The management of T1D in adults. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)
With a combined efforts of the European Association for the Study of Diabetes (EASD) and the American Diabetes Association (ADA), guidelines on the management of type 1 diabetes in adults is being published in Diabetologia journal under title “The management of type 1 diabetes in adults. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)”. The summary of this guideline is given below:
Objective:
To elaborate on the major areas that should be considered by healthcare professionals when managing adults with type 1 diabetes.
Method:
The management guidelines has being develop with the support of new treatments and technologies. Different topic are categorized as aims of management, diagnosis, glucose monitoring, schedule of care, insulin therapy, diabetes selfmanagement education and support, hypoglycaemia, psychosocial care, behavioural considerations,pancreas and islet transplantation, diabetic ketoacidosis, special populations, adjunctive therapies,inpatient management and future perspectives
Findings:
DIAGNOSIS
Type 1 Diabetes features
Younger age at diagnosis (<35 years)
Lower BMI (<25 kg/m2 )
Unintentional weight loss
Ketoacidosis
Glucose >20 mmol/l (>360 mg/dl)
Classical features include osmotic symptoms, ketosis without acidosis, family history or
History of autoimmune diseases
2 GAD should be the primary antibody measured and, if negative, should be followed by
Islet tyrosine phosphatase 2 (IA2) and/or zinc transporter 8 (ZNT8)
Monogenic diabetes is diagnosed in presence of one or more of the following features:
HbA1c <58 mmol/mol (7.5%)
One parent with diabetes
Features of specific monogenic cause (e.g. renal cysts, partial lipodystrophy, maternally inherited deafness, severe insulin resistance in the absence of obesity)
A C-peptide test is only indicated in people receiving insulin treatment
Features of type 2 diabetes
Increased BMI (≥25 kg/m2 )
Absence of weight loss
Absence of ketoacidosis and less marked hyperglycaemia
Less discriminatory features include non-White ethnicity, family history, longer duration
and milder severity of symptoms prior to presentation
AIMS AND GOALS FOR T1DM MANAGEMENT
Effectively glycemic control with exogenous insulin to maintain individual’s target range in order to prevent diabetes complication and progression while:
Minimising episodes of hypoglycaemia and preventing
Episodes of DKA
Effectively managing cardiovascular risk factors.
Providing solutions, treatments and devices that minimise diabetes-related distress, while promoting psychological wellbeing.
SCHEDULE OF CARE
Diabetes history
Date of diagnosis
Presentation at onset
Islet autoantibodies (date)
C-peptide (date)
Episodes of DKA or Level 3 hypoglycaemia
Hypoglycaemia awareness
Family history
Personal history of chronic complications
Personal history of common comorbidities
Other
Pregnancy and contraception history:
Immunisation history
Additional behavioural factors
Diet and nutrition: use of carbohydrate counting, weight history
Physical examination
Laboratory setting
Goals setting
Treatment plan
Referral
STANDARDIZED CGM METRICS FOR CLINICAL CARE
Number of days CGM device is worn: 14 days
Percentage of time CGM device is active: 70% of data from 14 days
Mean glucose
Glucose management indicator (GMI)
Glycaemic variability (%CV)
Time above range
Per cent of readings and time >13.9 mmol/l (>250 mg/dl); Level 2 hyperglycaemia
Per cent of readings and time >10.0 mmol/l (>180 mg/dl); Level 1 and Level 2 hyperglycaemia
Time in range (TIR)
Per cent of readings and TIR 3.9–10.0 mmol/l (70–180 mg/dl)
Time below range (TBR)
Per cent of readings and time <3.9 mmol/l (<70 mg/dl); Level 1 and Level 2 hypoglycaemia
Per cent of readings and time <3.0 mmol/l (<54 mg/dl); Level 2 hypoglycaemia
GOAL OF NUTRITION THERAPY FOR TYPE 1 DIABETES
Promote healthy eating patterns, emphasising a variety of nutrient-dense foods in appropriate sizes to improve overall health and to: Improve HbA1c, blood pressure and cholesterol and aid in maintaining weight
Individualise nutrition needs based on personal and cultural preferences, health literacy and access to healthy food choices
Provide practical tools for day-to-day meal planning
Focus on matching insulin doses with meal composition through advanced carbohydrate counting.
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