Welcome to the ATTD 2023 Interactive Program
Introduction (ID 793)
IS066 - The strengths and limitations of monitoring via OGTT (ID 794)
Abstract
Abstract Body
We will review the strengths and limitatoins of monitoring progression to Stage 3 T1D via OGTT
IS067 - The evidence for alternative monitoring technologies (ID 795)
Abstract
Abstract Body
When it comes to monitoring glucose, the last 50 years have seen a revolution, in particular when it comes to allowing people living with diabetes to measure their glucose levels themselves. It was only in the 1980’s that self-monitoring of blood glucose became available broadly with the home blood glucose meters. These have seen increasing accuracy, but most importantly increasing user friendliness, with reduction of the size of the capillary blood volume needed, with the improved lancets for sampling, and with greater affordability, increasing thus the accessibility of the technology and allowing people with diabetes around the world to perform capillary blood glucose measurements. This is of the utmost importance those using insulin, as they need the guidance of blood glucose levels in their day to day decisions on insulin doses, but also for those not on insulin, having the data on blood glucose levels is important for guidance and motivation, provided the data are part of educational programs.
The field was revolutionized with the arrival of systems allowing continuous glucose measurements, measuring glucose levels in subcutaneous tissue and recalculating them to blood glucose values. But it was only when the Abbott system LibreTM became available that this technology truly revolutionized the way glucose is measured in those living with diabetes. This system with intermittent scanning allowed a 14day sensor use, with great accuracy and most importantly greater affordability compared to the previous continuous glucose monitoring systems was a key moment in diabetes care. Democratization of sensor use lead to worldwide uptake and importantly pushed the field forward on thinking about new ways to express overall glucose control. The availability of 24h glucose curves, with many more data, drove to new concepts: times in ranges, coefficients of variability etc.. These turn out to be important additional inputs on top of the traditional concepts like HbA1c and are even overtaking HbA1c in daily practice and clinical trials. It will hopefully not be long before also regulators will embrace these new parameters.
The good news is that the field does not stand still! For a revolution to become a persisting reality, evolution is needed: linking sensor and pen data, linking sensors to pumps with artificial intelligence, creating (hybrid) closed loop systems, apps assisting those using sensors for glucose measures in decision making on insulin doses, food intake, exercise etc. and most importantly, increase affordability and user friendliness.
But new revolutions are on the horizon: not only glucose monitoring is being targeted, but also other metabolites come into the picture: lactate, ketones and others. And integration of all these values together with information on exercise, heart rate, food intake and even geography (person in the kitchen versus the bathroom…) will lead to completely different sets of information allowing artificial intelligence systems to assist those living with diabetes even better in therapeutic decision making, but particularly guiding them how to integrate diabetes better in their life, with less disruption and improved quality of life.
IS068 - What’s feasible in the clinical care setting? (ID 796)
Abstract
Abstract Body
The natural history of type 1 diabetes is well defined, and early stages of type 1 diabetes are defined by the presence of multiple type 1 diabetes associated autoantibodies (glutamic decarboxylase antibody, insulinoma antigen-2 antibody, insulin antibody, and zinc transporter 8 antibody). Internationally, the number of programs screening for early stages of type 1 diabetes through the measurement of type 1 diabetes associated autoantibodies continues to increase. In addition, all four major type 1 diabetes associated autoantibodies can be measured commercially in many countries. With increased screening and detection of individuals who are in early stages of type 1 diabetes, there is a need to provide routine clinical follow up to keep patients medically safe, reduce the risk of diabetic ketoacidosis, counsel on risk of disease progression and identify individuals who may be eligible for interventions. In a research setting, oral glucose tolerance tests, metabolic risk scores, HbA1c measurement, blood glucose testing and continuous glucose monitors may be used to monitor disease progression. It is unknown whether these tools used during follow-up visits in a research setting will be technically, economically or operationally feasible in a clinical setting. Whether our current monitoring strategies are feasible in a clinical setting is also dependent on the demand for such follow-up, which hinges on the successful implementation of screening individuals for early stages of type 1 diabetes. We will review experience from our general population screening program in Colorado, the Autoimmunity Study in Kids, as well as our Early Type 1 Diabetes Clinic to examine the acceptability, implementation, practicality and integration of the use of various monitoring tools in the clinical setting. We will also discuss how current monitoring strategies may be adapted to improve feasibility in a clinical setting.Discussion and Q&A (ID 797)