National Diabetes Week 2024

This week is National Diabetes Week and the theme for 2024 is diabetes technology and how we can improve access for all people living with diabetes. Technology plays a key role in helping people with type 1 diabetes to manage the often overwhelming day-to-day demands of balancing insulin doses, physical activity and food intake. There has been exciting progress in the development of closed-loop systems, advances in sensor technology, as well as improvements in potentially helping preserve beta-cell function in people with newly diagnosed type 1 diabetes. However, despite these advances, it is notable that a significant number of people with type 1 diabetes appear not to have engaged with their healthcare professional to discuss the availability of newer technologies, such as continuous glucose monitoring systems. In addition, access to insulin pumps remains limited to those with the appropriate private health insurance. We are also aware that type 1 diabetes is associated with an increased risk of cardiovascular disease, yet there are few clinical trials that address this need.

We have also seen advances in the understanding and management of type 2 diabetes. We increasingly appreciate that type 2 diabetes is heterogeneous in terms of pathophysiology and, therefore, management. The newest pharmacological agents, sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide 1 (GLP-1) receptor agonists and GLP-1/ glucose-dependent insulinotropic polypeptide dual agonists, continue to give rise to large clinical trials in not only people with diabetes, but also those with heart failure, renal disease and obstructive sleep apnoea. However, despite many ‘positive studies’, we have much to learn about the way in which these medications work, how to use them safely – particularly in the perioperative setting – and in which patients they might best be used, or not used. Despite these advances, the use of these agents in some of our most vulnerable populations, such as in those with mental illness, remains poor, partly because of underdiagnosis and delayed management of diabetes.

Other exciting compounds in the pipeline for the management of type 2 diabetes and obesity include nutrient-stimulated hormone-based therapies. Data from studies of these compounds indicate weight loss of a magnitude which we have not seen previously. Whether these or the existing GLP-1 receptor agonists and dual agonists can play a role in stemming the tide of obesity and type 2 diabetes remains a challenge for our policy makers, administrators and clinicians.

Here’s to the next decade of exciting developments and research.  MT