ADA Guidelines for Managing T1D

Robert Busch, MD: Let’s switch gears and talk about the treatment options we have for type 1 diabetes. Dr Simmons, what are the ADA [American Diabetes Association] guidelines for managing type 1 diabetes?

Kimberly Simmons, MD, MPH/MSPH: The guidelines for managing type 1 diabetes are focused on stage III, clinical type 1 diabetes. They recommend routine blood glucose monitoring, dietary advice, and standard physical activity—like for any other patient, who should be physically active. It also recommends insulin administration via multiple daily injections or an insulin pump. There’s a host of recommendations for people who have clinical type 1 diabetes.

For the group in early stages of type 1 diabetes, the recommendations are less clear in part because the data to guide us are very sparse. What we recommend to patients who are identified in early stages of type 1 diabetes is that they’re aware of the symptoms and do intermittent blood glucose monitoring, but those are not standard-of-care recommendations. Hopefully, we’ll have more of those in the following years, but the goal for people in early stages is to keep them safe.

We don’t want any of our patients going into diabetic ketoacidosis [DKA]. In Colorado, almost 60% of our children and our youth are in diabetic ketoacidosis when they’re diagnosed. There are more data emerging on the long-term consequences of that, including potentially worse glycemic control, leading to more complications. Some work shows there might be neurocognitive changes. Anything we can do to try to decrease their risk of DKA is great; it requires regular monitoring. Symptom education at regular intervals is important, and so is intermittent blood glucose monitoring. All the tools that we’ve talked about that can be used to diagnose type 1 diabetes can also be used to identify progression of type 1 diabetes. Although the frequency of those has to be worked out, in younger individuals, it’s probably important to do it more frequently than in an older individual, especially an adult.

Transcript Edited for Clarity