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Screening, monitoring, and treatment strategies evolve for early type 1 diabetes


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4 minutes

Chantal Mathieu, MD, PhD
Chantal Mathieu, MD, PhD

Early identification of and intervention for type 1 diabetes can delay the onset of symptoms, improve outcomes, and potentially someday even prevent the development of the disease. Panelists discussed strategies for Early Type 1 Diabetes Diagnosis and Management in a Monday, June 6, session.

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Chantal Mathieu, MD, PhD, Professor of Medicine at Katholieke Universiteit Leuven, Belgium, and Chair of Endocrinology at the University Hospital Gasthuisberg in Leuven, reviewed the benefits of screening for type 1 diabetes, posing the question of whether it’s time to screen for type 1 diabetes risk in the general population.

In the United Kingdom, the No. 1 criteria for a population screening program is that it should be an important health problem as judged by its frequency and/or severity, she explained.

Kimber M. Simmons, MD, MS
Kimber M. Simmons, MD, MS

“I think we all agree, those of us who are clinicians, that DKA (diabetic ketoacidosis) prevention in itself should rest that case,” Dr. Mathieu said. “Those of us who’ve seen DKA in newly diagnosed type 1 diabetes or those of us who have lost patients to DKA know what a severe disease type 1 diabetes is. And what we often forget is that, if you have DKA at the time of type 1 diabetes diagnosis, it impacts you for the rest of your life.”

Among the available screening tools, autoantibody testing can identify people who are in the early stages of the disease and are at high risk of developing clinical type 1 diabetes, providing a window of opportunity for early intervention and potentially preventing DKA, she said.

Kimber M. Simmons, MD, MS, Assistant Professor of Pediatrics at the Barbara Davis Center for Diabetes, discussed monitoring and follow-up for individuals who screen and confirm positive for stage 1 and stage 2 type 1 diabetes.

Ingrid Libman, MD, PhD
Ingrid Libman, MD, PhD

“Follow-up for these people is really important, but the evidence for how best to monitor clinically is really very limited,” Dr. Simmons said. “So, confirmed positive patients need to be monitored and educated by a health care provider who has some knowledge of pre-symptomatic type 1 diabetes and what that progression looks like, and importantly, has the time and resources in a busy practice.”

Symptom assessment and home blood glucose monitoring are essential monitoring tools, she noted. However, the tools used for a patient may change as monitoring goals change.

“For estimating the risk of progression or ensuring eligibility for early treatment through a clinical research trial, A1C, oral glucose tolerance tests, and continuous glucose monitors may also add value,” Dr. Simmons said.

Ingrid Libman, MD, PhD, Associate Professor in the Division of Pediatric Endocrinology at the University of Pittsburgh School of Medicine, and Director of the Diabetes Program at UPMC Children’s Hospital of Pittsburgh, talked about insulin treatment and best strategies for children with early stage 3 type 1 diabetes.

Jason L. Gaglia, MD, MMSc
Jason L. Gaglia, MD, MMSc

“We know that children presenting with early stage 3 type 1 diabetes benefit from early diagnosis, with preserved C-peptide and all that implies for prevention of complications down the road,” Dr. Libman said. “And we can’t forget the impact of overweight or obesity, so of course we will recommend healthy lifestyle and discuss the importance of physical activity and meal planning.”

Regarding the question as to whether, when, and how to start pediatric patients on insulin, she said monitoring for consistent patterns can help guide those decisions.

“If they only have post-prandial elevation, for example, you might consider starting short-acting insulin only, or if they have consistent elevations during the day, long-acting insulin given in the morning might be indicated,” Dr. Libman said.

Jason L. Gaglia, MD, MMSc, Assistant Professor of Medicine at Harvard Medical School, and Director of the Hood Center for the Prevention of Childhood Diabetes at the Joslin Diabetes Center, gave an overview of potential prevention therapies for type 1 diabetes that are under development, including antigen-specific, cytokine-targeting, immunomodulation, pro-survival, and cell therapies.

“Type 1 diabetes is a heterogeneous disease, and subgroups that are more likely to benefit from a particular type of therapy are being identified and new trials are being designed to focus on those groups,” Dr. Gaglia said. “The first prevention therapy with reasonable likelihood of obtaining approval, teplizumab, is currently before the (U.S. Food and Drug Administration), and this may change the landscape quite a bit.”