The management of type 1 diabetes in adults. A consensus report by the American diabetes association (ADA) and the European association for the study of diabetes (EASD)

Richard I. G. Holt; J. Hans Devries; Amy Hess-Fischl; Irl B. Hirsch; M. Sue Kirkman; Tomasz Klupa; Barbara Ludwig; Kirsten Nørgaard; Jeremy Pettus; Eric Renard; Jay S. Skyler; Frank J. Snoek; Ruth S. Weinstock; Anne L. Peters

doi:https://doi.org/10.2337/dci21-0043

The management of type 1 diabetes in adults. A consensus report by the American diabetes association (ADA) and the European association for the study of diabetes (EASD)

Richard I. G. Holt, J. Hans Devries, Amy Hess-Fischl, Irl B. Hirsch, M. Sue Kirkman, Tomasz Klupa, Barbara Ludwig, Kirsten Nørgaard, Jeremy Pettus, Eric Renard, Jay S. Skyler, Frank J. Snoek, Ruth S. Weinstock, Anne L. Peters

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) convened a writing group to develop a consensus statement on the management of type 1 diabetes in adults. The writing group has considered the rapid development of new treatments and technologies and addressed the following topics: Diagnosis, aims of management, schedule of care, diabetes self-management education and support, glucose monitoring, insulin therapy, hypoglycemia, behavioral considerations, psychosocial care, diabetic ketoacidosis, pancreas and islet transplantation, adjunctive therapies, special populations, inpatient management, and future perspectives. Although we discuss the schedule for follow-up examinations and testing, we have not included the evaluation and treatment of the chronic microvascular and macrovascular complications of diabetes as these are well-reviewed and discussed elsewhere. The writing group was aware of both national and international guidance on type 1 diabetes and did not seek to replicate this but rather aimed to highlight the major areas that health care professionals should consider when managing adults with type 1 diabetes. Though evidence-based where possible, the recommendations in the report represent the consensus opinion of the authors.

Original language	English
Pages (from-to)	2589-2625
Number of pages	37
Journal	Diabetes Care
Volume	44
Issue number	11
DOIs	https://doi.org/10.2337/dci21-0043
Publication status	Published - 1 Nov 2021

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https://doi.org/10.2337/dci21-0043

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Holt, R. I. G., Devries, J. H., Hess-Fischl, A., Hirsch, I. B., Kirkman, M. S., Klupa, T., Ludwig, B., Nørgaard, K., Pettus, J., Renard, E., Skyler, J. S., Snoek, F. J., Weinstock, R. S., & Peters, A. L. (2021). The management of type 1 diabetes in adults. A consensus report by the American diabetes association (ADA) and the European association for the study of diabetes (EASD). Diabetes Care, 44(11), 2589-2625. https://doi.org/10.2337/dci21-0043

@article{ba7d865bf1f74a249a5b7ec4240ca81b,

title = "The management of type 1 diabetes in adults. A consensus report by the American diabetes association (ADA) and the European association for the study of diabetes (EASD)",

abstract = "The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) convened a writing group to develop a consensus statement on the management of type 1 diabetes in adults. The writing group has considered the rapid development of new treatments and technologies and addressed the following topics: Diagnosis, aims of management, schedule of care, diabetes self-management education and support, glucose monitoring, insulin therapy, hypoglycemia, behavioral considerations, psychosocial care, diabetic ketoacidosis, pancreas and islet transplantation, adjunctive therapies, special populations, inpatient management, and future perspectives. Although we discuss the schedule for follow-up examinations and testing, we have not included the evaluation and treatment of the chronic microvascular and macrovascular complications of diabetes as these are well-reviewed and discussed elsewhere. The writing group was aware of both national and international guidance on type 1 diabetes and did not seek to replicate this but rather aimed to highlight the major areas that health care professionals should consider when managing adults with type 1 diabetes. Though evidence-based where possible, the recommendations in the report represent the consensus opinion of the authors.",

author = "Holt, {Richard I. G.} and Devries, {J. Hans} and Amy Hess-Fischl and Hirsch, {Irl B.} and Kirkman, {M. Sue} and Tomasz Klupa and Barbara Ludwig and Kirsten N{\o}rgaard and Jeremy Pettus and Eric Renard and Skyler, {Jay S.} and Snoek, {Frank J.} and Weinstock, {Ruth S.} and Peters, {Anne L.}",

note = "Funding Information: Duality of Interest. R.I.G.H. serves on the speakers{\textquoteright} bureau for and receives research support from Novo Nordisk. He serves on the speakers{\textquoteright} bureau for Abbott, Eli Lilly, Otsuka, and Roche. He also served as the Editor-in-Chief of Diabetic Medicine until December 2020. J.H.D. received research funding from Afon, Eli Lilly, and Novo Nordisk. He served on advisory boards for Adocia, Novo Nordisk, and Zealand Pharma and was on a speaker{\textquoteright}s bureau for Novo Nordisk. A.H.-F. is an auditor for the ADA{\textquoteright}s Education Recognition Program. She is a participant in a speaker{\textquoteright}s bureau for Abbott Diabetes Care and Xeris. She is also a member of Xeris{\textquoteright} advisory board. I.B.H. receives industry research funding from Medtronic Diabetes, Insulet, and Beta Bionics. He is a consultant for Bigfoot, Roche, and Abbott Diabetes Care. M.S.K. receives research funding from Novo Nordisk and Bayer. T.K. has served on advisory boards for Abbott, Ascensia, Bioton, Boehringer Ingelheim, Dexcom, Eli Lilly, Medtronic, Roche, Sanofi, and Ypsomed. He has received research funding from Medtronic and is a participant in a speakers{\textquoteright} bureau for Abbott, Ascensia, Bioton, Boehringer Ingelheim, Eli Lilly, Medtronic, Novo Nordisk, Roche, Sanofi, and Servier. B.L. declares that there are no relationships or activities that might bias, or be perceived to bias, their work. K.N. receives research funding from, is a member of the advisory board for, and is a stockholder in Novo Nordisk. She is an advisory board member for Medtronic and Abbott Diabetes Care and receives research funding from Dexcom, Medtronic, and Zealand Pharma. J.P. is a consultant to Sanofi, Novo Nordisk, Eli Lilly, Zealand, Mannkind, and Diasome. E.R. serves on the advisory board for Abbott, Air Liquide SI, Dexcom, Insulet, Sanofi, Roche, Novo Nordisk, and Eli Lilly, and received research support from Dexcom and Tandem. J.S.S. is a member of the board of directors for Applied Therapeutics and Dexcom. He serves on the scientific advisory board for Abv-ance, ActoBiotics, Adocia, Avotres, Oramed, Orgenesis, Sanofi Diabetes, Tolerion, and Viacyte. He received research support from Tolerion. He is an advisor and consultant to Boehringer Ingel-heim, Dance Biopharm/Aerami Therapeutics, Enthera, Ideal Life, Imcyse, Immnomolecular Therapeutics, Novo Nordisk, Provention Bio, Sanofi Diabetes, Signos, Tolerion, and VielaBio. He is a shareholder or option holder in Abvance, Avotres, Dance Biopharm/Aerami Therapeutics, Dexcom, Ideal Life, Immnomolecular Therapeutics, Oramed, and Orgenesis. F.J.S. is consultant to Abbott, Eli Lilly, Sanofi, and Novo Nordisk, and serves on the speakers{\textquoteright} bureau for Abbott, Eli Lilly, Sanofi, and Novo Nordisk. He has received research funding from Sanofi and Novo Nordisk. R.S.W. receives research funding from Eli Lilly, Medtronic, Insulet, Diasome, Kowa, Tolerion, Novo Nordisk, and Boehringer Ingelheim. A.L.P. serves on the advisory board for Abbott Diabetes Care, Eli Lilly, Novo Nordisk, Med-scape, and Zealand Pharmaceuticals. She has received research support from Dexcom and Insu-let and has received donated devices from Abbott Diabetes Care. She also has stock options from Omada Health and Livongo and is a special government employee of the FDA. No other potential conflicts of interest relevant to this article were reported. Author Contributions. R.I.G.H. and A.L.P. were co-chairs for the consensus report writing group. A.H.-F., I.B.H., M.S.K., J.P., J.S.S., and R.S.W. were the writing group members for the ADA. J.H.D., T.K., B.L., K.N., E.R., and F.J.S. were the writing group members for the EASD. All authors were responsible for drafting the report and revising it critically for important intellectual content. All authors approved the version to be published. Funding Information: Acknowledgments. We acknowledge the support of M.I. Hill, M. Saraco, and R.A. Gab-bay (all ADA, Arlington, VA), and P. Niemann, N. Buckley-Mu€hge, and M. Gruesser (all EASD, Dusseldorf, Germany), the Committee for Clinical Affairs of the EASD, and the Professional Practice Committee of the ADA. We acknowledge A. Jones (University of Exeter, Exeter, U.K.) for his invaluable help with the “Diagnosis of Type 1 Diabetes” section. We also acknowledge D.F. Kruger (Henry Ford Health System, Detroit, MI), G. Aleppo (Northwestern University, Chicago, IL), D. Schatz (University of Florida, Gainesville, FL), J. Speight (Australian Centre for Behavioural Research in Diabetes, Melbourne, VIC, Australia), A.-G. Ziegler (Technical University of Munich, Munich, Germany), and C. Mathieu (Katholieke Universiteit Leuven, Leuven, Belgium) for serving as internal peer reviewers for the EASD and ADA. We would like to thank C. Franklin and M. Bonar of the Leicester Diabetes Centre (Leicester, U.K.) for the graphic design of the figures and R.M. Ber-genstal and the International Diabetes Center, Minneapolis (MN), for the ambulatory glucose profile (AGP) figure (Fig. 2). Funding. The report was jointly commis sioned and funded by the ADA and EASD. The authors did not receive any payment for their involvement in the writing group. Publisher Copyright: {\textcopyright} 2021 by the American Diabetes Association.",

year = "2021",

month = nov,

day = "1",

doi = "https://doi.org/10.2337/dci21-0043",

language = "English",

volume = "44",

pages = "2589--2625",

journal = "Diabetes Care",

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publisher = "American Diabetes Association Inc.",

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Holt, RIG, Devries, JH, Hess-Fischl, A, Hirsch, IB, Kirkman, MS, Klupa, T, Ludwig, B, Nørgaard, K, Pettus, J, Renard, E, Skyler, JS, Snoek, FJ, Weinstock, RS & Peters, AL 2021, 'The management of type 1 diabetes in adults. A consensus report by the American diabetes association (ADA) and the European association for the study of diabetes (EASD)', Diabetes Care, vol. 44, no. 11, pp. 2589-2625. https://doi.org/10.2337/dci21-0043

The management of type 1 diabetes in adults. A consensus report by the American diabetes association (ADA) and the European association for the study of diabetes (EASD). / Holt, Richard I. G.; Devries, J. Hans; Hess-Fischl, Amy et al.
In: Diabetes Care, Vol. 44, No. 11, 01.11.2021, p. 2589-2625.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - The management of type 1 diabetes in adults. A consensus report by the American diabetes association (ADA) and the European association for the study of diabetes (EASD)

AU - Holt, Richard I. G.

AU - Devries, J. Hans

AU - Hess-Fischl, Amy

AU - Hirsch, Irl B.

AU - Kirkman, M. Sue

AU - Klupa, Tomasz

AU - Ludwig, Barbara

AU - Nørgaard, Kirsten

AU - Pettus, Jeremy

AU - Renard, Eric

AU - Skyler, Jay S.

AU - Snoek, Frank J.

AU - Weinstock, Ruth S.

AU - Peters, Anne L.

N1 - Funding Information: Duality of Interest. R.I.G.H. serves on the speakers’ bureau for and receives research support from Novo Nordisk. He serves on the speakers’ bureau for Abbott, Eli Lilly, Otsuka, and Roche. He also served as the Editor-in-Chief of Diabetic Medicine until December 2020. J.H.D. received research funding from Afon, Eli Lilly, and Novo Nordisk. He served on advisory boards for Adocia, Novo Nordisk, and Zealand Pharma and was on a speaker’s bureau for Novo Nordisk. A.H.-F. is an auditor for the ADA’s Education Recognition Program. She is a participant in a speaker’s bureau for Abbott Diabetes Care and Xeris. She is also a member of Xeris’ advisory board. I.B.H. receives industry research funding from Medtronic Diabetes, Insulet, and Beta Bionics. He is a consultant for Bigfoot, Roche, and Abbott Diabetes Care. M.S.K. receives research funding from Novo Nordisk and Bayer. T.K. has served on advisory boards for Abbott, Ascensia, Bioton, Boehringer Ingelheim, Dexcom, Eli Lilly, Medtronic, Roche, Sanofi, and Ypsomed. He has received research funding from Medtronic and is a participant in a speakers’ bureau for Abbott, Ascensia, Bioton, Boehringer Ingelheim, Eli Lilly, Medtronic, Novo Nordisk, Roche, Sanofi, and Servier. B.L. declares that there are no relationships or activities that might bias, or be perceived to bias, their work. K.N. receives research funding from, is a member of the advisory board for, and is a stockholder in Novo Nordisk. She is an advisory board member for Medtronic and Abbott Diabetes Care and receives research funding from Dexcom, Medtronic, and Zealand Pharma. J.P. is a consultant to Sanofi, Novo Nordisk, Eli Lilly, Zealand, Mannkind, and Diasome. E.R. serves on the advisory board for Abbott, Air Liquide SI, Dexcom, Insulet, Sanofi, Roche, Novo Nordisk, and Eli Lilly, and received research support from Dexcom and Tandem. J.S.S. is a member of the board of directors for Applied Therapeutics and Dexcom. He serves on the scientific advisory board for Abv-ance, ActoBiotics, Adocia, Avotres, Oramed, Orgenesis, Sanofi Diabetes, Tolerion, and Viacyte. He received research support from Tolerion. He is an advisor and consultant to Boehringer Ingel-heim, Dance Biopharm/Aerami Therapeutics, Enthera, Ideal Life, Imcyse, Immnomolecular Therapeutics, Novo Nordisk, Provention Bio, Sanofi Diabetes, Signos, Tolerion, and VielaBio. He is a shareholder or option holder in Abvance, Avotres, Dance Biopharm/Aerami Therapeutics, Dexcom, Ideal Life, Immnomolecular Therapeutics, Oramed, and Orgenesis. F.J.S. is consultant to Abbott, Eli Lilly, Sanofi, and Novo Nordisk, and serves on the speakers’ bureau for Abbott, Eli Lilly, Sanofi, and Novo Nordisk. He has received research funding from Sanofi and Novo Nordisk. R.S.W. receives research funding from Eli Lilly, Medtronic, Insulet, Diasome, Kowa, Tolerion, Novo Nordisk, and Boehringer Ingelheim. A.L.P. serves on the advisory board for Abbott Diabetes Care, Eli Lilly, Novo Nordisk, Med-scape, and Zealand Pharmaceuticals. She has received research support from Dexcom and Insu-let and has received donated devices from Abbott Diabetes Care. She also has stock options from Omada Health and Livongo and is a special government employee of the FDA. No other potential conflicts of interest relevant to this article were reported. Author Contributions. R.I.G.H. and A.L.P. were co-chairs for the consensus report writing group. A.H.-F., I.B.H., M.S.K., J.P., J.S.S., and R.S.W. were the writing group members for the ADA. J.H.D., T.K., B.L., K.N., E.R., and F.J.S. were the writing group members for the EASD. All authors were responsible for drafting the report and revising it critically for important intellectual content. All authors approved the version to be published. Funding Information: Acknowledgments. We acknowledge the support of M.I. Hill, M. Saraco, and R.A. Gab-bay (all ADA, Arlington, VA), and P. Niemann, N. Buckley-Mu€hge, and M. Gruesser (all EASD, Dusseldorf, Germany), the Committee for Clinical Affairs of the EASD, and the Professional Practice Committee of the ADA. We acknowledge A. Jones (University of Exeter, Exeter, U.K.) for his invaluable help with the “Diagnosis of Type 1 Diabetes” section. We also acknowledge D.F. Kruger (Henry Ford Health System, Detroit, MI), G. Aleppo (Northwestern University, Chicago, IL), D. Schatz (University of Florida, Gainesville, FL), J. Speight (Australian Centre for Behavioural Research in Diabetes, Melbourne, VIC, Australia), A.-G. Ziegler (Technical University of Munich, Munich, Germany), and C. Mathieu (Katholieke Universiteit Leuven, Leuven, Belgium) for serving as internal peer reviewers for the EASD and ADA. We would like to thank C. Franklin and M. Bonar of the Leicester Diabetes Centre (Leicester, U.K.) for the graphic design of the figures and R.M. Ber-genstal and the International Diabetes Center, Minneapolis (MN), for the ambulatory glucose profile (AGP) figure (Fig. 2). Funding. The report was jointly commis sioned and funded by the ADA and EASD. The authors did not receive any payment for their involvement in the writing group. Publisher Copyright: © 2021 by the American Diabetes Association.

PY - 2021/11/1

Y1 - 2021/11/1

N2 - The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) convened a writing group to develop a consensus statement on the management of type 1 diabetes in adults. The writing group has considered the rapid development of new treatments and technologies and addressed the following topics: Diagnosis, aims of management, schedule of care, diabetes self-management education and support, glucose monitoring, insulin therapy, hypoglycemia, behavioral considerations, psychosocial care, diabetic ketoacidosis, pancreas and islet transplantation, adjunctive therapies, special populations, inpatient management, and future perspectives. Although we discuss the schedule for follow-up examinations and testing, we have not included the evaluation and treatment of the chronic microvascular and macrovascular complications of diabetes as these are well-reviewed and discussed elsewhere. The writing group was aware of both national and international guidance on type 1 diabetes and did not seek to replicate this but rather aimed to highlight the major areas that health care professionals should consider when managing adults with type 1 diabetes. Though evidence-based where possible, the recommendations in the report represent the consensus opinion of the authors.

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The management of type 1 diabetes in adults. A consensus report by the American diabetes association (ADA) and the European association for the study of diabetes (EASD)

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