Type 2 diabetes (T2D) is a chronic metabolic disorder characterized by hyperglycemia due to insulin resistance and, eventually, inadequate insulin secretion. It poses significant health risks, contributing to cardiovascular diseases, renal dysfunction, neuropathy, and retinopathy. Proper glycemic control remains fundamental in managing T2D, as it can prevent or delay these long-term complications. The article by Stratton et al. emphasizes the importance of maintaining optimal glycemic levels and reviews the evidence supporting the early and sustained management of blood glucose to minimize these risks.
<h2>Key Highlights</h2>
<ol>
 <li>Evidence for Glycemic Control and its Role in Preventing Complications 
 The article underscores the crucial role of glycemic control in reducing complications associated with T2D. It references landmark trials, such as the UKPDS, that demonstrated how intensive glycemic management can significantly lower the risk of microvascular complications like retinopathy, nephropathy, and neuropathy. By targeting an HbA1c level of less than 7%, healthcare professionals (HCPs) can help patients avoid or delay these severe outcomes. 
 &nbsp;</li>
 <li>Macrovascular Benefits of Glycemic Control 
 Although the link between glycemic control and macrovascular outcomes (e.g., cardiovascular events) is complex, the article indicates that achieving and maintaining glycemic targets early in the disease progression can offer some protective effects. It highlights how the “legacy effect” or “metabolic memory” suggests that intensive early intervention can have lasting benefits, even when glycemic levels fluctuate later. 
 &nbsp;</li>
 <li>The Balance Between Efficacy and Safety 
 While aggressive glycemic management can reduce complications, it is crucial for HCPs to balance efficacy with safety, particularly in patients with long-standing diabetes or those at risk for hypoglycemia. The article discusses how personalized treatment strategies, including the selection of pharmacologic agents and the use of continuous glucose monitoring, can help optimize outcomes while minimizing adverse events. 
 &nbsp;</li>
 <li>Patient-Centered Approach 
 The article advocates for a patient-centered approach to glycemic control, emphasizing the need to individualize targets and therapies based on patient characteristics, comorbidities, and lifestyle factors. It encourages HCPs to involve patients in decision-making, set realistic goals, and provide ongoing education to promote adherence to treatment plans.</li>
</ol>
<h2>Conclusion</h2>

Achieving and maintaining optimal glycemic control is essential in the management of T2D to prevent long-term complications. This article provides robust evidence supporting early and intensive glycemic intervention while emphasizing the importance of individualized care. For HCPs, staying informed and proactive in managing blood glucose levels is key to improving patient outcomes and reducing the burden of diabetes-related complications.

TYPE-2-DIABETES

DIABETES

READ THE FULL STUDY HERE

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(Based on the study: Stratton IM, et al. BMJ. 2000;321(7258):405-12).

Is Glycemic Control the Key to Preventing Long-term Complications in Type 2 Diabetes?

The UK Prospective Diabetes Study (UKPDS) is a landmark study that has significantly influenced the management of type 2 diabetes (T2D). The study by Stratton et al., published in BMJ in 2000, explores the relationship between glycaemic control and the risk of macrovascular and microvascular complications in patients with T2D. This summary highlights the key findings and their implications for clinical practice.
The UKPDS was a prospective observational study involving 4,585 patients with newly diagnosed T2D. The study aimed to determine how long-term glycaemic control, measured by HbA1c levels, affects the incidence of various diabetic complications. Data were collected over a median follow-up period of 10 years.
<h2>Key Highlights</h2>
<ol>
 <li>Risk Reduction: 
 Each 1% reduction in updated mean HbA1c was associated with significant reductions in the risk of complications: 
 &nbsp; 
 <ul>
 <li>21% reduction in any diabetes-related endpoint.</li>
 <li>21% reduction in diabetes-related deaths.</li>
 <li>14% reduction in myocardial infarction.</li>
 <li>37% reduction in microvascular complications.</li>
 </ul></li>
</ol>

<ol>
 <li>Hide</li>
 <li>No Threshold Effect: 
 The study found no specific HbA1c threshold below which the risk of complications markedly decreased. Instead, the risk of complications continuously decreased with lower HbA1c levels. 
 &nbsp;</li>
 <li>Consistent Benefits: 
 The benefits of improved glycaemic control were consistent across different types of complications, emphasizing the importance of maintaining lower HbA1c levels to reduce overall risk.</li>
</ol>

The UKPDS demonstrates that better glycaemic control significantly reduces the risk of both macrovascular and microvascular complications in patients with T2D. The findings support the goal of achieving and maintaining lower HbA1c levels to minimize the risk of complications and improve patient outcomes.

<h2>Clincal implications for General Practice</h2>
Healthcare providers should focus on:

Strive to maintain HbA1c levels as low as safely possible to reduce the risk of complications.

Conduct frequent HbA1c testing to ensure glycaemic targets are met.

Implement a holistic approach to diabetes care, including lifestyle modifications, patient education, and appropriate pharmacotherapy.

By prioritizing these strategies, healthcare providers can help patients with T2D achieve better glycaemic control and reduce the incidence of diabetes-related complications.

Summary of The UK Prospective Diabetes Study (UKPDS).

How Does Glycaemic Control Impact Complications in Type 2 Diabetes?

Type 2 diabetes (T2D) remains a significant global health challenge, particularly in developing countries. The International Diabetes Management Practices Study (IDMPS) provides valuable real-world evidence on the management and outcomes of T2D over a 12-year period. This article summarizes key findings from the IDMPS, highlighting trends in glycaemic control, therapy use, and care practices.

<h2>When to Initiate Basal Insulin?</h2>
The IDMPS collected data from 66,088 individuals with T2D across 49 countries, involving 6099 physicians. The study spanned seven cross-sectional waves from 2005 to 2017, with each physician collecting data from ten consecutive patients during a two-week period.
<h2>Key Findings</h2>
<ol>
 <li>Glycaemic Control: 
 The proportion of participants achieving HbA1c &lt;7% decreased from 36% in 2005 to 30.1% in 2017. This decline underscores persistent challenges in achieving optimal glycaemic control. 
 &nbsp;</li>
 <li>Therapy Use: 
 Over 80% of participants were on oral glucose-lowering drugs (OGLDs), with a notable decline in sulfonylurea use. Insulin use increased from 32.8% to 41.2%, with a slight reduction in the time to insulin initiation. 
 &nbsp;</li>
 <li>Diabetes Education: 
 The proportion of participants receiving diabetes education rose from 59.0% to 78.3%, reflecting an increased emphasis on patient education and self-management. 
 &nbsp;</li>
 <li>Monitoring: 
 The frequency of HbA1c measurements improved significantly, with 92.9% of participants having at least two measurements within 12 months by the final wave.</li>
</ol>

Despite advancements in diabetes management, glycaemic control in developing countries remains suboptimal. The IDMPS highlights the need for systemic changes and better organization of care to improve outcomes for individuals with T2D. Enhanced diabetes education, timely therapy adjustments, and regular monitoring are crucial for achieving better glycaemic control and reducing the burden of diabetes-related complications.

<h2>Clincal implications for General Practice</h2>
Healthcare providers play a pivotal role in managing T2D. The findings from the IDMPS emphasize the importance of:

Ensuring frequent HbA1c testing to track glycaemic control.

Providing comprehensive diabetes education to empower patients in self-management.

Tailoring treatment plans to individual patient needs, including timely initiation and adjustment of insulin therapy.

By addressing these areas, healthcare providers can significantly improve the quality of care for patients with T2D, ultimately leading to better health outcomes.
This summary provides a concise overview of the IDMPS findings and their implications for healthcare providers. For more detailed information, refer to the original article by Aschner et al. in Diabetologia.

Summary of Aschner P, et al. Diabetologia. 2020;63(4):711-721.

Why is Glycaemic Control in Type 2 Diabetes Still a Challenge?

<h2>Type 1 diabetes: Detect early and follow up for a soft landing</h2>

The Sanofi symposium on the advancements in the detection of the early stages of T1D helped provide a deeper understanding of the disease and raise awareness on early detection strategies in T1D1.
This Sanofi symposium chaired by Chantal Mathieu, featured presentations by Colin Dayan, Emanuele Bosi, Sanjoy Dutta, and Chantal Mathieu, focusing on the importance of staging individuals with T1D.

From: Hendriks AEJ, Marcovecchio ML, Besser REJ, et al. Clinical care advice for monitoring of islet autoantibody positive individuals with presymptomatic type 1 diabetes. Diabetes Metab Res Rev. 2024;40(2):e3777. doi:10.1002/dmrr.3777.

Prof. Dayan started his speech by highlighting that T1D is a chronic autoimmune disease with metabolic outcomes. He noted that the progression of T1D is often accompanied by anti-islet antibodies (IAA, IA2, GADA and ZnT8A), and person living with diabetes tested positive for ≥2 autoantibodies with dysglycemia are highly likely to progress to stage 3 T1D2. The progression is more rapid in younger population (&lt;12 years) than in adults3.
Interestingly, in another session devoted to the mechanisms of T1D onset, Dr. Roberto Mallone highlighted the need to explore autoimmunity biomarkers beyond autoantibodies, with a specific focus on T cell biomarkers. Notably, autoimmune CD8+ T cells, activated by HLA molecules, are implicated in the disease’s pathogenesis4.

In addition, the complexity of T1D using insights from organ donors, challenges traditional views and highlights the role of pancreatic pathology and the need for deeper understanding. Advanced technologies offer insights into insulitis, beta cell dysfunction, and exocrine pancreatic involvement5,6.
Prof. Bosi highlighted that screening for T1D autoantibodies reduces the risk of DKA and associated complications, as evident in Fr1da and DPV registry, and provides an opportunity to HCPs to educate the patient and caregivers and allow for a soft landing into the disease7,8. Several screening initiatives are occurring worldwide, with Italy being the first country to implement a general population screening approach to T1D and celiac disease in children and adolescents.

Early screening and monitoring for T1D can reduce the psychological burden of diagnosis8. However, awareness among HCPs or families, as well as access to screening, remains low and is the primary barrier to screening programs. Dr. Dutta noted that JDRF is working to expand screening and provide support systems to HCPs through conferences, clinic-based training, and upcoming consensus guidelines. A draft of these guidelines was presented earlier that day at ATTD so stay tuned for the publication in the upcoming months. In the meantime, please feel free to consult the Clinical care advice for monitoring of islet autoantibody positive individuals with early stage type 1 diabetes recently published by the INNODIA consortium, Fr1da and GPPAD study groups (<a href="https://onlinelibrary.wiley.com/doi/10.1002/dmrr.3777" target="_blank">Clinical care advice for monitoring of islet autoantibody positive individuals with presymptomatic type 1 diabetes - Hendriks - 2024 - Diabetes/Metabolism Research and Reviews - Wiley Online Library</a>).

<h4>References:</h4>
<ol>
 <li>
 Insel RA, Dunne JL, Atkinson MA, et al. Staging presymptomatic type 1 diabetes: a scientific statement of JDRF, the Endocrine Society, and the American Diabetes Association. Diabetes Care. 2015;38(10):1964-1974. doi:10.2337/dc15-1419</li>
 <li>
 Besser REJ, Bell KJ, Couper JJ, et al. ISPAD Clinical Practice Consensus Guidelines 2022: Stages of type 1 diabetes in children and adolescents. Pediatr Diabetes. 2022;23(8):1175-1187. doi:10.1111/pedi.13410</li>
 <li>
 Redondo MJ, van Raalte DH. Age Ain't Nothing But a Number . . . or Is It?. Diabetes Care. 2023;46(6):1135-1136. doi:10.2337/dci23-0013</li>
 <li>
 Samassa F, Mallone R. Self-antigens, benign autoimmunity and type 1 diabetes: a beta-cell and T-cell perspective. Curr Opin Endocrinol Diabetes Obes. 2022;29(4):370-378. doi:10.1097/MED.0000000000000735</li>
 <li>
 Leete P, Morgan NG. Footprints of Immune Cells in the Pancreas in Type 1 Diabetes; to "B" or Not to "B": Is That Still the Question?. Front Endocrinol (Lausanne). 2021;12:617437. Published 2021 Feb 25. doi:10.3389/fendo.2021.617437</li>
 <li>
 Alexandre-Heymann L, Mallone R, Boitard C, Scharfmann R, Larger E. Structure and function of the exocrine pancreas in patients with type 1 diabetes. Rev Endocr Metab Disord. 2019;20(2):129-149. doi:10.1007/s11154-019-09501-3</li>
 <li>
 Hummel S, Carl J, Friedl N, et al. Children diagnosed with presymptomatic type 1 diabetes through public health screening have milder diabetes at clinical manifestation. Diabetologia. 2023;66(9):1633-1642. doi:10.1007/s00125-023-05953-0</li>
 <li>
 Ziegler AG, Kick K, Bonifacio E, et al. Yield of a Public Health Screening of Children for Islet Autoantibodies in Bavaria, Germany. JAMA. 2020;323(4):339-351. doi:10.1001/jama.2019.21565</li>
</ol>

<h2>Exploring artificial intelligence in diabetes care: Optimizing health and sports performance</h2>

Artificial Intelligence technologies such as closed-loop systems and continuous glucose monitoring (CGM) systems, can enhance diabetes management and quality of life, and are even used to boost sports performance for both individuals with and without diabetes.
With the capability to measure glucose levels in the interstitial fluid, CGM can provide insights into an individual’s metabolism and energy levels during physical activity. CGM aids in developing options for managing glucose levels in people living with diabetes during exercise, such as consuming small amounts of carbohydrates before hypoglycemia occurs. Ongoing efforts to improve technology accuracy and the development of digital apps have led to the widespread adoption of CGM technology, even among athletes without diabetes, to optimize their performance and nutrition.
More generally, discussions delved into how these technologies can improve diabetes management and enhance quality of life. Studies showcased positive outcomes, such as increased time in range and reductions in hyperglycemia and hypoglycemia, emphasizing the potential of these innovations to address health disparities. Highlighting the importance of considering ethnic and socioeconomic factors in decision-making, the talks underscored the need for advocacy for evidence-based guidelines and collaboration with health organizations to ensure equitable access to these innovations for people living with diabetes.

TYPE-1-DIABETES

Highlights ATTD 2024

<h2>Orion studie</h2>
De ORION-studie was een prospectief, observationeel onderzoek dat in 11 landen werd&nbsp;uitgevoerd met 493 deelnemers ouder dan 18 jaar met diabetes type 2. De deelnemers werden&nbsp;ten minste acht weken voorafgaand aan de studie behandeld met glargine-300 en werden over drie&nbsp;tijdsperioden beoordeeld: pre-ramadan (1-3 maanden ervoor), tijdens de ramadan (1 maand) en&nbsp;post-ramadan (1 maand erna).1

INTEGRATED-DIABETES-CARE

LEES HIER DE HELE PUBLICATIE

Ondanks de mogelijkheid voor een medische uitzondering, bleek uit een groot wereldwijd onderzoek dat vier van de tien moslims met diabetes type 1 en acht van de tien moslims met diabetes type 2 meer dan vijftien dagen vasten tijdens de ramadan.2

Diabetes en ramadan: ORION studie

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Diabetes type 2

Voor zorgverleners

Is Glycemic Control the Key to Preventing Long-term Complications in Type 2 Diabetes?

How Does Glycaemic Control Impact Complications in Type 2 Diabetes?

Why is Glycaemic Control in Type 2 Diabetes Still a Challenge?

Highlights ATTD 2024

Diabetes en ramadan: ORION studie