Abstract Body

In people with type 1 diabetes, diabetic ketoacidosis (DKA) is a medical emergency and a major threat to life. While a failure in insulin delivery would also be signalled by increasing glucose levels, there are other causes of elevated glucose levels which are less likely to be associated with ketosis e.g. carbohydrate ingestion covered by an inadequate bolus, or emotional stress. In addition, DKA can also present without hyperglycaemia. Therefore, ketone levels should be checked in the face of significantly elevated glucose levels or if the person has nausea or vomiting. The current standard of care is measurement of capillary blood ketones using a ketone-capable meter. However, some people with type 1 diabetes may not check their ketones in a timely manner as not all meters have a ketone measuring function, and many people do not have in date ketone testing strips with them.

Continuous glucose monitors are now the standard of care for glucose monitoring in people with type 1 diabetes in advantaged countries. These devices currently sense a single analyte only (interstitial glucose). Evidence indicates that interstitial ketone levels closely mirror those in blood. Incorporating a ketone sensor as part of a multianalyte platform which also senses glucose would overcome some of the limitations associated with our current approach to the early detection and management of ketosis. An ideal device would not increase the user’s physical, emotional, or financial burden. The ketone component of the multianalyte sensor should act analogously to a car’s airbag, sitting unobtrusively in the background for most of the time, and becoming evident and lifesaving under those (hopefully exceptional) circumstances when needed. A continuous glucose/ ketone sensor would be relevant to the general type 1 diabetes population and of particular importance for those with recurrent DKA; during an acute illness; those who are pregnant; those on an SGLT2 inhibitor; those on a low carbohydrate diet; or those undertaking high intensity exercise.

Abstract Body

The number of older people living with type 1 diabetes is increasing. In an advantaged country such as Australia there are three times as many people aged 60 years or older living with this condition than aged 20 years or less. Older people are faced with unique challenges in managing their glucose levels. They vary widely in their functional state and have a higher prevalence of impaired hypoglycaemia awareness. Regardless, glucose control remains important because the adverse impact of both hypoglycaemia and hyperglycaemia are particularly pertinent to the older person living with type 1 diabetes. While Automated Insulin Dosing (AID) systems have been shown to improve glucose control in the general diabetes population and age has not impacted outcomes there have been few randomised-control trials targeting older people with type 1 diabetes. Data from available studies indicate that use of AID systems results in a significant increase in time in range in older adults without an increase in hypoglycaemia risk, with real world observational data providing supporting evidence. However, these data are derived largely from older high-functioning adults. Further AID trials are needed, including studies with more advanced systems that are tailored to address the needs of older people across the full spectrum of health including reduced vision, reduced manual dexterity, and impaired cognition.