Madrid — Yes type 1 diabetes, in terms of epidemiology, genetics, and possible constitutive causes, and in the disease course before and after diagnosis. This point was made clear in Can T1D do precision medicine? meeting.
At the 63rd Congress of the Spanish Society for Endocrinology (SEEN), Maria Jose Redondo, M.D., Director of Research, Department of Diabetes and Endocrinology, Texas Children’s Hospital Baylor College of Medicine, Houston, Texas, said that evidence supports implementing precision medicine strategies. It’s a “clue” for
“Physiopathologically, there are different forms of type 1 diabetes that must be considered in therapeutic approaches. The aim is to explain this heterogeneity to discover its underlying etiology and define endtypes.” The paradigm that followed was the European Diabetes Association (EASD), the American Diabetes Association (ADA), and other organizations,” Redondo said.
She added that our knowledge of the factors that explain these epidemiological and genetic variations has advanced significantly. , the immunological processes appear to be different.”
Metabolic factors are also involved in the development of type 1 diabetes in adolescents and adults. “This metabolic heterogeneity is a very important aspect as we currently only use glucose to diagnose diabetes, especially to classify diabetes as type 1. Other factors You have to actually measure it, like this: C-peptidebecause it has been found that people with higher levels of this peptide show a closer process. type 2 diabetes It has atypical features of type 1 diabetes (obesity, advanced age, lack of the typical genetic factors associated with type 1 diabetes) that resemble type 2 diabetes,” said Redondo.
escape classification
The expert added that the evidence suggests that the classification of different types of diabetes should be reviewed. gestational diabetesmonogenic (neonatal) diabetes, related monogenic diabetes cystic fibrosis, pancreatogenic diabetes, steroid-induced diabetes, and post-transplant diabetes. However, in clinical practice, cases such as autoimmune diabetes and type 1 diabetes are emerging that are very difficult to diagnose and classify. insulin resistancepositive antibodies for type 2 diabetes, e.g. obesity (Unclear whether type 1 diabetes or type 2 diabetes), drug-induced diabetes insulin Autoimmune type 1 diabetes with resistant, persistent C-peptide, or monogenic diabetes in obese people.
“Thus, the current classification does not guide prevention or treatment, and the heterogeneity of the disease is not as clear as we would like. Inflammation is present in the case and the gene that confers impaired beta cell secretion is present in monogenic diabetes and possibly also in type 2 diabetes. It’s kind of a diabetes background, and you could argue that it interacts with other diabetics — factors that have happened in certain people,” Redondo said.
“Furthermore, it was shown that metformin It can improve insulin resistance and cardiovascular events in obese type 1 diabetic patients. On the other hand, most of her type 2 diabetics do not require insulin after diagnosis. In addition to this, the inability to distinguish between those who respond to immunomodulatory agents and those who do not in the prevention of type 1 diabetes highlights the existence of pathogenic processes that may manifest themselves in different types of diabetes. It has been. While many people with the same diagnosis actually have very different diseases, they clearly don’t fit into a single disease type,” she noted.
Toward precise diagnosis
“Encapsulating” all these factors is the first step in applying precision medicine to type 1 diabetes, and an area where concrete action is being taken, Redondo explained. One of these actions is determining BMI [body mass index]This has been incorporated into diabetes prediction strategies used in clinical trials. This is because we know that people with a higher BMI have significantly different risks, along with other factors. Similarly, teplizumab is useful in individuals with anti-islet antibodies and DR4 They respond better than those who do not have the gene or who have it. DR3 Gene reaction is bad. ”
Other recent advances along these lines include identifying treatments that can delay or even prevent the onset of type 1 diabetes in people with positive antibodies, and to predict who will develop the disease. includes the development of algorithms and models for and therefore preventative treatment. within reach.
“The aim is to use all the information available from each individual to understand the etiology and etiology of disease at a particular point in time, and to understand changes that occur throughout life. The same is true for diabetes: The next step is to discover and test etiology-focused therapeutic strategies that can have the most clinical impact on each patient at any given time,” said Redondo.
technical tools
The expert referred to recent advances in diabetes technology, particularly semi-closed systems (sensors/pumps, etc.) that, in her opinion, have fundamentally changed the management of the disease. “But the main goal is to make type 1 diabetes preventable or reversible in people who have developed it.
Fernando Gómez Peralta, M.D., elected coordinator of the Diabetes Department of SEEN and head of the Endocrinology and Nutrition Department at the General Hospital of Segovia, Spain, will deliver a presentation entitled “Technology and Diabetes: Clinical Experience,” which will be jointly developed with the Spanish Diabetes Association. was organized by
According to this expert, technology and digital tools are changing the daily lives of people with the disease. “For example, continuous blood glucose monitoring and the newly connected insulin pen and cap system have increased the benefits for users of new insulin treatments,” he said.
He explained that most systems allow access to complete data on glycemic control and the treatments received and to share them with caregivers, professionals, and families. was done insulin pump The sensor system has an auto-tuning function insulin therapy These algorithms have been shown to significantly reduce time to target glucose and reduce hypoglycemic events,” he said.
“For glucose monitoring, there are longer duration (up to 2 weeks) and more accurate devices that are easy to use for patients, require no calibration, and are characterized by cumbersome capillary blood glucose levels.”
For insulin dosing, Gómez said we expect some models to have very interesting features in the future. Equipped with a self-regulating algorithm, it is highly effective, safe and clearly improves blood sugar control.
“For insulin injection users, a connected pen will allow integration of dynamic glucose information and doses, as well as integration of user support tools for insulin adjustments,” added Gómez.
Experts stressed that the challenge for the future is to close the digital divide to increase the ability and motivation to access these options. To be able to do so, the healthcare system will have to face significant costs, and more material and human resources must be provided to the system so that it can be integrated with endocrinology and diabetes services and units. .”
Redondo and Gomez have not disclosed any financial relationship involved.
This article Medscape Spanish version.
