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Highlights from ATTD 2024

Type 1 diabetes:
Detect early and follow up for a soft landing

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 DayanEmanuele BosiSanjoy Dutta, and Chantal Mathieu, focusing on the importance of staging individuals with T1D.

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 (<12 years) than in adults3.

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.

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

Exploring AI in diabetes care:
Optimizing health and sports performanc

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.

Videos
Impressions from peers

References

  1. 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
  2. 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
  3. 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
  4. 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
  5. 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
  6. 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
  7. 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
  8. 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
MAT-SE-2400232 v.1.0 14.03.2024