The report was further revised in light of this consultation. The revised draft report was presented at the virtual ADA Scientific Sessions in 2021, after which public comments were invited. The draft consensus report was peer reviewed (see the Acknowledgments section) and suggestions were incorporated as deemed appropriate by the authors. Each section, in turn, was reviewed and approved by the entire writing group. The chosen individuals had specific knowledge of the area and were tasked with reviewing and summarizing the available literature. Two members of the writing group, one from the ADA and one from the EASD, were assigned to be the primary authors of each section. While acknowledging the major significance and cost of screening, diagnosing, and managing the chronic microvascular and macrovascular complications of diabetes, a detailed description of the management of these complications is beyond the scope of this report. The importance of diabetes self-management education and support (DSMES) and psychosocial care are rightly documented in the report. In addition to complex medication regimens, other behavioral modification is also needed all of this requires considerable knowledge and skill to navigate between hyper- and hypoglycemia. Unlike many other chronic conditions, type 1 diabetes places a unique burden of management on the individual with the condition. Recent advances in the diagnosis of type 1 diabetes have been considered. The consensus report has focused predominantly on current and future glycemic management strategies and metabolic emergencies. The writing group was aware of both national and international guidance on type 1 diabetes and did not seek to replicate this, but rather aimed to highlight the major areas of care that health care professionals should consider when managing adults with type 1 diabetes. ![]() Recognizing the ongoing challenge of type 1 diabetes and the rapid development of new treatments and technologies, the European Association for the Study of Diabetes (EASD) and the American Diabetes Association (ADA) convened a writing group to develop a consensus report on the management of type 1 diabetes in adults, aged 18 years and over. Basal insulin analogs were designed with prolonged duration of action and reduced pharmacodynamic variability compared with protamine-based (NPH) human insulin, while rapid-acting analogs were introduced with quicker onset and shorter duration than short-acting (“regular”) human insulin, resulting in reduced early postprandial hyperglycemia and less later hypoglycemia several hours after the meal ( 3). In the 1980s, semisynthetic and recombinant human insulins were developed, and in the mid 1990s, insulin analogs became available. Over the ensuing decades, insulin concentrations were standardized, insulin solutions became more pure, resulting in reduced immunogenicity, and additives, such as zinc and protamine, were incorporated into insulin solutions to increase the duration of action. Beginning in 1922, relatively crude extracts of exogenous insulin, derived from animal pancreases, were used to treat people with type 1 diabetes. Prior to the discovery of insulin a century ago, type 1 diabetes was associated with a life expectancy as short as a few months. ![]() ![]() Though evidence-based where possible, the recommendations in the report represent the consensus opinion of the authors. The writing group was aware of both national and international guidance on type 1 diabetes and did not seek to replicate this but rather aimed to highlight the major areas that health care professionals should consider when managing adults with type 1 diabetes. Although we discuss the schedule for follow-up examinations and testing, we have not included the evaluation and treatment of the chronic microvascular and macrovascular complications of diabetes as these are well-reviewed and discussed elsewhere. The writing group has considered the rapid development of new treatments and technologies and addressed the following topics: diagnosis, aims of management, schedule of care, diabetes self-management education and support, glucose monitoring, insulin therapy, hypoglycemia, behavioral considerations, psychosocial care, diabetic ketoacidosis, pancreas and islet transplantation, adjunctive therapies, special populations, inpatient management, and future perspectives. The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) convened a writing group to develop a consensus statement on the management of type 1 diabetes in adults.
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