ADA and EASD report on T1D management

This is a brief summary on the joint report with references at the end.


Overarching goal of diabetes care:

“To support people with T1D to live a long and healthy life. Providing approaches, treatments, and devices that minimize the psychosocial burden of living with T1D and, consequently, diabetes-related distress, while promoting psychological well-being,” states the report."

Seems like diabetes on-line resources (forums, videos, etc) should be included.

In the past 20 years, I’ve learned far more from “DOC” online, rather than medical resources.
Hearing from others often prompts me to bring something up with my endo, rather than endo suggesting it first.


Some important comments (I used the Springer link):

Blood ketone measurement is the method of choice and so adults with type 1 diabetes should be offered blood ketone testing strips and a meter [86].

Yep. Never been offered one though - I buy the Abbott teststrips from Amazon, much favoured by the keto crowd. Absolutely essential for me when my Dash pod decides it wants to be Mickey Mouse playing the Sourcerer’s Apprentice.

Section 10: Pyschosocial care

Speaks for itself.

Then (actually earlier - this is in section 2):

The absence of autoantibodies does not exclude type 1 diabetes, since approximately 5–10% of White European people with new-onset type 1 diabetes have negative islet antibodies [8, 9, 25], and further consideration of the diagnosis is necessary. Furthermore, antibodies may disappear over time [26]. In those diagnosed below the age of 35 years, type 1 diabetes is still the most likely diagnosis, particularly if there are no clinical features of type 2 diabetes or monogenic diabetes. In those aged over 35 years, type 2 diabetes becomes increasingly likely with absent islet autoantibodies and older age. However, it can be hard to differentiate between type 1 diabetes and type 2 diabetes based on age and clinical features in non-White European populations.

I feel that clear distinction between type 1 and type 2 is extremely important for the medical profession because they categorize on that distinction and if it is wrong they **** up. As the paper says next:

It is important to make a clinical decision about how to treat the person with diabetes.

There is a good, readily understandable, explanation of the testing in the following paragraphs.

It’s a long, thorough, study that explains to us the consensus of the medical establishment. I haven’t read it through yet but I think for all of us it can help us talk to doctors and understand how they think. Doctors are professionals and therefore they live in a very etiolated world surrounded by themselves and isolated from the rest of humanity, yet they are very important on us so it is incumbent on us to learn how they think.


I agree @MM2 and @jbowler

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Thanks for the excerpts @jbowler ! The one above is likely important so the patient can be pigeon-holed into a shoebox treatment program of one size fits most. The insurance companies like it too since it helps them in their denial of claims processes.

Possibly I am taking this out of context, but this short quote just strikes a raw nerve with me.


The quote is towards the end of Section 2:

It summarizes what Section 2 says by example as the authors go over all the available diagnosis techniques. The issue of monogenic diabetes is certainly something I wasn’t aware of; I’ve seen the term MODY but never bothered to investigate what it meant. Likewise I’d never before heard of “immune check-point inhibitors[4]”

Figure 1 in Section 2 helps explain the current thinking on how the diagnostic techniques can be used, but the text of Section 2 along with all the footnotes attached to the figure explain the limitations.