Toward precision diagnostics
“Encapsulating” all these factors is the first step to applying precision medicine in type 1 diabetes, an area, Dr. Redondo explained, in which concrete actions are being carried out. “One of these actions is to determine BMI [body mass index], which has been incorporated into the diabetes prediction strategy that we use in clinical trials, since we know that people with a high BMI, along with other factors, clearly have a different risk. Likewise, we’ve seen that teplizumab could work better in the prevention of type 1 diabetes in individuals with anti-islet antibodies and that people who have the DR4 gene respond better than those who don’t have it and that those with the DR3 gene respond worse.”
Other recent advances along these lines involve the identification of treatments that can delay or even prevent the development of type 1 diabetes in people with positive antibodies, as well as the development of algorithms and models to predict who will develop the disease, thus placing preventive treatments within reach.
“The objective is to use all available information from each individual to understand the etiology and pathogenesis of the disease at a given moment, knowing that changes occur throughout life, and this also applies to other types of diabetes. The next step is to discover and test pathogenesis-focused therapeutic strategies with the most clinical impact in each patient at any given time,” said Dr. Redondo.
Technological tools
The specialist referred to recent advances in diabetes technology, especially semiclosed systems (such as a sensor/pump) that, in her opinion, have radically changed the control of the disease. “However, the main objective is to make type 1 diabetes preventable or reversible in people who have developed it,” she said.
Fernando Gómez-Peralta, MD, PhD, elected coordinator of the Diabetes Department at SEEN and head of the endocrinology and nutrition unit of General Hospital of Segovia, Spain, spoke about these technological advances in his presentation, “Technology and Diabetes: Clinical Experiences,” which was organized in collaboration with the Spanish Diabetes Society.
According to this expert, technological and digital tools are changing the daily lives of people with this disease. “Continuous glucose monitoring and new connected insulin pen and cap systems have increased the benefits for users of treatment with new insulins, for example,” said Dr. Gómez-Peralta.
He explained that most systems make it possible to access complete data regarding glycemic control and the treatment received and to share them with caregivers, professionals, and family members. “Some integrated insulin pump and sensor systems have self-adjusting insulin therapy algorithms that have been shown to greatly increase time-to-target glucose and reduce hypoglycemic events,” he said.
“Regarding glucose monitoring, there are devices with a longer duration (up to 2 weeks) and precision that are characterized by easier use for the patient, avoiding the need for calibration, with annoying capillary blood glucose levels.”
In the case of insulin administration, it is anticipated that in the future, some models will have very interesting features, Dr. Gómez-Peralta said. “Integrated closed-loop glucose sensor and insulin pump systems that have self-adjusting algorithms, regardless of the user, are highly effective and safe, and clearly improve glycemic control.
“For users of insulin injections, connected pens allow the integration of dynamic glucose information with doses, as well as the integration of user support tools for insulin adjustment,” Dr. Gómez-Peralta added.
The specialist stressed that a challenge for the future is to reduce the digital divide so as to increase the capacity and motivation to access these options. “In the coming years, health systems will have to face significant cost so that these systems are made available to all patients, and it is necessary to provide the systems with more material and human resources so that they can be integrated with our endocrinology and diabetes services and units.”
Dr. Redondo and Dr. Gómez-Peralta have disclosed no relevant financial relationships.
This article was translated from the Medscape Spanish edition and a version appeared on Medscape.com.