COMMENTARY

Final Roadmap on Type 1 Diabetes Management in Adults: ADA/EASD Consensus Statement

Anne L. Peters, MD

Disclosures

November 15, 2021

This transcript has been edited for clarity.

Hi. I'm Dr Anne Peters. Today, I'm going to discuss the final version of the American Diabetes Association/European Association for the Study of Diabetes (ADA/EASD) consensus statement on the management of type 1 diabetes in adults that was presented at this year's EASD meeting.

In addition to the presentation, the consensus statement was simultaneously published in Diabetes Care and Diabetologia. We presented a draft version of this statement at the ADA, after which we opened it up to public comment. We received feedback from a wide variety of sources. Fortunately, most of the comments were easy to address, and we revised the manuscript accordingly.

Just so you recall how this consensus statement came about, the EASD and the ADA each chose seven individuals who were asked to prepare the consensus report. After about a year and a half of Zoom meetings, we were able to come out with true consensus guidelines.

How type 1 diabetes is managed does differ between various countries, but in general, the management principles are the same. There are two main points to this guideline. First, individualization of care is vital and it is extremely important to address a patient's psychosocial needs.

There is no one-size-fits-all approach to type 1 diabetes management, and people will have their own preferences as to what they do and do not want to use for the management of their disease. Our job is to be sure that the tools are available and that we offer enough assistance, education, and training for people to be able to use these tools.

Don't Forget Psychosocial Support

The psychosocial needs of patients are often not addressed or at least not formally addressed, and I think that we need to be very mindful of how hard it is to live with a chronic disease such as type 1 diabetes. During different phases of people's lives, it may be easier or harder for them to cope. I do urge you to read the manuscript that we published to get all the details about what we're recommending, but here are a few highlights.

First, we discuss a new approach to the diagnosis of type 1 diabetes in adults. At first, I didn't like this approach because it differed from how I did it historically, but we pulled in some experts and really reviewed the data. It turns out that what we describe in this document — and there's a figure that you can refer to that makes it clear — makes a lot of sense. I think it is the best evidence-based approach for the diagnosis of type 1 diabetes in adults.

Second, we advocate for the use of continuous glucose monitoring (CGM) for all people with type 1 diabetes. Again, this doesn't mean that everyone's going to want CGM, but I think that everybody needs to have the opportunity to use it because of the benefits that have been proven in terms of many outcomes.

Third, automated insulin delivery is the gold standard for the management of type 1 diabetes. We do recognize that it's not for everyone — at least not yet — but we discuss how it compares with other approaches for glycemic management. In the document, we discuss all of the approaches that we can think of for the management of people with type 1 diabetes, from the simplest to the most advanced therapies. We want people to be able to get care in any setting. Obviously, they need basic tools. All people with type 1 diabetes need access to insulin; monitoring; and, hopefully, medical care that can support them in their diabetes management.

Finally, we review adjunctive therapies — which, although not largely approved for use, are tools that are beneficial off-label or on-label, depending on the approach, for some patients. We clearly need to do more research on therapies in addition to insulin for the management of type 1 diabetes.

Overall, this document should serve as a roadmap for the management of people with type 1 diabetes. We clearly outline what we consider the best care. Frankly, all people with type 1 diabetes should have access to the best care because we want them to reach their goals and avoid the complications and difficulties of living with this disease.

Thank you. This has been Dr Anne Peters for Medscape.

Anne L. Peters, MD, is a professor of medicine at the University of Southern California (USC) Keck School of Medicine and director of the USC clinical diabetes programs. She has published more than 200 articles, reviews, and abstracts, and three books, on diabetes, and has been an investigator for more than 40 research studies. She has spoken internationally at over 400 programs and serves on many committees of several professional organizations.

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