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Strategies to Prolong T1D Stage Progression: Impact of Diabetes Ketoacidosis and Potential for Extending Insulin Independence
Jennifer D. Goldman, RPh, PharmD, CDCES, BC-ADM, FCCP, discusses the stages of T1D progression. She emphasizes the risks of delaying intervention in stage 2 T1D, including heightened DKA risk and severe complications, along with potential treatment efficacy reduction and poorer long-term glycemic control.
The following transcript has been lightly edited for clarity and style.
Dr. Kashif Latif: If I intervene there, there are tons of studies that have shown that the younger the proband or the patient is when we determine, the higher likelihood. And with the TrialNet we used to start at birth and thereafter, but now things have changed and it's at two and a half years and thereafter, and the data shows that the time from detection of antibodies to development of clinical type 3- stage 3 type 1 diabetes is close to a decade or more. So we have a lot of time to intervene, and we are now at a point where we can offer FDA-approved therapy, number one, and number two is that there are so many more trials that we can offer and review. So, I think that this is the time, and us as providers, this is ripe opportunity for us to be on the lookout for people in whose life we can make a difference.
Dr Jennifer Goldman: To the audience, are you aware that type 1 diabetes progresses through different stages? We might be now. Doctor Latif gave a good description. Interestingly, I've spent 27 years in diabetes, and it's only in the last year or two that I was very familiar with the stages of type 1 diabetes despite that practice. So 64% said yes. So despite my working in that area, I didn't. If asked you to define the stages of type 1 diabetes, how confident are you that you can do that? Or how confident were you that you could do that? We know Dr. Latif was a good teacher there. So 64% lived in my world of not confident. And so, hopefully, by the end, you'll leave here with a lot more confidence.
Also, to who do you usually refer patients for confirmation of progression from stage 2 to stage 3 in specialized management? Are you referring them out? All right, 100% endocrinologist-pediatric, endocrinologist-immunologist.
