During a Saturday afternoon symposium jointly sponsored by the ADA and the International Society for Pediatric and Adolescent Diabetes (ISPAD), four international experts will take a retrospective look at the 1993 Diabetes Control and Complications Trial (DCCT), reviewing lessons learned from the landmark trial and examining how the treatment and management of type 1 diabetes have evolved since.
The two-hour symposium, 25 Years after the Announcement of the DCCT Results—What Is the Status of Type 1 Diabetes in Youth, and How Can We Do Better?, begins at 4:00 p.m. in room W311.
Joseph Wolfsdorf, MB, BCh, Professor of Pediatrics and Director of the Diabetes Program at Boston Children’s Hospital, will compare type 1 diabetes treatment prior to the DCCT with current treatment strategies in the U.S.
“One of the things the DCCT did was give us a mandate to aim for blood sugar control as near to normal as possible—i.e., specific blood sugar targets. It also highlighted the model of integrated team care, meaning physicians working with diabetes educators, diabetes nutritionists, and behavioral specialists,” Dr. Wolfsdorf said. “Yet, if you look at how pediatric diabetes practices are resourced in the U.S. today and the ratio of the number of patients to physicians and other diabetes care professionals, it’s clear that it’s impossible to give every patient the appropriate amount of time and support they need to achieve and maintain optimal results.”
A small percentage of patients in the pediatric age range achieve the goal of maintaining A1C less than 7.5 percent, Dr. Wolfsdorf said, and the compliance percentage is even smaller for individuals 18 and older, who have a more stringent A1C target of less than 7 percent.
“Despite the fact that we have compelling scientific evidence telling us that goal is going to keep you healthy, and despite the fact that we have fabulous new technologies to help you do it—namely pumps and sensors and an array of better insulins than we had in the days of the DCCT—on a population basis, we are failing miserably,” Dr. Wolfsdorf said. “Pediatric diabetes centers have just too few resources to do the high-intensity care that the DCCT was able to deliver as part of a major clinical trial funded by the National Institutes of Health. In typical fee-for-service clinical practices funded by the health care system, we lack the resources necessary to achieve those goals.”
The challenges are not confined to the U.S., but new treatment paradigms along with technological and pharmacological advances have improved outcomes in many parts of the world, noted Sabine E. Hofer, MD, PhD, Associate Professor in the Department of Pediatrics at the Medical University of Innsbruck, Austria. Dr. Hofer and Knut Dahl-Jørgensen, MD, PhD, Professor of Pediatrics at Oslo University Institute of Medicine, Norway, will offer global perspectives on type 1 diabetes care.
“Since the early 2000s, we’ve seen major advances and changes in treatment possibilities. In Europe, the use of diabetes technology has rapidly increased in all pediatric age groups, most pronounced in the very young age group,” Dr. Hofer said. “This revolution in treatment options led to a reduction of severe hypoglycemic events, allowing us to redefine metabolic goals for children with diabetes. As a consequence, various national diabetes societies in Europe decreased their metabolic goal in the pediatric age group.”
Robust diabetes registries would be useful for looking at changes in diabetes care and examining the risk factors for the development and progression of complications, Dr. Hofer added. “Participation in diabetes registries that compare diabetes centers on a national, as well as an international basis can influence and improve outcome and care of children with diabetes,” she said.
In the symposium’s final presentation, Rose Gubitosi-Klug, MD, PhD, Associate Professor at Case Western Reserve University School of Medicine and Chief of Pediatric Endocrinology at Rainbow Babies and Children’s Hospital, will review key insights gained from the DCCT and highlight ongoing investigations and future study goals.
“We’ve been able to track the progression of complications in the DCCT cohort, still followed in the Epidemiology of Diabetes Intervention and Complications (EDIC) study, and especially focus on the topics of hypoglycemia and retinopathy progression among the participants who entered the trial as adolescents,” Dr. Gubitosi-Klug said. “We’ve learned, for example, that youth with type 1 diabetes are highly unlikely to develop treatable retinal lesions prior to 18 years of age if their initial screening exam shows no or mild nonproliferative diabetic retinopathy.”
Hypoglycemia, she said, remains an ever-present danger that necessitates continued efforts to improve the educational and technological interventions for type 1 diabetes.
“Efforts to optimize diabetes management remain critical to the prevention of the complications of diabetes,” Dr. Gubitosi-Klug said. “We hope that ongoing and future studies will help us further understand the course or trajectory of complications at an individual level to guide personalized care.”