TAKE THE GO BEYOND CHALLENGE

In 5 quick questions, test your knowledge about the latest data in type 1 diabetes and learn more about the daily obstacles your patients are facing.

THE GO BEYOND CHALLENGE1 of 5

About ____% of patients with T1D are not reaching the A1C goal of <7% with current management approaches.

The correct answer is 75%.1

Insulin-related challenges—like hypoglycemia, weight gain and patient burden—can limit a patient’s ability to reach target glucose levels.1,2,7

The answer is 75%.1

Insulin-related challenges—like hypoglycemia, weight gain and patient burden—can limit a patient’s ability to reach target glucose levels.1,2,7

CV risk is ____ times greater in patients with T1D than in the general population.

The correct answer is 10 times.8

Patients with T1D are living longer, with more prevalent CV risk factors like obesity and hypertension. In fact, ~60% of patients with T1D are overweight/obese and 3X more likely to be hypertensive.1,9,10

The answer is 10 times.8

Patients with T1D are living longer, with more prevalent CV risk factors like obesity and hypertension. In fact, ~60% of patients with T1D are overweight/obese and 3X more likely to be hypertensive.1,9,10

Even patients with controlled T1D can spend up to ___ hours each day out of glycemic range.

The correct answer is 9 hours.11

In the US, the average patient with T1D spends about 7 hours in hyperglycemia and more than 90 minutes in hypoglycemia daily.2

The answer is 9 hours.11

In the US, the average patient with T1D spends about 7 hours in hyperglycemia and more than 90 minutes in hypoglycemia daily.2

Patients with T1D report ______ as their #1 priority in defining treatment success.

The correct answer is Time in Range (TIR).3

While A1C is the priority for clinicians, TIR is the top priority for patients with T1D—because it can directly impact their daily life.3

The answer is Time in Range (TIR).3

While A1C is the priority for clinicians, TIR is the top priority for patients with T1D—because it can directly impact their daily life.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

Nice Job!

Share The Challenge

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
 

Hypoglycemia, which impedes2:

  • Cognitive function
  • Reaction times
  • Information processing
  • Psychomotor and executive function

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

 
Scale graphic in grey and red
 

Weight gain, which may lead to14:

  • Obesity
  • Hypertension
  • Dyslipidemia
  • Insulin resistance

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:

 
Alarm clock graphic in grey and red
 

Complexity and demands of day-to-day management17

 

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%)8

CV DISEASE

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:

  • 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.11,13

Each glucose high and low can affect
how patients feel at the time.22,*

*2018 AACE T1D Unmet Needs Survey conducted among 255 adult patients by the Harris Poll22,B

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
fluctuate daily13:

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.2,3,17

In fact, 84% of patients in a
survey worry about their blood

glucose levels.3

PERCENTAGE OF
PATIENTS
AVOIDING

LIFE-ENHANCING
ACTIVITIES22,

57% Going out to eat

49% Social gatherings

48% Exercising

45% Going on vacation

39% Driving

2018 AACE T1D Unmet Needs Survey conducted among 255 adult patients by The Harris Poll.22

Here’s what real patients
with T1D
are saying about
their condition:

 

[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 (N=50 patients with T1D).

WHAT DO PATIENTS
SAY MATTERS MOST
TO THEM?

 

 

Time in Range is the
#1 patient priority for

treatment success in a survey
of patients
with T1D.3

HOW DO YOUR PEERS
FEEL ABOUT
CURRENT T1D

MANAGEMENT?22,§

93%of endocrinologists wish
there was more they could
do for
their patients

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.

Explore the pathways with your patients

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.

Glucose absorption by SGLT1
and
release of incretin occur
following
a meal.
SGLT1 is responsible for

postprandial glucose
absorption in
the gut.
Following a meal, glucose
is
transported into the

bloodstream.

GLP is an incretin hormone
that plays a key role in
lowering
blood glucose
through its effects on
multiple organs.

GLP-1 acts on the pancreas.

GLP-1 acts on the stomach

and brain.

GLP-1 acts on the liver
and
muscle.

Glucagon is another
important hormone involved
in the regulation of blood
glucose.

Hyperglucagonemia
exacerbates hyperglycemia
in patients with diabetes.

<SGLT2 reabsorbs >90% of
glucose
filtered by the
kidney.
SGLT1 reabsorbs the
remainder of
the filtered
glucose.

LEARN WHY IT’S
TIME TO GO
BEYOND
INSULIN
ALONE
IN T1D

Watch the videos below
to see what your peers are
saying about
topics such as:

  • The challenges of insulin
    alone
  • Measures beyond A1C
  • Non-insulin pathways in
    glucose homeostasis
  • The specific challenges a
    patient faces on a daily basis

    (patient-physician dialogue)

The Challenges of Insulin Alone in the Management of Today’s Patient With T1D

 

Redefining Success Beyond A1C

 

Emotional Burden of Type 1 Diabetes

 

The Role of Non-Insulin Pathways in Glucose Homeostasis

 

The Role of Non-Insulin Pathways in Glucose Homeostasis

 

  • Now Playing The Challenges of Insulin Alone in the Management of Today’s Patient With T1D
  • Now Playing Redefining Success Beyond A1C
  • Now Playing Emotional Burden of Type 1 Diabetes
  • Now Playing The Role of Non-Insulin Pathways in Glucose Homeostasis
  • Now Playing T1D Unmet Needs Survey Results

JOIN THE
MOVEMENT

IT’S TIME TO
GO BEYOND INSULIN ALONE

SHARE WHY YOU’RE #READYTORALLY

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. 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.22

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  3. 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.13

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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. American Diabetes Association. Standards of medical care in diabetes—2018. Diabetes Care. 2018;41(Suppl.1):S1–S159.

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. 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.

  17. 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.

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

  19. 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.

  20. 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.

  21. 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.

  22. Data on file. T1D Unmet Needs Survey. Sanofi. July 2018.

  23. 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.

  24. Knop FK. A gut feeling about glucagon. Eur J Endocrinol. 2018;178(6):R267-R280.