What is the diagnosis and management of Type 1 Insulin-Dependent Diabetes Mellitus (IDDM)?

From the Guidelines

Type 1 diabetes mellitus requires lifelong insulin therapy, and the most effective treatment approach is intensive insulin management using multiple daily injections or continuous subcutaneous insulin infusion (CSII) via an insulin pump, as recommended by the 2024 standards of care in diabetes 1.

Key Components of Treatment

• Insulin replacement plans typically consist of basal insulin, mealtime insulin, and correction insulin
• Basal insulin includes NPH insulin, long-acting insulin analogs, and continuous delivery of rapid-acting insulin via an insulin pump
• Mealtime insulin includes rapid-acting insulin analogs, such as Humalog, NovoLog, or Apidra
• Correction insulin is used to correct high blood glucose levels

Insulin Dosing and Monitoring

• Insulin dosing is based on carbohydrate intake, blood glucose levels, and physical activity
• Blood glucose monitoring is essential, with target ranges typically 80-130 mg/dL before meals and under 180 mg/dL after meals
• Patients should check glucose levels 4-10 times daily or use continuous glucose monitoring

Automated Insulin Delivery Systems

• Automated insulin delivery (AID) systems are safe and effective for people with type 1 diabetes, and can improve achievement of glycemic goals while reducing the risk of hypoglycemia 1
• AID systems are preferred and should be considered for individuals with type 1 diabetes who are capable of using the device safely

Regular Medical Follow-up

• Regular medical follow-up is necessary, including HbA1c testing every 3-6 months (target usually <7%)
• Patients must learn carbohydrate counting, recognize hypoglycemia symptoms, and always carry fast-acting glucose

Treatment Goals

• The goal of treatment is to achieve normoglycemia and prevent diabetic ketoacidosis and hypoglycemia
• Treatment plans should be tailored to the individual and reassessed regularly to account for specific factors, including cost, that impact choice of treatment 1

From the FDA Drug Label

In two clinical studies (Studies A and B), adult patients with type 1 diabetes (Study A, n=585, Study B n=534) were randomized to 28 weeks of basal-bolus treatment with Insulin Glargine or NPH insulin. In another clinical study (Study C), patients with type 1 diabetes (n=619) were randomized to 16 weeks of basal-bolus treatment with Insulin Glargine or NPH insulin. In these 3 adult studies, Insulin Glargine and NPH insulin had similar effects on HbA1c (Table 9) with a similar overall rate of severe symptomatic hypoglycemia [see Adverse Reactions (6. 1)]. Pediatric Patients with Type 1 Diabetes In a randomized, controlled clinical study (Study D), pediatric patients (age range 6 to 15 years) with type 1 diabetes (n=349) were treated for 28 weeks with a basal-bolus insulin regimen where regular human insulin was used before each meal. Similar effects on HbA1c (Table 10) were observed in both treatment groups [see Adverse Reactions (6. 1)].

Type 1 IDDM can be treated with Insulin Glargine.

• The basal-bolus treatment with Insulin Glargine had similar effects on HbA1c compared to NPH insulin in adult and pediatric patients with type 1 diabetes 2.
• Insulin Glargine can be administered once daily at bedtime in patients with type 1 diabetes.
• The overall rate of severe symptomatic hypoglycemia was similar between Insulin Glargine and NPH insulin treated patients.

From the Research

Type 1 IDDM Overview

• Type 1 diabetes mellitus (T1DM) is a condition that requires insulin therapy as its primary treatment 3
• The goal of insulin therapy in T1DM is to achieve good glycemic control, with a target hemoglobin A1c (HbA1c) level of <7.5% 3, 4

Insulin Regimens

• Typically, patients with T1DM require initiation with multiple daily injections at the time of diagnosis, using short-acting or rapid-acting insulin analogues given before meals, along with intermediate or long-acting insulin 3
• Basal-bolus therapy, which combines a long-acting basal insulin with a rapid-acting insulin at mealtimes, is also an effective approach for managing T1DM 5
• Continuous subcutaneous insulin infusion (CSII) is another option for patients with T1DM, particularly those who experience frequent or severe hypoglycemia or have pronounced dawn phenomenon 6, 7

Glycemic Targets

• The target HbA1c level for nonpregnant adults with T1DM is <7% (53 mmol/mol) 6
• For children and adolescents with T1DM, the target HbA1c level is ≤7.5% 4
• Blood glucose monitoring is an essential part of effective insulin therapy, with targets for pre-meal, bedtime, and mean blood glucose levels 4

Insulin Types

• Rapid-acting insulin analogues, such as aspart, glulisine, and lispro, are preferred for prandial glycemic control 6
• Basal insulin analogues, such as glargine and detemir, are preferred for basal insulin therapy due to their reduced peak profile and extended duration of action 6, 5