For U.S. Healthcare Professionals Only.
The correct answer is 75%.1
The answer is 75%.1
CV risk is ____ times greater in patients with T1D than in the general population.
The correct answer is 10 times.8
The answer is 10 times.8
Even patients with controlled T1D can spend up to ___ hours each day out of glycemic range.
The correct answer is 9 hours.11
The answer is 9 hours.11
Patients with T1D report ______ as their #1 priority in defining treatment success.
The correct answer is Time in Range (TIR).3
The answer is Time in Range (TIR).3
Non-insulin pathways that play a role in glucose homeostasis include:
The correct answer is all of the above.4,12
The answer is all of the above.4,12
ADULT PATIENTS ARE NOT REACHING
A1C GOAL OF <7%1
CHALLENGES OF INSULIN ALONE
Insulin, the cornerstone of T1D therapy, is associated with several challenges including:
Hypoglycemia, which impedes2:
If left untreated, may lead to seizures, coma, or death.2
Fear of hypoglycemia is a barrier to optimal glycemic control and can cause greater glycemic variability, greater calorie intake, and less physical activity.13
Weight gain, which may lead to14:
Insulin resistance, which affects approximately 20% of patients with T1D, is a significant factor in the progression of T1D, and an independent risk factor for CVD.15,16:
Complexity and demands of day-to-day management17
THE T1D PATIENT PROFILE IS INCREASING
Today, patients have more co-morbidities than ever.
Most are adults, and they’re living longer with higher CV risk factors.
~60% of adults1
~3X higher prevalence than in the general population (43% vs 15%)8
10X greater risk in patients than in the general population8
HEART FAILURE (HF)
4X greater risk of hospitalization for HF than controls19
JOIN THE MOVEMENT
BECAUSE PATIENTS WITH T1D NEED MORE
REDEFINING SUCCESS BEYOND A1C
ADA and AACE recommend using other measures to evaluate
T1D treatments, such as2:
LIMITATIONS OF A1C
While A1C is a well-accepted measure, it doesn’t tell the
Day-to-day variability can vary widely,
even with a controlled A1C.11,13
Each glucose high and low can affect
how patients feel at the time.22,*
TIME IN RANGE
In a day, the average patient with T1D spends ~7 hours in hyperglycemia
and >90 minutes in hypoglycemia.2
Even with an A1C of 6.1%, see how a patient’s glycemic levels can
T1D CAN BE A DAILY EMOTIONAL BURDEN
Patients must constantly balance insulin dosing with
lifestyle changes, and illness, which can impact their
In fact, 84% of patients in a
survey worry about their blood
57% Going out to eat
49% Social gatherings
45% Going on vacation
Here’s what real patients
with T1D are saying about
[T1D is] a disease that
demands SO much
I can go weeks within
range, then have 5 days of
Diabetes makes me feel
and unable to
WHAT DO PATIENTS
SAY MATTERS MOST
HOW DO YOUR PEERS
93%of endocrinologists wish
there was more they could
72%feel limited by the
available T1D options
§2018 AACE T1D Unmet Needs Survey conducted by The Harris Poll.22
NON-INSULIN PATHWAYS PLAY AN
IMPORTANT ROLE IN GLUCOSE CONTROL
Watch how SGLT1, GLP-1, glucagon, and SGLT2 affect glucose homeostasis in different organ systems in a patient with T1D in the video below.
Here’s an in-depth look at how each of the non-insulin pathways are involved in glucose homeostasis and which organ systems they affect.
GLP is an incretin hormone
that plays a key role in
through its effects on
GLP-1 acts on the pancreas.
GLP-1 acts on the stomach
GLP-1 acts on the liver
Glucagon is another
important hormone involved
in the regulation of blood
in patients with diabetes.
IT’S TIME TO
GO BEYOND INSULIN ALONE
Evidence gathered from 76 US-based pediatric and adult endocrinology practices in 33 states to assess A1C over the life span. 16,061 patients with T1D were grouped according to age at the time of the most recent A1C value available and a mean A1C was computed for that age using recently updated data (87% measured in-clinic point-of-care device, 11% local laboratory, and 2% unknown).1RETURN>
Poll assessing the attitudes of endocrinologists and adults living with type 1 diabetes (T1D) in the United States about managing the disease, the unmet needs of the community, perceptions of new disease-management advances, and attributes of future innovations that might benefit the community.22RETURN>
A prospective repeated-measures design was used with real-time event monitoring, questionnaires, and a daily fear diary. Thirty-seven patients 8 to 35 years of age with T1D diagnosed for at least 1 year were recruited. Data were collected over 6 consecutive days.13RETURN>
Miller KM, Foster NC, Beck RW, et al. T1D Exchange Clinic Network. Current state of type 1 diabetes treatment in the U.S.: updated data from the T1D Exchange Clinic Registry. Diabetes Care. 2015;38(6):971-978.
Agiostratidou G, Anhalt H, Ball D, et al. Standardizing clinically meaningful outcome measures beyond HbA1c for type 1 diabetes: A consensus report of the American Association of Clinical Endocrinologists, the American Association of Diabetes Educators, the American Diabetes Association, the Endocrine society, JDRF International, The Leona M. and Harry B. Helmsley Charitable Trust, the Pediatric Endocrine society, and the T1D Exchange. Diabetes Care. 2017;40(12):1622-1630.
Runge AS, Kennedy L, Brown AS, et al. Does time-in-range matter? Perspectives from people with diabetes on the success of current therapies and the drivers of improved outcomes. Clin Diabetes. 2017 Dec; cd170094. doi.org/10.2337/cd17-0094.
Wright EM, Loo DDF, Hirayama BA. Biology of human sodium glucose transporters. Physiol Rev. 2011;91(2):733-794.
Gorboulev V, Schürmann A, Vallon V, et al. Na+-D-glucose cotransporter SGLT1 is pivotal for intestinal glucose absorption and glucose-dependent incretin secretion. Diabetes. 2012;61(1):187-196.
Munir KM, Davis SN. The treatment of type 1 diabetes mellitus with agents approved for type 2 diabetes mellitus, Expert Opin Pharmacother. 2015;16(15):2331-2341. doi:10.1517/14656566.2015.1084502.
American Diabetes Association. Standards of medical care in diabetes—2018. Diabetes Care. 2018;41(Suppl.1):S1–S159.
de Ferranti SD, de Boer IH, Fonseca V, et al. Type 1 diabetes mellitus and cardiovascular disease. A scientific statement from the American Heart Association and American Diabetes Association. Circulation. 2014;130:1110-1130.
Bode BW, Garg SK. The emerging role of adjunctive noninsulin antihyperglycemic therapy in the management of type 1 diabetes. Endocr Pract. 2016;22(2):220-230.
Maahs DM, Kinney LG, Wadwa P, et al. Hypertension prevalence, awareness, treatment, and control in an adult type 1 diabetes population and a comparable general population. Diabetes Care. 2005;28(2):301-306.
Bolinder J, Antuna R, Geelhoed-Duijvestijn P, Kröger J, Weitgasser R. Novel glucose-sensing technology and hypoglycaemia in type 1 diabetes: a multicentre, non-masked, randomised controlled trial. Lancet. 2016;388:2254-2263.
Pettus J, Reeds D, Cavaiola TS, et al. Effect of a glucagon receptor antibody (REMD-477) in type 1 diabetes: a randomized controlled trial. Diabetes Obes Metab. 2018;1-4. Accessed May 1, 2018. doi:10.1111/dom.13202.
Martyn-Nemeth P, Quinn L, Penckofer S, Park C, Hofer V, Burke L. Fear of hypoglycemia: influence on glycemic variability and self-management behavior in young adults with type 1 diabetes. J Diabetes Complications. 2017;31(4):735-741.
Purnell JQ, Hokanson JE, Cleary PA, et al. The effect of excess weight gain with intensive diabetes treatment on cardiovascular disease risk factors and atherosclerosis in type 1 diabetes: Results from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study (DCCT/EDIC) study. Circulation. 2013;127(2):180-187.
Fourlanos S, Narendran P, Byrnes GB, Colman PG, Harrison LC. Insulin resistance is a risk factor for progression to Type 1 diabetes. Diabetologia. 2004;47:1661-1667.
Dabelea D, Pihoker C, Talton JW, et al. Etiological approach to characterization of diabetes type: the SEARCH for Diabetes in Youth Study. Diabetes Care. 2011;34:1628-1633.
Aschner P, Horton E, Leiter LA, Munro N, Skyler JS; the Global Partnership for Effective Diabetes Management. Practical steps to improving the management of type 1 diabetes: recommendations from the Global Partnership for Effective Diabetes Management. Int J Clin Pract. 2010;64(3):305-315.
Drucker DJ. The biology of incretin hormones. Cell Metabolism. 2006;3:153-165. doi:10.1016/j.cmet.2006.01.004.
Rosengren A, Vestberg D, Svensson AM, et al. Long-term excess risk of heart failure in people with type 1 diabetes: a prospective case-control study. Lancet Diabetes Endocrinol. 2015;3:876-885.
Katz M, Giani E, and Laffel L. Challenges and opportunities in the management of cardiovascular risk factors in youth with type 1 diabetes: lifestyle and beyond. Curr Diab Rep. 2015;15(119):1-11.
Morrish NJ, Wang S-L, Stevens, LK, Fuller JH, Keen H; WHO Multinational Study Group. Mortality and causes of death in the WHO multinational study of vascular disease in diabetes. Diabetologia. 2001;44[Suppl 2]:S14-S21.
Data on file. T1D Unmet Needs Survey. Sanofi. July 2018.
Song P, Onishi A, Koepsell H, Vallon V. Sodium glucose cotransporter SGLT1 as a therapeutic target in diabetes mellitus. Exp Opin Ther Targets. 2016;20(9):1109-1125.
Knop FK. A gut feeling about glucagon. Eur J Endocrinol. 2018;178(6):R267-R280.