s a diabetes educator, it is extremely important to remain up-to-date on the management of diabetes mellitus. I have been familiar with recent articles on the management of type 1 diabetes published in the last two years. These publications have provided more guidance and information on this particular classification. Within my practice, a majority of the patients, if not all have been diagnosed with type 2 diabetes. It is rare for our providers and myself to manage an individual with type 1 diabetes, as most the time s/he are referred to an endocrinologist.
After discussing type 1 diabetes with the pharmacy students last month, I wanted to review recent continuing education programs on the topic. I came across a presentation in the AADE15 Sessions On-demand by Lori Laffel M.D., MPH that provided an update and review on type 1 diabetes at the AADE 15 meeting in New Orleans, LA. She is Chief of the Pediatric, Adolescent, and Young Adult Section and Senior Investigator of the Genetics and Epidemiology Section at the Joslin Diabetes Center and Harvard Medical School, respectively, in Boston.
It is no surprise that there have been many advancements with medications and evidence among individuals with type 2 diabetes; the prevalence has increased by 30.5% over eight years.
The presentation was a good reminder of those articles that were published on the lifespan of individuals with type 1 diabetes. I was quite taken aback with the epidemiology of those who have type 1 diabetes, such as the unknown numbers and estimations of this classification among adults over the age of 20 years. While we have increasing numbers of patients diagnosed with type 1 diabetes who survive to adulthood, approximately 25 to 50% of individuals are diagnosed with this classification in their adulthood. It is no surprise that there have been many advancements with medications and evidence among individuals with type 2 diabetes; the prevalence has increased by 30.5% over eight years. The prevalence of type 1 diabetes has increased by 21.1%, which is significant when you consider the number of individuals with this classification. Therefore, more research is needed to better understand type 1 diabetes and the possibility of residual C-peptide production from the pancreatic beta-cells.
The Diabetes Control and Complications Trial provided us with information about glycemic control among those with type 1 diabetes. From the study, we learned that intensive control reduces the risk of microvascular complications through lowering A1c. However, there is the risk of hypoglycemia with intensive therapy.
It is a great review to remind us how A1c goals have evolved over the past ten years and should change as a person gets older. Mainly, this presentation emphasizes the importance of individualizing A1c goals for those who are very young or older, as well as healthy versus unhealthy. While these are not the only factors, there are many factors to consider when individualizing a targeted A1c level. As a comparator, we individualize blood pressure goals. For example, an individual who is over the age of 60 years could have a blood pressure go plus the 150/90 mm Hg per JNC-VIII guidelines. Another reasonable option is to target this particular blood pressure goal first, prior to striving for blood pressure less than 140/90 mm Hg (desired for those with diabetes).
Overall, it is extremely important that we remain up-to-date and knowledgeable about management for individuals with type 1 diabetes. We should also encourage any patient who has type 1 diabetes to recruit their first-degree relatives to a research within the United States, so that we can continue the research about this particular classification. It is expected that there may be more evidence in the upcoming years about diabetes, particularly about any residual beta-cell function on the pancreas for endogenous insulin production.
About the Author
Jennifer Clements received her Doctorate of Pharmacy from Campbell University in 2006 and completed a primary care residency at a Veterans Affairs Medical Center in 2007. She is also a certified diabetes educator and board certified in pharmacotherapy. Currently, she is the Interim Chair and Associate Professor in the Department of Pharmacy Practice at Presbyterian College School of Pharmacy.