medwireNews: People with type 1 diabetes have high-priority concerns that go beyond glucose control, including complex and mentally taxing treatment and weight gain, report researchers.
The team looked at 15 outcomes, which were ascertained based on prior discussions with 50 members of an online diabetes community and five in-person interviews with small groups of people with type 1 diabetes.
When they surveyed 1313 people with type 1 diabetes, aged between 20 and 86 years, the respondents gave 12 of these 15 outcomes an average score above 10.0, indicating that these represented unmet needs. The three with the highest scores were:
- Simplification of diabetes management
- Achieving or maintaining target glycated hemoglobin (HbA1c) levels
- Maintaining daytime glucose levels within target range (70–180 mg/dL)
“Overall, simplification of treatment was considered the greatest opportunity for improvement on current treatments, even in the groups of patients who used insulin pumps and CGM [continuous glucose monitoring],” the team observes in Diabetes Technology & Therapeutics.
Most respondents had relatively well controlled blood glucose, with 58% having HbA1c levels below 7% (53 mmol/mol) and only 11% reporting levels higher than 8% (64 mmol/mol). They had an average BMI of 27.4 kg/m2, 78% were using an insulin pump, and 61% were using CGM.
Other high-scoring issues included reducing the mental effort needed for diabetes management, preventing weight gain, and increasing overnight time in range.
Jeremy Pettus (University of California, San Diego, USA) and study co-authors highlight that patients identified several important issues beyond simple HbA1c control. Moreover, they found that 93% of participants would consider use of adjunct sotagliflozin for its weight loss and time in range benefits, despite being aware of its risks, including the increased risk for diabetic ketoacidosis (DKA).
Indeed, when assessing the importance participants attached to the benefits and drawbacks of sotagliflozin treatment, change in bodyweight was the highest-ranked issue (25.3% attribute importance). This was followed by time in range, at 18.3%; and HbA1c, at 12.2%; with other issues scoring between 2.6% and 10.7%.
The researchers note that hypoglycemia and DKA were not highly ranked, either as unmet needs or as issues that would affect people’s decision to use sotagliflozin. They attribute the low hypoglycemia concern partly to the high proportion of people using CGM, with its attendant alerts and alarms.
However, they also suggest that this, and the lack of concern about DKA “despite its potentially serious consequences,” may indicate “a possible educational gap in patients with type 1 diabetes, which might help to improve their diabetes management, glycemic variability, and overall well-being.”
The researchers add: “The education of patients about DKA may be especially important for those who have [sodium-glucose cotransporter 2 inhibitors] added to their treatment regimens, given their potential association with increased rates of DKA.”
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Diabetes Technol Ther 2019; doi:10.1089/dia.2019.0027