From the Guidelines
To prevent progression in Type 1 Diabetes Mellitus (T1DM), achieving a target HbA1c of 7.0% is crucial, as it helps prevent or delay the microvascular complications of diabetes, including diabetic kidney disease (DKD) 1.
Strategies for Prevention
The following strategies can help prevent disease progression in T1DM:
- Intensive insulin therapy, combined with regular blood glucose monitoring, is essential to maintain optimal plasma glucose and HbA1c levels for age 1.
- A standard regimen includes basal insulin (like Lantus, Levemir, or Tresiba) once or twice daily, plus rapid-acting insulin (such as Humalog, Novolog, or Fiasp) before meals.
- Most patients require 0.5-1.0 units of insulin per kilogram of body weight daily, divided between basal (50%) and bolus doses (50%) 1.
- Continuous glucose monitoring (CGM) devices or frequent self-monitoring (4-7 times daily) helps maintain blood glucose between 70-180 mg/dL, with an A1C target below 7% 1.
- Regular exercise (150 minutes weekly), a balanced diet with consistent carbohydrate counting, and regular medical follow-ups every 3-6 months are crucial to prevent complications like retinopathy, nephropathy, and neuropathy 1.
- Early intervention with immunomodulatory therapies like teplizumab may delay disease onset in high-risk individuals.
- Managing obesity is also important, as it contributes to insulin resistance, dyslipidemia, and cardiometabolic complications in T1DM 1.
Key Considerations
- T1DM progression cannot be completely halted as it's an autoimmune condition, but these approaches can significantly slow disease advancement and reduce complications.
- A transdisciplinary research strategy addressing metabolism, molecular mechanisms, lifestyle, neuropsychology, and novel therapeutics is needed to develop type 1 diabetes–specific weight management recommendations that account for the competing outcomes of glycemic control and weight management 1.
From the Research
Strategies to Prevent Disease Progression in Type 1 Diabetes Mellitus (T1DM)
- The primary goal of treatment of T1DM is to maintain near-normoglycemia through intensive insulin therapy, avoid acute complications, and prevent long-term microvascular and macrovascular complications 2.
- Effective strategies to prevent disease progression in T1DM include:
- Basal-bolus therapy either with multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII) to achieve target glycemic control 2, 3.
- Comprehensive education and support for patients and their families to manage T1DM effectively 2, 4.
- Regular self-monitoring of blood glucose and/or continuous glucose monitoring to avoid critical hypoglycemia and glucose variability 2, 4.
- Adaptation of insulin doses based on daily patterns of blood glucose, exercise, and pubertal status 2.
- Consideration of new therapy options such as sensor-augmented insulin pump therapy and emerging therapies like the artificial pancreas 2, 5.
- Additional strategies include:
- Tight blood glucose control to decrease the incidence of microvascular and macrovascular complications 4.
- Individualized glycemic goals, with most nonpregnant adults striving for an A1C level less than 7% 3, 4.
- Regular monitoring of blood pressure and lipid levels to prevent cardiovascular disease events 4.
- Development of sick-day plans and education on warning signs of hypoglycemia and diabetic ketoacidosis 4.