Real-time continuous glucose monitoring, sensor-augmented pump therapy, and new guidelines for cardiovascular risk are three of the newest important components of care that are recommended in, “Type 1 Diabetes Through the Life Span: A Position Statement of the American Diabetes Association,” released today at the ADA’s 74th Scientific Sessions in San Francisco. All three components, as well as the many other detailed ADA recommendations published in the July issue of Diabetes Cares, are embedded throughout the UNC Health Care system.
Type 1 diabetes, once called juvenile-onset diabetes, is now more prevalent in adults than it is in children. “In fact, about one-third of type 1 cases—perhaps more—initially appear during adulthood,” said Sue Kirkman, MD, professor of medicine at UNC and one of four authors of the ADA position statement. “People can get type 1 diabetes at any age.”
Kirkman began work on the ADA guidelines when she was the Senior Vice-President for Medical Affairs and Community Information for the ADA, a position she held for more than five years before joining UNC in 2013.
In previous years, the ADA had issued reports including general guidelines for diabetes care, but such reports were more focused on children with type 1 diabetes or patients with type 2, which is a much more common disease.
“This is really the first ADA position statement on type 1 diabetes through the lifespan, from little kids to geriatrics.”
“This is really the first ADA position statement on type 1 diabetes through the lifespan, from little kids to geriatrics,” Kirkman said. “Type 1 diabetes is a completely different disease than type 2 and needs to be treated as such.”
The position statement includes detailed information on clinical diagnosis clues, family history, transition from pediatric to adult doctors, chronic complications, disease monitoring, and therapeutic options.
The guidelines include a new, lower target for blood glucose levels in children to reduce the risk of cardiovascular disease and kidney disease caused by too much glucose in the blood. The position statement also includes background information on type 1 diabetes.
At UNC, under the guidance of former ADA president John Buse, MD, PhD, scientists and clinicians strive to improve care for type 1 diabetes patients in a variety of ways, from improved hospital care and clinical studies to basic science research focused on finding a cure and novel approaches to new treatments:
• UNC is one of the few places in the country with a policy that allows patients to maintain their own care for type 1 diabetes when they are admitted to UNC Hospitals for unrelated reasons, such surgery or childbirth.
“We worked hard to put this self-management program in place because we know that patients are best at taking care of their own diabetes,” said Buse, professor of medicine and director of the UNC Diabetes Care Center.
• Several UNC staff members, including Kirkman, volunteer at diabetes camps for kids in North Carolina.
• Buse’s staff is about to start a pair of type 1 diabetes clinical trials to test the effectiveness of two different kinds of type 2 diabetes drugs for patients with type 1.
• This fall Buse will lead a third clinical study involving the “bionic pancreas,” which involves three pieces of technology—insulin pumps, glucose monitors, and a device that uses a specific algorithm to manage the amount of insulin automatically added to patients depending on their individual needs. UNC is one of five sites for this national study.
• Beth Mayer-Davis, PhD, a professor in the UNC Gillings School of Global Public Health and adjunct professor in the UNC School of Medicine, is the national chairperson of the SEARCH for Diabetes in Youth Study to improve prognosis through nutrition for kids with type 1 diabetes. Read more
• In basic science, Lola Reid, PhD, professor of cell biology and physiology, is studying the stem cells that produce the insulin-secreting cells that have been rendered useless in people with type 1 diabetes. Reestablishing such cells may offer a path toward a cure.
• Also, Zhen Gu, PhD, an assistant professor in the joint UNC / NC State Biomedical Engineering Department, is working to perfect a “smart” treatment using nanoparticles injected under the skin to release insulin as glucose levels rise. Read more
Read the ADA press release for the new type 1 diabetes guidelines.