Treatment | Diabetes Textbook

Big gains in type 1 diabetes glucose-control management in recent years

A new study led by researchers at the Johns Hopkins Bloomberg School of Public Health reveals significant improvements in blood sugar management among individuals with type 1 diabetes over the past 15 years, driven by the widespread adoption of continuous glucose monitoring (CGM) and insulin delivery devices.

The study analyzed nearly 200,000 de-identified electronic health records from 2009 to 2023, tracking the use of CGM and insulin pumps alongside blood sugar control (measured by HbA1c levels). Key findings include:

Improved Glucose Control: The percentage of children under 18 with optimal HbA1c levels (<7%) rose from 7% (2009–2011) to 19% (2021–2023)—a 171% increase. Among adults, optimal control increased from 21% to 28% (33% increase).
Surge in Technology Use:
- CGM adoption skyrocketed from 4% to 82% in youths and 5% to 57% in adults.
- Insulin pump use rose from 16% to 50% in youths and 11% to 29% in adults.
- Concurrent use of both devices jumped from 1% to 47% in youths and 1% to 22% in adults.

Despite progress, disparities persist, with non-Hispanic white patients and those with commercial insurance showing higher rates of technology adoption and glucose control. For example, only 12% of non-Hispanic Black youths achieved optimal control in 2021–2023, compared to 21% of non-Hispanic white youths.

The researchers emphasize the need for better access to diabetes technologies to reduce these gaps. While the advancements are promising, most patients still do not meet optimal glucose targets, indicating room for further improvement.

Published in JAMA Network Open (August 11), the study highlights how modern diabetes technologies have transformed care, with future research planned to examine long-term complications like heart and kidney disease in type 1 diabetes patients.

Key Takeaways:

Technology Drives Improvement: CGM and insulin pumps have significantly enhanced blood sugar management.
Disparities Remain: Racial and insurance-based gaps in access and outcomes need addressing.
Ongoing Challenges: Most patients still lack optimal control, calling for further innovation and policy changes.

DASH Diet Modified for Diabetes Lowers Blood Sugar Levels in Clinical Trial

A recent clinical trial led by researchers at Johns Hopkins Bloomberg School of Public Health found that a modified version of the DASH diet, called DASH4D, is effective in lowering blood sugar levels in adults with type 2 diabetes. The DASH4D diet is similar to the original DASH diet but is lower in carbohydrates and higher in unsaturated fats, with reduced potassium levels to improve safety for individuals with chronic kidney disease.

The study, published in Nature Medicine, involved 89 participants with type 2 diabetes who ate prepared meals at a clinical research center for 20 weeks. The results showed that when participants consumed the DASH4D diet, they had a clinically meaningful reduction in average blood glucose level and an increase in average time spent with blood glucose in the recommended range compared to when they consumed a standard diet.

Specifically, the study found that:

Participants on the DASH4D diet had blood sugar levels that were on average 11 mg/dL lower than when eating the standard diet.
Participants on the DASH4D diet stayed in the optimal blood glucose range for an extra 75 minutes a day.
Larger improvements were seen in participants who had higher blood glucose levels at the start of the trial, with those with HbA1c above 8% experiencing an increase in time in the optimal blood glucose range by about three hours per day.

The researchers hope that the results will lead to incorporating the DASH4D diet into clinical guidelines and improving type 2 diabetes management in the broader population. The study’s findings suggest that the DASH4D diet can be a sustainable and effective approach to managing type 2 diabetes, with potential benefits for population health.

Phase 3 study supports use of canagliflozin for type 2 diabetes in children and adolescents

A recent phase 3 clinical trial published in Annals of Internal Medicine supports the use of canagliflozin for treating type 2 diabetes in children and adolescents. The study involved 171 participants aged 10-18 years with inadequate glycemic control, who received either oral canagliflozin or a placebo for 52 weeks.