Recently, I received an email from Diabetes Care about articles published ahead of print. My eye was drawn to read a position statement of the American Diabetes Association (ADA) on type 1 diabetes. In a 20-page publication, Chiang and colleagues provided background information and clinical guidance for the management of individuals with type 1 diabetes from infancy to an older age.
Here are some highlights from the article:
- Pancreatic autoantibodies should be used to confirm the diagnosis of type 1 diabetes. Since my practice site is located in a rural area, I have not recommended obtaining these laboratory tests, but most commercial laboratories do not have reliably sensitive or specific assays for certain autoantibodies.
- As recommended in the 2014 ADA guidelines, relatives of patients with type 1 diabetes should be referred to a clinical research study. You can refer to sites by the National Institute of Health and Juvenile Diabetes Research Foundation for research information and location of centers.
- There is a lot of great information about development issues (Table 2), clinical evaluation (Table 4), and DSME content (Table 6) for patients with type 1 diabetes from infancy to an older age. This section would be a great topic for discussion and presentation at the AADE15 meeting in New Orleans, LA.
- I was familiar with celiac disease among patients with type 1 diabetes, but did not know the statistics – 1-16% versus 0.3-1% in the general population, respectively.
- There has been change in desired A1C goals for the youth. Previous goals were: <8.5% for children younger than 6 years, <8% for children 6 to 12 years of age, and <7.5% for adolescents 13 to 19 years of age. In this position statement, the ADA recommended an A1C goal of <7.5% for all pediatric age groups.
- A growing area of research is beta-cell replacement therapy. On page 2047 of the position statement, recommendations of patient candidates for pancreas transplant and islet transplantation are provided.
- Pramlintide and some incretin agents have been studied as adjunctive therapy among patients with type 1 diabetes. While the studies have been small in sample size and short in length, the evidence is promising (i.e. reduction in A1C, reduction in total insulin dose, and promotion of weight loss). However, additional evidence is needed to have stronger conclusions and clinical application for patients with type 1 diabetes.
For more information, you can refer to the article: Chianga JL, Kirkman MS, Laffel LMB, Peters AL. Type 1 diabetes through the life span: a position statement of the American Diabetes Association, published in Diabetes Care on June 16, 2014 (DOI: 10.2337/dc14-1140).