[ Diabetes Type 2 ]

Guidelines for Intervention Trials in Subjects With Newly Diagnosed Type 1 Diabetes

All rights reserved. The Syllabus covers new guidance as it comes out so you will always be up to date and ready to put recommendations into practice. The Guideline Development Group (GDG) oversees the development process. Today, increasing numbers of patients are receiving part, or in some cases all, of their routine care in the community. Fear of hypoglycaemia and of weight gain are major barriers to success, as is fitting diabetes self‑management into busy lifestyles. Several new therapeutic and monitoring tools have become available over the recent years, for example, short- and long‑acting insulin analogs, personal pumps, and continuous glucose monitoring systems. Standardization of islet autoantibody assays (2–13) and of the intravenous glucose tolerance test for measuring first-phase insulin response (14–18) has been a major advance, allowing stratification for disease risk among relatives.

IDF ( Europe ) has an agreement with the sponsors of this publication to allow reproduction in appropriate circumstances at a premium to the support level given by those sponsors. If you spend less time on the activity we recommend claiming fewer credits. 4 July 2012 The draft scope is out for consultation with stakeholders. Other areas have not been so well researched and therefore many recommendations are graded level D (see Figure 1, below), based on the consensus views of the expert multidisciplinary guideline development group. Structured education programmes in flexible insulin therapy have been shown to improve diabetes control (lower HbA1c and less hypoglycaemia), but achieving and sustaining optimal diabetes control for avoidance of complications remains challenging. Some patients present acutely with dehydration and ketoacidosis, whereas others have minimal or no symptoms (45,46). Natural history studies have indicated that these differences may correlate with the rate of loss of β-cell function and residual β-cell function, determined by genetic (47–49) and other (50–66) factors that modify disease pathology.

provision of skills to adapt insulin therapy to lifestyle; development of understanding to allow coping with new challenges; control of risk factors for eye, kidney, foot, and arterial damage; early detection and management of any complications of diabetes. Document the following at clinical presentation: age, sex, pubertal status, family history of diabetes, blood glucose, bicarbonate, presence or absence of ketoacidosis, weight loss, polyuria, polydypsia, HbA1c, islet autoantibodies, insulin requirement, and HLA typing. The natural history of pre- and postclinical type 1 diabetes varies with age. It advocates the use of strips and meters to suit individual needs, but does not recommend any other site than the fingertips for self-monitoring. For adults with type 1 diabetes, what are the optimum technologies (such as insulin pump therapy and/or continuous glucose monitoring, partially or fully automated insulin delivery, and behavioural, psychological and educational interventions) and how are they best used, in terms of clinical and cost effectiveness, for preventing and treating impaired awareness of hypoglycaemia? The more susceptibility alleles there are, the younger the age of onset and diagnosis, with a more autoaggressive immune response reflected by the number of islet antibodies (68–70). Therefore, the requirement for effective intervention treatment is likely to be more demanding in younger subjects.

On the other hand, a slower rate of β-cell destruction in older subjects may indicate a wider window of opportunity for intervention; although, if the process was “regulated,” it would be important that intervention treatment did not jeopardize this. Although an upper age limit may delineate classic type 1 diabetes from slowly progressive type 1 diabetes or latent autoimmune diabetes of adults (71–73), the combination of clinical type 2 diabetes and autoantibodies may still occur in children and younger adults (74). Age is also an issue with respect to consent and recruitment.

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