Scientists from the American Diabetes Association (ADA) held an open Twitter chat to discuss new guidelines for children with Type 1 diabetes, as part of the rollout of the association’s first Type 1-only position paper. Endocrinologists Dr. Jane Chiang and Dr. Sue Kirkman fielded questions for the ADA.
In a move that stirred up online chatter, the ADA tightened its A1C goals for children. Previously, ADA guidelines called for A1C goals of 8.5 or lower for children under 6 years old, 8.0 or lower for children ages 6 to 12, and then 7.5 or lower for teens. The new guidelines now call for an A1C score of 7.5 or lower for all children, regardless of age.
The recently-released position paper is the first from the ADA to discuss Type 1 diabetes exclusively. In the past, Type 1 and Type 2 guidelines were lumped together. Issuing Type 1-only position papers will help physicians focus on the unique characteristics and treatment options for Type 1, Dr. Chiang said.
“Diabetes is not a one-size-fits-all disease, and it’s important that we recognize that,” Dr. Chiang said
A1C goals for children were tightened because new research shows that children with high blood glucose levels before puberty are at greater risk for heart and kidney problems later on in life, according to Dr. Chiang. A1C guidelines always must balance the long-term health impact of high blood glucose levels with the short-term danger of hypoglycemia. In the past, an A1C goal of 7.5 or lower for children seemed too difficult to reach without risking increased hypoglycemia. Dr. Kirkman believes that pumps and other advances in diabetes home care technology will now make such a goal more attainable without dire risk of hypoglycemia.
“There will always be concerns about hypoglycemia, but the good news is we now have better tools to prevent it,” Dr. Kirkman said.
Not everyone involved with the chat was convinced, however. Rachel Heard, a certified diabetes educator, said that families of children with diabetes often struggle to meet recommended A1C goals, and they need more resources if they are going to meet the new one.
“People with T1D need more support than what is currently available,” Heard said.
Both Dr. Chiang and Dr. Kirkman agreed that more support is needed. The ADA has called upon insurance companies to understand that frequent testing is a necessity, not a choice, for many with Type 1 diabetes, and the costs for supplies must be fully reimbursed. The two doctors also suggest it’s important that more people in the diabetes community offer each other peer support, and advocate for those with Type 1.
In October 2014, the ADA is scheduled to come out with its first-ever guidelines concerning how to care for children with Type 1 diabetes in a daycare setting.
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Craig Idlebrook is a past editor for Insulin Nation, Type 2 Nation, and Información Sobre Diabetes. He is now the community engagement and content manager for T1D Exchange.
WEST LAFAYETTE, Ind. – Purdue researchers have discovered a compound that could lead to the treatment of chronic pain without the need for patients to rely on opioids.
A team led by Val Watts, associate head and professor of medicinal chemistry and molecular pharmacology in Purdue’s College of Pharmacy, said the compound shows unparalleled selectivity in inhibiting the adenylyl cyclase 1 (AC1).
Adenylyl cyclases are enzymes that organize the production of cyclic adenosine monophosphate, an important biological messenger in numerous organisms. There are 10 isoforms of adenylyl cyclases found in humans. Numerous studies have suggested that AC1 could be used as a drug target for chronic pain.
The compound identified at Purdue has shown selectivity for inhibiting AC1 versus the other nine isoforms.
“With the AC1 technology, there’s a chance to treat chronic pain directly or through reducing the side effects of the opioids,” said team member Richard van Rijn, assistant professor of medicinal chemistry and molecular pharmacology in Purdue’s College of Pharmacy. “There’s an issue with misuse of opioids used to treat chronic pain. They are good as a short-term analgesic for acute pain, but don't address the underlying issues of chronic pain.”
Opioids are a class of drugs that include the illicit drug heroin as well as prescription pain relievers oxycodone, hydrocodone, codeine, morphine, fentanyl and others. They interact with opioid receptors on nerve cells in the brain and nervous system to produce pleasurable effects and relieve pain.
According to the Centers for Disease Control and Prevention, overdose deaths involving prescription opioids have quadrupled since 1999. From 1999 to 2015, more than 183,000 people have died in the United States from overdoses related to prescription opioids.
The Watts group is the first to identify a compound that is selective for AC1 only.
Findings from the study are published in a research paper by Watts’ group that recently appeared in Science Signaling. There is also a recent news feature about the research in Science.
While the research is still in its early stages, another potential application for the compound is the possibility of reducing opioid dependence. Separate research has shown that completely deleting the AC1 enzyme reduces the signs of dependence.
“If you decrease the physical symptoms of withdrawal, that could help reduce psychological dependence,” Watts said. “You might also be able to stop relapse.”
The Purdue Office of Technology Commercialization has filed a provisional patent for the technology. For more information about developing and commercializing this or other Purdue innovations, contact the Purdue Office of Technology Communication at 765-588-3470, firstname.lastname@example.org
Grants from the National Institutes of Health and the Purdue Executive Vice President for Research and Partnerships helped fund the research.
About Purdue Office of Technology Commercialization
The Purdue Office of Technology Commercialization operates one of the most comprehensive technology transfer programs among leading research universities in the U.S. Services provided by this office support the economic development initiatives of Purdue University and benefit the university's academic activities. The office is managed by the Purdue Research Foundation, which received the 2016 Innovation and Economic Prosperity Universities Award for Innovation from the Association of Public and Land-grant Universities. For more information about funding and investment opportunities in startups based on a Purdue innovation, contact the Purdue Foundry at email@example.com. For more information on licensing a Purdue innovation, contact the Office of Technology Commercialization at firstname.lastname@example.org.
Writer: Curt Slyder, 765-588-3342, email@example.com
Sources: Val Watts, 765-496-3872, firstname.lastname@example.org
Richard van Rijn, 765-494-6461, email@example.com