Another month, another international conference for the CWD Team this spring. After spending a week in Amsterdam for ATTD, the team visited Bangkok, Thailand, for the International Diabetes Federation conference. This conference happens every three years and tends to cover broader topics in diabetes than ATTD.
On the first day of the conference, Dr. Chantal Mathieu presented about using CGMs to screen for diabetes. Based on the latest research, Dr. Mathieu suggests that the nomenclature regarding diabetes is shifting to help include those with only one positive antibody, which is still a gray area. She presented data that showed using a CGM to diagnose different stages of diabetes is significantly more accurate than using an HbA1C or an oral glucose tolerance test (OGTT). The timing and frequency of using CGM to screen for diabetes at various stages are still to be determined.
More data that was presented:
- The risk for diagnosis of stage 3 diabetes at 5 years for someone with stage 1 diabetes is 44%; for those with stage 2 diabetes, it’s 75%.
- 18% time above range (>140 mg/dl) seems to be the tipping point for the likelihood of rapid progression from stage 2 to stage 3 type 1 diabetes.
- Screening helps reduce the risk for DKA, allows for psychosocial adjustment, diabetes education before symptoms start, development of glycemic management skills, and potentially enrollment in clinical trials to help delay the onset.
In the same session, Dr. Viral Shah presented data on using CGM in people without diabetes as a baseline for people with diabetes. He discussed CGM as the standard of care for T1D and a much better tool than HbA1C. Dr. Shah states that current research shows that the earlier the CGM is started after diagnosis, the better. He showed data from a large study of adults with diabetes that starting within the first six months led to the best outcomes.
The study showed that even when adding CGM later, with an average start of 2.5 years into diagnosis, the HbA1C remained 1-1.2% higher than those who started within the first 6 months. Further data presented shows that the glycemic trajectory for a person with diabetes is set in the first 3-15 months after diagnosis, emphasizing the importance of early access to technology. Regarding access, Dr. Shah stated, “Any amount of CGM is better than no CGM,” and he encouraged attendees to prioritize getting their patients on CGM.
In a session focused on expanding the use of automated insulin delivery (AID) systems, presenters discussed using them for the elderly, people with cognitive impairment, fasting during Ramadan, disordered eating, and people who are incarcerated. All these populations found improvement in outcomes with AID systems, as well as those with both type 1 and type 2 diabetes on dialysis. Dr. Katarina Braune from Germany presented the lived experience of people with diabetes using AID systems and emphasized the importance of offering choices to help PWD succeed.
There was also a session about the heterogeneity of T1D, discussing the ever-changing data about the spectrum of diabetes. Presenters discussed the challenges of identifying the number of adults with T1D due to misdiagnosis and underreporting. Speakers presented about latent autoimmune diabetes in adults (LADA) and the variable experiences of people with the diagnosis. A new focus for diagnosed adults is preserving beta-cell function and cardiorenal protection. Possible contributing factors to susceptibility of diagnosis of T1D include higher BMI at 12 months of age, infections in the chest or gut, lower volume of the pancreas, and higher levels of monocytes in the blood.
Another area of focus was patient involvement in diabetes research and care. Emma Doble from the United Kingdom discussed how she has been working with the British Medical Journal (BMJ) as a patient editor. More and more journals have partnered with people living with different conditions to ensure that articles published are written with the patient’s perspective in mind. The World Health Organization released a statement in 2024 encouraging social participation in research and publications.
The conference was encouraging all around, and the ability to connect with diabetes community members across the globe was incredibly rewarding. The opportunities to collaborate and help each other are endless, and we at CWD are excited to pursue new ways to help the global diabetes community.
Written and clinically reviewed by Marissa Town, RN, BSN, CDCES
