- CDC News
- Cardiovascular Clinical Consult
- Adult Immunization
- Hepatology
- Rare Disorders
- Pediatric Immunization
- Implementing The Topcon Ocular Telehealth Platform
- Weight Management
- Screening
- Monkeypox
- Clinical Guidelines
- Men's Health
- Psychiatry
- Allergy
- Nutrition
- Women's Health
- Cardiology
- Substance Use
- Pediatrics
- Kidney Disease
- Genetics
- Complimentary & Alternative Medicine
- Dermatology
- Endocrinology
- Oral Medicine
- Otorhinolaryngologic Diseases
- Pain Management
- Gastroenterology
- Geriatrics
- Infectious Disease
- Orthopedics
- Obesity Medicine
- Rheumatology
- Technology
- Oncology
- Nephrology
- Anemia
- Neurology
- Pulmonology
Living with Type 1 Diabetes
Panelists discuss the burden of living with type 1 diabetes, including high levels of stress and anxiety and talk about how they help patients manage the daily requirements.
The following transcript has been edited for clarity and length.
Javier Morales. MD: Good evening, and welcome to Patient Care Frontline Insights. Today, we'll be discussing Paving the Path to Prevention: Managing Early Treatments for Type 1 Diabetes Progression. I’m Dr. Javier Morales, an internist from Long Island and Associate Clinical Professor of Medicine at the Zucker School of Medicine at Hofstra/Northwell. I’m joined by an esteemed panel: Dr. Shira Eytan, an endocrinologist at Park Avenue Endocrinology in New York City; Dr. David Robertson from Atlanta Diabetes Associates, in Atlanta, GA; Bethany Kinsey, a nurse practitioner with Wellstar Health System in Holly Springs, Georgia; and Dr. Quentin Van Meter of Van Meter Pediatric Endocrinology, also in Atlanta. Thank you all for joining us.
We have several areas to cover tonight including:
- Highlighting the goals of National Diabetes Month, particularly increasing awareness and managing type 1 diabetes through early intervention and proactive health care strategies.
- Discussing screening for type 1 diabetes, including available tools, criteria, and the potential to delay disease progression with timely intervention.
- Exploring type 1 diabetes staging and the role of therapies like teplizumab in delaying progression.
- Navigating through the treatment process with teplizumab, including securing insurance approval and managing its infusion process.
- Optimizing patient outcomes by equipping health care professionals with the strategies they need to reduce associated complications and help patients improve quality of life.
To start, let’s engage the audience with a question: Who constitutes the primary population at increased risk for developing type 1 diabetes? Your options are:
- Children and adolescents
- Adults over 30
- Individuals with a family history of type 1 diabetes
- People with autoimmune conditions
- None of the above
Take a moment to answer.
Dr. Robertson, do you think there’s a significant number of undiagnosed type 1 diabetes cases in the community?
David Robertson, MD: Absolutely, but it depends on the stage. By stage III, with symptomatic hyperglycemia, many patients end up in the ER with diabetic ketoacidosis (DKA). However, research suggests there could be 100,000 to 200,000 individuals with undiagnosed stage I or stage II diabetes, in addition to the 60,000 diagnosed annually.
Morales: Let’s see what the audience says. Interestingly, many believe adults over 30 are less likely to develop type 1 diabetes. Bethany, could you elaborate on the burden of type 1 diabetes?
Bethany Kinsey, NP: Of course. I’m a nurse practitioner and certified diabetes care and education specialist (CDCES). Type 1 diabetes impacts not only patients but their entire support systems. Each year, about 64,000 Americans are diagnosed, mostly at stage III when symptoms are evident. However, screening for autoantibodies earlier could make a significant difference.
It’s important to note that type 1 diabetes can occur at any age. While 41% of diagnoses occur in individuals under age 20 hears, 59% are adults. Family history is a major risk factor for type 1 diabetes, increasing the likelihood 15-fold for first-degree relatives.
Morales: That’s an important point. Adults over 30 years old can absolutely develop type 1 diabetes, despite common misconceptions.
Kinsey: Exactly. On World Diabetes Day, November 14, we honored Dr. Frederick Banting, co-discoverer of insulin. Yet diabetes’ burden remains immense. For example, 36% of people with diabetes report distress, though I believe the actual number is higher based on my clinical experience. Fear of complications affects 63%, and 28% struggle to remain positive due to the chronic nature of the disease.
Living with type 1 diabetes impacts every aspect of life—sleep, relationships, daily activities. In clinic, it is sometimes surprising how I often act as a counselor, helping patients cope with the emotional toll, though I frequently refer them to professional therapists.
Morales: Addressing diabetes distress is critical, whether in type 1 or type 2 diabetes. Shira, how do you approach this in your practice?
Shira Eytan, MD: I make a point to ask about lifestyle concerns—How are you sleeping? How's your stress levels? How's work going? I provide them space for discussion. If distress is overwhelming, I offer referrals to therapists or schedule more frequent visits to help them feel a little bit more in control and that they have adequate time to talk about all the ups and downs. It’s about building a support system and giving patients the time they need.
Quentin Van Meter, MD: For children, school-aged children, I often ask about school performance, how are their grades and participation in extracurricular activities. Declining grades or disengagement from hobbies and sports can signal depression. These are key indicators for me to intervene.
Man With Newly Diagnosed Type 2 Diabetes: What HbA1c Goal-And How to Get There?
May 8th 2013The patient, an active 49-year-old man, had an HbA1c of 8.6 after diabetes was first diagnosed. It’s now 7.6 with metformin and lifestyle measures. Is the current A1c goal adequate, or should you treat more aggressively?
