During Monday afternoon’s symposium Successes with Type 1 Diabetes Complications and Survival, four researchers will review the latest data on the development and progression of type 1 diabetes complications. The two-hour symposium will begin at 4:30 p.m. in room 28.
Trevor J. Orchard, MD, MMedSci, FAHA, FACE, Distinguished Professor of Epidemiology at the University of Pittsburgh School of Health Sciences, will share new, unpublished data from the Pittsburgh Epidemiology of Diabetes Complications Study (EDC). Dr. Orchard has served as principal investigator of the EDC since its inception in 1985. He will offer a historical perspective on major diabetes outcomes, including renal failure, heart attack, stroke, and blindness.
The new EDC data comes from a 50-year historical perspective looking at cumulative incidences of diabetes complications based on individuals diagnosed with childhood-onset diabetes between 1950 and 1980. Patients were followed through biennial questionnaires and up to eight examinations.
Results from the EDC indicate that while life expectancy and the general health of diabetes patients has improved greatly when compared to the public as a whole, excessive risk for most major diabetes outcomes and complications remains. Another of the key new findings is that while outcomes for some complications such as heart disease mortality have improved, other areas like renal, nerve, and eye complications haven’t improved much.
“The bottom line is that we’re not really preventing complications,” Dr. Orchard said. “We’re delaying them. That’s good in many ways, but it isn’t good enough.”
EDC investigators have also looked at two sub-cohorts—patients diagnosed in the 1960s and patients diagnosed in the 1970s—and compared the groups using a baseline of about 22 years of disease duration. In the 1960s group, glycemic control, smoking, and cholesterol were predictors of major diabetes outcomes. But the 1970s group didn’t show those as key predictors, which may indicate improved control of blood glucose, cholesterol, and a reduction in overall smoking, Dr. Orchard said.
Hypertension was an equally strong predictor in both cohorts, he added.
“This, we suggest, is because we’re not adequately treating blood pressure in terms of complication prevention. Therefore, a major focus for the future is to determine the appropriate BP goals for the young adult with type 1 diabetes,” Dr. Orchard said.
Hillary A. Keenan, PhD, an epidemiologist at Joslin Diabetes Center, Assistant Professor of Medicine at Harvard Medical School, and Associate Director of Biostatistics for Harvard Catalyst, will follow Dr. Orchard with a lecture titled “Studies of Those with 50 or More Years with Type 1 Diabetes—What Have We Learned?”
Dr. Keenan will compare data from the Joslin 50-Year Medalist Study, the Canadian Study of Longevity in Type 1 Diabetes, and the Golden Years Cohort from the United Kingdom. She will also discuss evidence of an endogenous protective factor for diabetic nephropathy recently published in Nature Medicine.
Trisha Lynette Dunning, PhD, AM, RN, CDE, Chair in Nursing at Deakin University and Barwon Health in Australia, will follow with a lecture titled “Clinical Care of Older People with Type 1 Diabetes.”
Most people assume that older people with diabetes have type 2, Dr. Dunning said. As a result, little information exists about older type 1 patients, she said. But she will cite research indicating that about 25 percent of people in elderly care facilities have type 1 diabetes.
“We know that with modern treatments these older people are surviving and we will be diagnosing people with type 1,” Dr. Dunning said. “The prevalence of older people with type 1 is increasing, too. But they have quite different needs from people with type 2 diabetes because they depend on insulin.”
Caring for older patients with type 1 diabetes requires personalized care that emphasizes the individual, not just the diabetes, Dr. Dunning said. Health care providers should focus on safety and quality of life and adopt a proactive, risk-assessment management approach with care decisions based on each patient’s values, goals, preferences, and life expectancy, she added.
Dr. Dunning will also discuss important management issues such as cognitive function, depression, cardiovascular risk, falls, pain, and hospital admissions. She will also talk about the role of family care, as more than 60 percent of older type 1 diabetes patients get their home care from a spouse.
Diabetes guidelines don’t always address general health care issues that should be considered alongside traditional, diabetes-specific issues, Dr. Dunning said.
“This includes things like continuing to screen for cancers and making sure patients have vaccinations,” she explained. “These things need to be part of the annual assessments that we talk about, which don’t get done all the time with older people. It’s more of a holistic approach and focusing on the person and not the diabetes.”
Dr. Dunning will discuss guidelines that she and her colleagues developed to address many of these concerns. One tool they developed helps identify patients at increased hypoglycemia risk, while other tools address pain assessment and risk of falls.
Janet K. Snell-Bergeon, PhD, MPH, Assistant Professor of Pediatrics and Epidemiology and Co-Head of Clinical Epidemiology at the Barbara Davis Center for Diabetes at the University of Colorado Anschutz Medical Campus, will open the session with a lecture titled “Have Patterns in Morbidity and Mortality Due to Type 1 Diabetes Changed?”