Anne Peters: Advances in Diabetes, 2014
In 2009, I suggested to the American Diabetes Association (ADA) that we needed separate guidelines for managing type 1 diabetes patients, who need a very different approach to care than type 2 diabetes patients. The first step in the process involved working with Lori Laffel, MD, MPH, a pediatric endocrinologist at the Joslin Diabetes Center in Boston. Together, we created a treatment Sourcebook and took the practice pearls from that to create the "Type 1 Diabetes Through the Life Span" position statement.
Type 1 diabetes is no longer just a pediatric disease. With improved care, we now have far more adults than children with type 1 diabetes (1-2 million vs 160,000). In fact, most patients with type 1 diabetes are now living long enough to qualify for Medicare, with different needs.
The greatest change in this new approach occurs in the full pediatric range where we followed the data to recommend a lower A1c target of less than 7.5%. We have learned that higher blood sugars harm developing brains, and with the newer insulin products and new technology such as continuous glucose monitoring (CGM), the risk for hypoglycemia is lower than in the past. The target is then raised as people age, depending on a variety of factors, including hypoglycemia awareness.
We often have to fight to give our patients the tools they need to manage type 1 diabetes, such as getting enough strips to test their blood glucose frequently enough, or getting insurance coverage for insulin pumps and CGM. With the new guidelines, we now have the information all in one place to guide care and support reimbursement. (In fact, I cite it all the time to fight insurance reimbursement denials).
Because our type 1 patients are responsible for most of their own care, we wanted to provide treatment information in a form that they and their caregivers can use as well. Therefore, a patient/parent/caregiver version of the Sourcebook is being written for publication in the next year.
The First Guidance for Type 1 Diabetes
In 2009, I suggested to the American Diabetes Association (ADA) that we needed separate guidelines for managing type 1 diabetes patients, who need a very different approach to care than type 2 diabetes patients. The first step in the process involved working with Lori Laffel, MD, MPH, a pediatric endocrinologist at the Joslin Diabetes Center in Boston. Together, we created a treatment Sourcebook and took the practice pearls from that to create the "Type 1 Diabetes Through the Life Span" position statement.
Type 1 diabetes is no longer just a pediatric disease. With improved care, we now have far more adults than children with type 1 diabetes (1-2 million vs 160,000). In fact, most patients with type 1 diabetes are now living long enough to qualify for Medicare, with different needs.
The greatest change in this new approach occurs in the full pediatric range where we followed the data to recommend a lower A1c target of less than 7.5%. We have learned that higher blood sugars harm developing brains, and with the newer insulin products and new technology such as continuous glucose monitoring (CGM), the risk for hypoglycemia is lower than in the past. The target is then raised as people age, depending on a variety of factors, including hypoglycemia awareness.
We often have to fight to give our patients the tools they need to manage type 1 diabetes, such as getting enough strips to test their blood glucose frequently enough, or getting insurance coverage for insulin pumps and CGM. With the new guidelines, we now have the information all in one place to guide care and support reimbursement. (In fact, I cite it all the time to fight insurance reimbursement denials).
Because our type 1 patients are responsible for most of their own care, we wanted to provide treatment information in a form that they and their caregivers can use as well. Therefore, a patient/parent/caregiver version of the Sourcebook is being written for publication in the next year.
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