Clinical Guidelines for Type 1 Diabetes Mellitus with an ...

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Clinical Guidelines for Type 1 Diabetes Mellitus with an Emphasis on Older Adults

A Report prepared by Sinclair AJ1 and Dunning T2 and an International Group of Experts 2019

Working Group Chairs

Professor Alan Sinclair MSc MD FRCP Visiting Professor in Diabetes Care, Kings College, London, UK

and Professor Trisha Dunning, PhD AM

Chair in Nursing Deakin University, Australia

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FOREWORD

This Guideline for managing type 1 diabetes mellitus in adults is a timely development and has created the opportunity to incorporate an emphasis on older people with this condition. It represents a decision taken by an international group of scientists and clinicians to address management concerns reflecting the increasing numbers of adults with type 1 diabetes and the continuing shortfalls in quality diabetes care that is apparent even in well-resourced clinical care pathways.

This diabetes Guideline has a key objective to educate and upskill health professionals in managing adult people with type 1 diabetes and their families by providing clear practical advice on assessment and management ; it will also have value for clinical researchers and scientists, local and national commissioners of health care strategies, and create a platform for enhancing the effectiveness of clinical interventions in reducing the public and personal health burden associated with this condition.

The Guideline has recognised that many older adults (aged 70 years and over) have type 1 diabetes and some may also present de novo with type 1 diabetes in later life. With advancing age comes the increased risk of pre-disability conditions such as frailty and dementia, and the need to consider care provided predominantly by close family and informal carers. These latter scenarios increase the complexity of type 1 diabetes management and where appropriate specific age-related recommendations have been provided. In contrast, we have not included management guidelines relating to type 1 diabetes in pregnancy as we felt this subject was outside our remit for this guideline.

Our international working group consisted of clinical experts who were each given the task of identifying new and pertinent information on type 1 diabetes in adults and have attempted where possible to provide an evidence-based approach in making recommendations. They have been assisted by being given a set of descriptive categories of a broad range of people with diabetes. The major theme in managing type 1 diabetes remains a package of `individualised care' and we have also tried to ensure that wherever possible we have adhered to key principles of diabetes care previously laid down by other diabetes organisations such

3 that our recommendations assist in enhancing health outcomes, raise the awareness of type 1 diabetes in adult and ageing populations, and uphold the importance of health equality and equity which dampens the emergence of discrimination.

Professor Alan Sinclair, Kings College, London, UK

Professor Trisha Dunning, Deakin University, Australia

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Working Group

Professor Alan Sinclair, London, UK (Working Group Co-Chair) Professor Trisha Dunning, Geelong, Australia (Working Group Co-Chair)

Professor Wayne H-H Sheu, Taichung, Taiwan Dr Shih-Yi Lin, Taichung, Taiwan Dr Ahmed Hafiz, Rotherham, UK Professor Graydon Meneilly, Vancouver, Canada Professor Medha Munshi, Harvard, USA Professor Giuseppe Paolisso, Naples, Italy Dr Raffaele Marfella, Naples, Italy Professor Leocadio Rodriguez Manas, Madrid, Spain Professor Isaac Sinay, Buenos Aires, Argentina Dr Sylvia Rosas, Boston, USA Dr Srikanth Bellary, Birmingham, UK Dr Noela M Prasad, Melbourne, Australia Dr Richard Le Mesurier, Melbourne, Australia Professor Solomon Tesfaye, Sheffield, UK Michelle Robins, Melbourne, Australia Dr Ketan Dhatariya, Norwich, UK Professor Michael Sampson, Norwich, UK

Acknowledgements Sital Harris (Birmingham, UK) ? Nutritional Therapy Professor Peter Scanlon (Cheltenham, UK) ? Diabetic Eye Disease

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Duality of interest statement Members of the Guidelines Working Group declared dualities of interest in respect of commercial enterprises, governments, and non-governmental organizations. No fees were paid to Working Group members in connexion with the current activity.

Correspondence and related literature

Correspondence to: Professor Alan Sinclair, United Kingdom: ajsinclair@

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