Towards New Standards In Type 1 Diabetes Management (S1/#1)

Insulin remains a cornerstone for diabetes management around the world. A century of years ago, diagnosis with type 1 diabetes would mean a death sentence to the one afflicted & woeful to the family at large.

The unique challenges of T1D in children & Adolescents, for both individuals & their caregivers, and clinicians:

HbA1c (a haemoglobin to which glucose is bound) and rate of hypoglycemia is declining with modern therapy but remains above the target in all age, despite the increased use of insulin pumps and CGMs (Continuous Glucose Monitoring).
Moreover, on the subject of (DKA) Diabetic Ketoacidosis – (a complex metabolic disorder that occurs when the liver starts breaking down fat at an excessive rate producing ketones, which can cause the blood to become dangerously acidic), a therapy to suppress the condition was introduced such as: Blood ketone monitoring & education programs but still DKA remains a challenge on a worldwide scale. The issues leading to DKA are actually associated with: Eating disorders, ethnic minorities & HbA1c above target.

Above all, the big issue is that some patients get used to a certain HbA1c and then becomes very difficult to increase and intensify their therapy to get them back on track to have a more aggressive approach to a glycaemic control. Additionally, fear of hypoglycemia remains one of the biggest obstacles in terms of reaching glycaemic goals. Thus, this may lead to under-insulinization and again increasing the risk of DKA, thus the challenge on glycaemic control in pediatric populations.

Recommendations are:

Intensive insulin therapy that allows more flexibility in dosing time could help reduce long-term complications in children and adolescents with Type 1 Diabetes (T1D) would be able to improve their controls.
NB. There are a range of glycaemic targets for children with diabetes depending on their risk of awareness of hypoglycemia.
Targeted DKA prevention programs could result in substantial healthcare cost reduction and reduced patient morbidity & mortality.
To counteract against such delicate behaviors and process, governments and medicine manufacturers have to ensure constant insulin deliveries.

Second-generation basal insulin analogs: in Children & Adolescents?

1. Gla-300 (glargine-300) has demonstrated similar glycaemic efficacy compared with Gla-100 in children & adolescents aged 6-17 years with Type 1 Diabetes (T1D);
2. Comparable overall hypoglycemic incidence and rates were also demonstrated with Gla-300 compared with Gla-100;
3. In the study in adolescents & children, the percentage (%) of the individuals reporting severe hypoglycaemia was lower in patients using Gla-300 compared with patients using Gla-100. The percentage of patients with hypoglycaemic episodes with ketosis was lower with Gla-300 compared with Gla-100.
4. Tresiba (INN-insulin degludec) is indicated for treatment of diabetes mellitus in adults, adolescents and children from the age of 1 year.

Towards Modernizing Diabetes Care Using New Metrics
Towards Improving Diabetes Care 

Curtsy of Professor Thomas Danne 

#dedoc Voice


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