CURIOUS ABOUT AUTOIMMUNE TYPE 1 DIABETES?
<h2>Click below to learn more about presymptomatic stages in Type 1 Diabetes, its burden, early detection, and more.</h2>

People who develop autoimmune Type 1 Diabetes (T1D) face a lifelong, multi-facetted burden that is both physical and psychological. If the person who is diagnosed is a child or adolescent, this burden often affects the child&rsquo;s entire family, as well as the child&rsquo;s social relations such as daycare, school, and friends.

Curious about the characteristics of pre-symptomatic- and stage 3 Type 1 Diabetes? Interested in learning about the potential benefits of screening for autoimmune Type 1 Diabetes?

This infographic summarizes survey data*&nbsp;about the impact that families across the Nordic countries have felt when being diagnosed with autoimmune Type 1 Diabetes (T1D).

Systematic early detection of autoimmune Type 1 Diabetes might be a new way to avoid acute and chronic complications of the condition.&nbsp;This new approach may play a role as a revolutionary shift, helping to shape the future of Type 1 Diabetes management.

Start to think differently about Type 1 Diabetes by considering the pre-symptomatic stages of the condition and how it affects people of all ages and their families.

In 10 minutes or an hour, get a view of the discussion from the webinar &ldquo;Early Detection and Surveillance of Autoimmune Type 1 Diabetes&rdquo;.

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The Type 1 Diabetes (T1D) field is evolving. Recognition of the presymptomatic stages in T1D is growing.1-4  The clinical benefits of early detection of T1D are being highlighted.3-4 Programmes focusing on early detection through testing and screening for presymptomatic autoimmune T1D are increasingly offered to risk populations and the general population.1,2

TYPE-1-DIABETES

DIABETES

Autoimmune Type 1 Diabetes

Managing glycaemic levels in type 2 diabetes (T2D) is crucial to reducing the risk of vascular complications and mortality. The study by Zoungas et al., published in Diabetologia in 2012, investigates the relationship between HbA1c levels and the risks of macrovascular and microvascular events, as well as death, in patients with T2D. This summary highlights the key findings and their implications for clinical practice.

<h2>Study Overview</h2>
The study analyzed data from 11,140 participants in the ADVANCE trial, a large-scale, randomized controlled trial. Participants were assigned to either intensive or standard glucose control, and their HbA1c levels were monitored over time. The study aimed to identify glycaemic thresholds associated with increased risks of vascular complications and death.
<h2>Key Findings</h2>
<ol>
 <li>Non-linear Relationship 
 The study found a non-linear relationship between HbA1c levels and the risks of macrovascular events, microvascular events, and death. This means that the risk did not increase uniformly with higher HbA1c levels. 
 &nbsp;</li>
 <li>Thresholds Identified
 <ul>
 <li>Macrovascular Events and Death: 
 Risks increased significantly above an HbA1c level of 7.0%. Below this threshold, there was no significant change in risk.</li>
 <li>Microvascular Events: 
 Risks increased significantly above an HbA1c level of 6.5%. Below this threshold, there was no significant change in risk. 
 &nbsp;</li>
 </ul></li>
 <li>Risk Increase 
 For every 1% increase in HbA1c above these thresholds, the risk of macrovascular events increased by 38%, microvascular events by 40%, and death by 38%.</li>
</ol>

The study by Zoungas et al. provides evidence of specific glycaemic thresholds above which the risks of vascular complications and death increase significantly in patients with T2D. These findings suggest that maintaining HbA1c levels below 7.0% for macrovascular events and death, and below 6.5% for microvascular events, is crucial for minimizing risks.

<h2>Clinical implications for General Practice</h2>
Healthcare providers should aim to:

Regularly monitor HbA1c levels to ensure they remain below the identified thresholds.

Tailor treatment plans to maintain HbA1c levels within the optimal range for each patient.

Emphasize the importance of glycaemic control and educate patients on how to achieve and maintain target HbA1c levels.

By focusing on these areas, healthcare providers can help reduce the risk of vascular complications and improve outcomes for patients with T2D.

TYPE-2-DIABETES

READ THE FULL STUDY HERE

Summary of Zoungas S, et al. Diabetologia. 2012;55:636–643.

Glycaemic Targets and Vascular Complications in Type 2 Diabetes: What Are the Thresholds?

The 2022 guidelines from the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) provide evidence-based recommendations on managing type 2 diabetes, focusing on the use of basal insulin when patients fail to achieve glycemic control through other methods. The article outlines when and how to initiate basal insulin, offering practical steps for general practitioners (GPs) to implement these strategies effectively.

Watch the video below or read the summary including selected highlights from the guidelines, and a link to the full overview.

Practical Guidance based on the 2022 ADA/EASD Guidelines.

When to Initiate Basal Insulin?

<h2>When to Initiate Basal Insulin?</h2>
The ADA/EASD 2022 guidelines recommend considering basal insulin for type 2 diabetes patients who are unable to achieve adequate glycemic control (generally an HbA1c above 7.0%) despite the use of multiple oral agents or GLP-1 receptor agonists. For GPs, this typically involves monitoring patients with consistently elevated fasting plasma glucose levels (over 13.9 mmol/L) or an HbA1c level exceeding 86 mmol/mol (10%), as well as those presenting with symptoms of catabolism (e.g., weight loss, increased thirst, and urination).
The guidelines suggest that GPs initiate basal insulin with a long-acting preparation, starting at a low dose (e.g., 10 IU daily or 0.1–0.2 IU/kg/day). Close monitoring and gradual titration based on fasting glucose levels (aiming for 4.4-7.2 mmol/L) help minimize the risk of hypoglycemia. GPs are encouraged to adapt this approach to each patient, considering factors like age, duration of diabetes, other medical conditions, and the individual’s lifestyle.
<h2>Clinical Implications for General Practice</h2>
The updated guidelines highlight the importance of early and individualized interventions for GPs managing type 2 diabetes patients. Starting basal insulin when oral therapies are insufficient helps maintain glycemic targets and prevents complications such as cardiovascular issues, neuropathy, and retinopathy. GPs should remain proactive in monitoring progress, adjusting doses, and providing patient education on insulin management to optimize care outcomes.

For further details and guidance, consult the full 2022 ADA/EASD guidelines available <a href="https://www.diabetesjournals.org/" target="_blank">here</a>.

Practical Guidance based on the 2022 ADA/EASD Guidelines.

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Wetenschappelijk nieuws

Autoimmune Type 1 Diabetes

Glycaemic Targets and Vascular Complications in Type 2 Diabetes: What Are the Thresholds?

When to Initiate Basal Insulin?