ADULT PATIENTS ARE NOT REACHING
A1C GOAL OF <7%1

Despite decades of advances in treatment and education, poor
glycemic control persists for most patients with T1D.

Pie chart showing that for ages 18-25, 86% of patients with T1D are NOT at goal and 14% are at goal
 

 
Pie chart showing that for ages 26-49, 70% of patients with T1D are NOT at goal and 30% are at goal
 

 
Pie chart showing that for ages ≥50, 71% of patients with T1D are NOT at goal and 29% are at goal
 

 

CHALLENGES OF INSULIN ALONE

Insulin, the cornerstone of T1D therapy, is associated with several challenges including:

Bar chart graphic with grey representing hypoglycemia and red representing hyperglycemia
 

Hypoglycemia7

 
Scale graphic in grey and red
 

Weight gain which may lead to8:

  • Obesity
  • Hypertension
  • Dyslipidemia

 
Alarm clock graphic in grey and red
 

Complexity and demands of day-to-day management7

 

THE T1D PATIENT PROFILE IS INCREASING
IN COMPLEXITY

Today, patients have more co-morbidities than ever.

Most are adults, and they’re living longer with higher CV risk factors.

OVERWEIGHT/OBESE

~60% of adults1

HYPERTENSION

~3X higher prevalence than in the general population (43% vs 15%)11

CV DISEASE

10X greater risk in patients than in the general population11

HEART FAILURE (HF)

4X greater risk of hospitalization for HF than controls12

REDEFINING SUCCESS BEYOND A1C

ADA and AACE recommend using other measures to evaluate
T1D treatments, such as2:

  • Hyper- and hypoglycemia
  • Time in Range
    (Blood glucose between 70 and 180 mg/dL)
  • Patient-reported outcomes

LIMITATIONS OF A1C

While A1C is a well-accepted measure, it doesn’t tell the
whole story.

A line chart showing two different levels of glycemic variability
 

 

Day-to-day variability can vary widely,
even with a controlled A1C.9,13

TIME IN RANGE

Even with an A1C of 6.1%, see how a patient’s glycemic levels
can fluctuate daily9:

WHICH MEASURES

BEYOND A1C DO YOU USE?

T1D CAN BE A DAILY EMOTIONAL BURDEN

Patients must constantly balance insulin dosing with
food intake,
activity,
lifestyle changes, and illness,
which can impact their
emotional well-being.2,3,7

See what real patients
are saying*:

 

[T1D is] a disease that
demands SO much
of my
mental energy
and time.”

 
 

I can go weeks within
range, then have 5 days of
uncontrollable highs…”

 
 

Diabetes makes me feel
weak
and unable to
be myself.”

 

*dQ&A Online Community, 2017.

WHY
TIME IN RANGE (TIR) MATTERS

 

 

TIR is the #1 patient priority for treatment success in a survey of patients with T1D.3

NON-INSULIN PATHWAYS PLAY AN
IMPORTANT ROLE IN GLUCOSE CONTROL

SODIUM GLUCOSE CO-TRANSPORTERS (SGLT 1 AND 2)14
gut% kidney%
SGLT1 and 2 play a role in regulating blood glucose (BG) levels.
  • SGLT1: The primary glucose transporter in
    the intestine responsible for postprandial
    glucose absorption
  • SGLT2: The primary glucose transporter in
    the kidney, responsible for >90% reabsorption
    of filtered glucose
GLUCAGON15
liver%
  • An important hormone in the regulation of BG
  • Hyperglucagonemia, a hallmark of diabetes,
    is associated with hyperglycemia via increased
    hepatic glucose production
GLUCAGON-LIKE PEPTIDE-1 (GLP-1)10
brain% stomach% pancreas%

GLP-1 regulates glucose levels by:

  • Enhancing glucose-dependent insulin
    secretion
  • Inhibiting glucagon secretion
  • Suppressing appetite
  • Delaying the gastric emptying rate

JOIN THE
MOVEMENT

IT’S TIME TO
GO BEYOND INSULIN ALONE

SHARE WHY

STUDY DESIGNS
  1. 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).1

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  2. 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.9

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REFERENCES
  1. 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.

  2. 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.

  3. 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.

  4. Wright EM, Loo DDF, Hirayama BA. Biology of human sodium glucose transporters. Physiol Rev. 2011;91(2):733-794.

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. Drucker DJ. The biology of incretin hormones. Cell Metabolism. 2006;3:153-165. doi:10.1016/j.cmet.2006.01.004.

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. 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.