There is little rigorous scientific research into type 1 diabetes, and there is no clear roadmap for managing the symptoms that can result from the disease, such as heart disease and kidney disease. People with type 1 diabetes have a life expectancy that is 13 years shorter than average, and cardiovascular disease is the main cause of this shortened life expectancy.

To fill this void, a group of endocrinologists drafted a peer-reviewed standard of care document designed to guide primary care physicians who provide front-line care to the 50% of adults with type 1 diabetes. did.

“We’re doing all this great research on cardiovascular risk prevention in type 2 diabetes,” said study co-author, professor of medicine in the Department of Metabolism, Endocrinology, and Nutrition, and professor of diabetes care and supervisor at UW Medicine. said one Irl Hirsch. “Here in the United States, he has 1.8 million people with type 1 diabetes, but there’s very little direct research. I went to the New England Journal of Medicine and said, ‘Look, this is a big problem. “Yo,” he said.

“Even when you go around the world and look at guidelines, there’s not complete consensus, especially when you start looking at diabetes in adolescents and young adults.”

The result of that conversation was an article published on April 3rd. This article provides a clear and simple explanation of how heart, kidney, and liver disease manifests in type 1 patients, and provides the best treatment options for hyperglycemia, hypertension, obesity, and some specific heart conditions. It is specified.

Hirsch and his colleagues believe this guidance is important. A 2014 Swedish study found that people with type 1 diabetes who had well-regulated blood sugar levels were twice as likely to die from cardiovascular events. Women are twice as likely to die as men.

“This went through rigorous peer review, but even the reviewers didn’t all agree because there was no clear evidence,” Hirsch said. “I think some of our conclusions may generate academic disagreement, and that’s fine. But we’ve done this as well as we can, and we’ve done it in very typical patient cases. I gave a presentation.”

Hirsch said the care of kidney patients is one area where the new guidance could have a major impact.

“Kidney disease does not change kidney function, and albumin alone in the urine can dramatically change the risk of cardiovascular disease,” Dr. Hirsch says. “That’s a really important point. Here at UW Medicine, he’s working on a project funded by the Juvenile Diabetes Research Foundation to evaluate drugs used for type 2 diabetes and kidney disease and their effectiveness in type 1 diabetes. We are about to start two clinical trials.”

Treatment of type 2 diabetes has recently experienced a boom. Unfortunately, patients with type 1 diabetes have not had access to GLP-1 drugs (Ozempic, Wegovy) that are approved for type 2 diabetes and obesity and have also shown efficacy against heart and kidney disease. . Patients with type 1 diabetes are also not candidates for SGLT2 inhibitors (Jardiance, Farxiga) due to the risk of diabetic ketoacidosis.

“These drugs are very effective in type 2 diabetes,” Hirsch says. “However, SGLT2 inhibitors come with a black box warning and are contraindicated in type 1 diabetes. Importantly, the kidneys, which are very closely linked to cardiovascular disease, and in the prevention of cardiovascular disease in general, The tools we have for type 1 diabetes don’t exist for type 1 diabetes. There’s no single treatment that fits both types of diabetes.”

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