Speaker 1:

Welcome to AACE Podcasts. Thanks for tuning in as we elevate clinical endocrinology by taking deep dives into trends and topics that can help us improve our patient care and global health. Find the latest episodes on aace.com/podcasts. And now let's meet the endocrine experts who will be talking with us today.

Hi and welcome to another AACE podcast.

Introduction

I'm Dr. Lubaina S. Presswala. I'm a clinical endocrinologist, an assistant attending physician at Memorial Sloan Kettering Cancer Center, and assistant professor of Medicine at Weill Cornell Medicine in New York.

I am the online resource work group leader for the Diabetes Disease State Network at AACE.

My area of expertise is diabetes management and the use of advanced diabetes technologies in people with cancers.

Topic Introduction

Today we are discussing a very important and exciting topic: the early detection and monitoring of Type One diabetes.

Before we begin, I'd like to thank our sponsor Sanofi for their support in bringing this engaging podcast to our listeners.

Guest Introductions

Joining me today are two leading endocrinologists, Dr. Jeff Unger and Dr. Javier Morales, who bring extensive experience in managing diabetes.

Dr. Unger, welcome to our podcast. Please introduce yourself and tell us a little bit about yourself.

It's great to be here. I'm a family physician as well as a diabetologist, practicing concierge medical care, dealing with intensive diabetes management in Southern California. I am honored to be here.

Dr. Morales, please introduce yourself to our listeners.

Sure. My name is Dr. Javier Morales. I am an internist practicing in Long Island and a diabetologist. I am an associate clinical professor of medicine at the Donald and Barbara Zucker School of Medicine at Hofstra Northwell. I also practice with the Advanced Internal Medicine Group located in East Hills, New York. Thank you for inviting me.

The Burden of Type One Diabetes

So let me start by highlighting the significance of type one diabetes. There are about 8.4 million individuals worldwide with type one diabetes, and predictions estimate this number may increase to 15 million by the year 2040.

Dr. Unger, can you elaborate on the enormous burden associated with type one diabetes?

Yeah, it's scary. Every year, 64,000 new Americans are diagnosed with type one diabetes. This is a disease that never goes away. It's like being at work 24 hours a day for the rest of your life. It’s important to identify this disease early, educate patients, and treat it intensively from the start.

Screening for Type One Diabetes

Dr. Morales, can you explain the different stages of type one diabetes and the key factors in each stage?

Sure. There are three stages:

• Stage One: The immune system begins attacking beta cells, but blood sugar levels remain normal and there are no symptoms.
• Stage Two: Beta cell destruction continues, leading to dysglycemia, but symptoms have not yet appeared.
• Stage Three: Significant beta cell destruction leads to hyperglycemia, requiring insulin therapy. Symptoms such as increased thirst, frequent urination, fatigue, and weight loss become apparent.

The Importance of Early Detection

Dr. Unger, who should be screened for type one diabetes?

We should screen anyone at risk—those with a family history of type one diabetes, autoimmune disorders like Hashimoto's thyroiditis, celiac disease, or vitiligo. If a person has two or more autoantibodies, they are at significant risk.

Current Advances in Treatment

Fortunately, we now have an immune-modulating drug, Teplizumab, that can delay the need for insulin therapy for up to three years. This is a major advancement in the treatment of type one diabetes.

Challenges in Screening

One of the biggest challenges we face is encouraging people to get screened. Many families delay screening despite the known benefits. We need to emphasize the importance of early detection to prevent complications and improve long-term outcomes.

Monitoring Post-Screening

Once a patient has been screened, continuous glucose monitoring (CGM) can help track blood sugar levels and detect trends that may indicate disease progression.

Role of Lifestyle Changes

Dr. Morales, do lifestyle changes help delay the onset of type one diabetes?

Yes, but CGM is the key. It allows us to track how diet and exercise impact blood sugar levels. While lifestyle changes are important, CGM provides real-time feedback that helps patients make better decisions.

Addressing Emotional Distress

Type one diabetes can be overwhelming for patients and families. The emotional burden, often called diabetes distress syndrome, affects many people. Support from healthcare professionals, diabetes educators, and mental health resources is essential.

Final Thoughts

Dr. Unger, what are the key takeaways for clinicians?

Primary care physicians should take the lead in screening. If a patient has a family history of type one diabetes or autoimmune diseases, screening should be done early. If two autoantibodies are detected, CGM should be used for monitoring.

Dr. Morales, any final thoughts?

Early detection is crucial. If you have a family history of type one diabetes or an autoimmune disorder, get screened. Identifying risk early allows for intervention that can delay disease progression and improve outcomes.

Conclusion

Thank you, Dr. Unger and Dr. Morales. We appreciate your insights on this critical topic.

We also want to thank our sponsor, Sanofi, for their support in bringing this engaging podcast to our listeners.

Thank you for tuning in.

Speaker 1:

Thanks for listening to another great AACE podcast. Join us for another episode at aace.com/podcasts and help us in our mission to elevate clinical endocrinology. Together we are AACE.