ANNE PETERS: So we've never had a specific guideline for people with type 1 diabetes. And one of the problems is that people with type 1 diabetes have always had to fall under people with type 2 diabetes in terms of guidelines, and it's a completely different disease.
And we also recognized that the ADA/EASD type 2 physician statement or consensus guideline or whatever they call it for type 2s has received a lot of notice. It's changed how we practice medicine for people with type 2 diabetes. So we believe that type 1 diabetes is a separate entity and therefore deserved its own consensus report. And I think we've managed to do it.
There are so many things, by the way, that aren't well done. I'm just pointing this out. But let me just say it, I'm a clinician. And I take care of hundreds and hundreds of people with diabetes. And the biggest missing portion is a focus on the psychosocial, issues the psychological problems the anxiety, the depression, the diabetes distress, the mental health help.
And I also think that it's so hard to always have to think about what you're doing and eating and exercise and everything else. And with type 1 diabetes, it's this huge overlay to the whole rest of your life. And if you're stressed, if you're distressed, if you're working two jobs, if you have a couple of kids at home.
If whatever else is happening in your life is going on, and you don't have the help and support you need, and you don't particularly have the psychological support, it's really hard to manage a disease as complicated as type 1 diabetes. So I think that throughout the report, we keep saying this care is individualized. And you can never forget that component to care.
That if you don't help a patient from whatever their psychological needs are, whatever their social environment is, you can't heal them. And so we need to really be conscious of that. In a very specific way, the report says that the automated insulin delivery systems, which are the most technically advanced systems, are, in fact, the best system for managing type 1 diabetes, and they've compared it to other systems, and we want people to have access to that.
But not everybody wants that. And I think that people need to realize they have a choice, and they can choose amongst the different systems. So I think patient choice and individualization of care is noted throughout.
And then there's a really interesting beginning to the whole document, which is how do you diagnose type 1 diabetes? And there's a lot of confusion because everybody thought it happened in childhood, but it can happen at any age and. Providers often are unaware of what they should be thinking in terms of getting an adult patient, saying is this type 1 or type 2 and how do we figure it out?
So I think there's really good guidance that personally, I've never seen before defined as well for how to diagnose type 1 diabetes. So there's a lot inherent in there. But I think that the take-home is, look at the individual, diagnose them correctly, and then give them the support they need, plus all the different pieces and tools and insulins they need to manage their disease.
It's a good question. So I think you'd have to ask an individual that. But I think that providers need to consider it a part of care. So if a patient wants it, they should have it, and a provider should offer it.
And in fact, I don't ever impose my beliefs on a patient, but I tell them that I think most people who wear at least a continuous glucose monitor tend to do better because they can see their highs in their lows. They can be alarmed if they're going to go low. It's a safety tool in a way.
So I tell people why I think it's helpful, and I think that people should use them. But again, it's my job is access. And then an individual patient's job is to figure out what works for them. So I try to integrate that. But I think providers all need to provide access to technology if people have type 1 diabetes.
I think that there's a gap in terms of diagnosis. And we don't know the prevalence in other populations. But I also feel that the management is the same, but it's the diagnosing part. So I work in east Los Angeles. I work in a very under-resourced part of town.
And there most of my patients are Latino. And they all look like they have type 2 diabetes because they have metabolic syndrome. They have hypertension and dyslipidemia.
And yet, I have a whole clinic of people with type 1. And if you looked at them, you'd say it's type 2. And so it's important to start studying it in those populations. But we haven't studied in those populations because it's rarer and type 2 is so common in those populations.
And the other thing is that in the United States, we can't test for MODY very easily. And so it's much more common in Europe to test for MODY because the gene tests are less expensive or more available. So I have lots of patients where I am sure that they have MODY where I can't test them.
So I think that we need to know more in these other populations, but people need to fund the research. But I clinically do it all the time-- diagnose type 1 diabetes in these populations where you don't think that it's common, but we don't even know. So I'm the one who made them put that part about it this is data that's relevant to a European, Caucasian population because you've got to define what you're even looking at.
So I hate to say it, but I really said that we have to define who this works in because we don't know. We don't know if it works in a different population, in my east LA population. But I just think clinicians need to realize that studies happen in a specific group of people. And we need to understand how generalizable that is.
Well, I don't think this is a knowledge gap, but I think it's a treatment gap-- is that the biggest problem with type 1 diabetes is hypoglycemia, low blood sugars. And the insulin delivery systems will suspend if you're on an automated system and try to give you less insulin. But it doesn't necessarily just bring you back quickly.
And glucagon is the antidote to insulin. And what I would love to see, now that we have these stable soluble forms of glucagon, is ways to give glucagon to bring blood sugars back up so people are more even. And they're working on these hybrid closed loop systems which have glucagon and insulin.
But short of that, I think it'd be really cool to even have glucagon for someone to give before they go exercising so their blood sugars stay up so they don't go low so it's not such a problem. So what I'd love to see, in addition to everything else, is a better way to balance insulin with X, Y, or Z. And glucagon is a good balance.
So I'd love to see us have ways of giving glucagon that gave little small doses to help periods of time of mild hypoglycemia so people have more balance. It's all about balance because the blood sugars can go up and they can go down. And it's all up to the patient to balance it out. And the more tools I can give someone to balance their diabetes, their blood sugars, the better.
It's a very good question. So the first thing is, is that it was 14 of us who were supposed to be meeting in-person over the course of a year and a half, and it all was on Zoom. And Richard Holt from the UK was my co-chair and actually the one who wanted to do this to begin with. And he was amazing.
I could have never asked for a better partner than him. But I've never seen him in-person. And every single one of us on the calls, the 14 of us, had our own perspectives. And I'm not so sure it was because it was Europe versus the US. But part of it had to do with everybody had their own way and their own research areas. So we were very disparate that way.
But every single person on the committee really cared about the health of people with type 1 diabetes. So it was more a group of people who really cared, coming from different perspectives, trying to create consensus. And we did. I mean, we all agree with everything, which is shocking.
And I can't imagine how we could have done that so effectively, but it worked. And I'm looking forward to them. We all go out and have a beer together in real life. But I think it was a really good committee that worked.
And the differences between the US and Europe weren't the big difference. It really had to do with who knew more about what. And it was more synergistic because I thought it would all be about access to health care, whatever, but it wasn't.
It was really about what's best for the patient. And patients are people, and people are people everywhere. So one of the better experiences of my academic life was working on this committee. It was pretty cool.