, preclinical stages of type 1 diabetes.
Development of the consensus guidance was led by Breakthrough T1D
(formerly JDRF) and is endorsed by the ADA and the European
Association for the Study of Diabetes. It was simultaneously
published in Diabetes Care and Diabetologia.
The consensus provides specific advice to care for children,
adolescents, and adults, and includes educational and psychosocial
advice. The consensus emphasizes the benefits of early detection of
type 1 diabetes, including reduced risk of diabetic ketoacidosis at
diagnosis, increased planning and preparation time, and the
opportunity to consider research aimed at delaying and preventing
type 1 diabetes.
"We are experiencing a paradigm shift in type 1 diabetes care,
and we can now identify people in the earlier, presymptomatic
stages of type 1 diabetes, before insulin is required, and
intervene," said Anastasia
Albanese-O'Neill, PhD, APRN, CDCES, Breakthrough T1D,
(formerly JDRF), New York, NY, and
co-chair of the symposium. "Until now, there was no consensus on
how to care for these individuals in the clinical setting and
provide appropriate education and psychological support. This new
guidance should be used widely by healthcare providers to inform
and guide the care of individuals in early stage T1D."
The authors of this consensus cite the next critical steps as
the diffusion of knowledge and clinical implementation to ensure
the benefits are realized by individuals in early stage type 1
diabetes and their families. Intensive communication and education
on how to operationalize this paradigm shift in the treatment of
type 1 diabetes will be essential.
CGM Metrics Identify Risk of Imminent Type 1 Diabetes
Development
Results show that a CGM model developed from metrics collected
from participants with one or more of the markers used to predict
the risk and progression of type 1 diabetes (positive islet
autoantibody (IAb) typeS), demonstrated CGM metrics can help
predict type 1 diabetes progression and classify the participants'
risk of impending type 1 diabetes diagnosis.
The study combined baseline CGM data from five studies including
the Autoimmunity Screening for Kids (ASK), Belgian Diabetes
Registry (BDR), Diabetes Autoimmunity Study in the Young (DAISY),
Type 1 Diabetes Prediction and Prevention (DIPP), and TrialNet
Pathway to Prevention (TrialNet) with a median follow-up time of
2.6 years. A CGM and baseline factor model and a baseline-only
model were compared. The CGM model classified participants as low,
medium, or high risk of stage 3 type 1 diabetes based on less than
10%, 10% through less than 30%, and greater than or equal to 30%
probability by year two.
The results of the study showed the probability of developing
type 1 diabetes by two years was 4%, 17%, and 51% in the low,
medium, and high risk groups. Notably, compared to low-risk
participants, high-risk participants had higher % time >140
mg/dL (TA140) – which is associated with a high risk of progression
to clinical diabetes, higher total increase in glucose over a
period of time or area under the curve 140 mg/dL (AUC140), and
higher spread in glucose readings around the average or glucose
standard deviation.
"Over the years, our understanding of the relationship between
CGM metrics and T1D progression has improved. This data is exciting
because now we can say using CGM metrics to classify risk of
imminent stage 3 T1D diagnosis is effective," said Peter Calhoun, PhD, Jaeb Center for Health
Research, Tampa, FL, and lead
investigator. "CGM monitoring can help assist in identifying high
risk patients, who would most benefit from early intervention."
The authors hope future drug trials will use CGM metrics as an
eligibility requirement to identify those at the highest risk of
progression and patients with one or more positive islet
autoantibodies will consider utilizing CGMs temporarily to better
understand their own risk of developing stage 3 type 1
diabetes.
Research presentation details:
Dr. Calhoun will present the findings at the following oral
presentation session:
- Oral Presentations - New Technology—What's New? (Presidents'
Select Abstract)
CGM Metrics from Five Studies Identify Participants at High Risk of
Imminent Type 1 Diabetes (T1D)
DevelopmentT1D
- Presented on Friday, June 21,
2024 at 2:00 PM EDT
Dr. Albanese-O'Neill will present the findings at the following
symposium:
- Symposium - Consensus Monitoring Guidance in Early Stage Type 1
Diabetes
- Presented on Monday, June 24,
2024 at 8:00 AM EDT
About the ADA's Scientific Sessions
The ADA's 84th Scientific Sessions, the world's largest
scientific meeting focused on diabetes research, prevention, and
care, will be held in Orlando, FL
on June 21-24. More than 11,000
leading physicians, scientists, and health care professionals from
around the world are expected to convene both in person and
virtually to unveil cutting-edge research, treatment
recommendations, and advances toward a cure for diabetes. Attendees
will receive exclusive access to thousands of original research
presentations and take part in provocative and engaging exchanges
with leading diabetes experts. Join the Scientific Sessions
conversation on social media using
#ADAScientificSessions.
About the American Diabetes Association
The American Diabetes Association (ADA) is the nation's leading
voluntary health organization fighting to bend the curve on the
diabetes epidemic and help people living with diabetes thrive. For
83 years, the ADA has driven discovery and research to treat,
manage, and prevent diabetes while working relentlessly for a cure.
Through advocacy, program development, and education we aim to
improve the quality of life for the over 136 million Americans
living with diabetes or prediabetes. Diabetes has brought us
together. What we do next will make us Connected for Life®. To
learn more or to get involved, visit us
at diabetes.org or call 1-800-DIABETES (1-800-342-2383).
Join the fight with us on Facebook (American Diabetes Association),
Spanish Facebook (Asociación Americana de la Diabetes), LinkedIn
(American Diabetes Association), Twitter (@AmDiabetesAssn), and
Instagram (@AmDiabetesAssn).
Contact:
Amy Robinson
arobinson@brgcommunications.com
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SOURCE American Diabetes Association