Type 2, but as dangerous as Type 1... “Islet failure diabetes should be designated a severe, intractable disease”

[Financial News] A proposal has been made to classify patients with type 2 diabetes whose ability to produce insulin has almost disappeared as a separate category called “islet failure diabetes,” designate it a severe, intractable disease, and manage it through a specialized care system. Starting in December, these patients with severe type 2 diabetes will also be eligible for support for continuous glucose monitors (CGMs) and automated insulin delivery devices, but it has been pointed out that device support alone is not enough.
 The Korean Diabetes Association (KDA) held a symposium titled “A New Paradigm in Diabetes Treatment: Expanding Benefits and Reducing the Burden of Severe Diabetes” on the 15th at COEX Magok Convention Center in Gangseo-gu, Seoul, to discuss ways to expand coverage for severe diabetes.
 Participants proposed refining eligibility criteria to reflect patients’ actual treatment needs and disease severity, and converting the current support for medical expenses into covered medical benefits. They also suggested introducing new reimbursement fees for device setup and training, and gradually expanding eligibility for support to include patients with type 2 diabetes who receive insulin therapy.
 Kim Nam-hoon, head of the KDA’s Diabetes Specialty Task Force and a professor of endocrinology at Korea University Anam Hospital, gave a presentation titled “Type 2 Diabetes with Pancreatic Dysfunction and Islet Failure: The Significance of Severe Type 2 Diabetes and the Importance of Its Management.”
 According to Professor Kim, islet failure diabetes is a condition in which the ability to produce insulin has almost disappeared, making specialized insulin treatment necessary. It occurs not only in type 1 diabetes but also in advanced type 2 diabetes and diabetes following pancreatic resection. It is associated with high blood glucose variability and an elevated risk of acute metabolic complications such as hypoglycemia and ketoacidosis. Kim stressed that, given the severity of the disease and its socioeconomic burden, it should be designated a severe, intractable disease and patients should have access to specialized care.
 The diagnostic criteria proposed by the KDA require patients to meet both conditions: an assessment of C-peptide levels and “use of multiple daily insulin injections or an insulin pump.” The aim, it explained, is to accurately identify patients with reduced insulin secretion and connect them with active treatment.
 He also highlighted the need for systematic education and ongoing care. “With multiple daily insulin injections, doses need to be adjusted according to factors such as carbohydrate intake, an individual’s ratio (the amount of carbohydrates that can be managed with one unit of insulin), residual insulin and activity level. This means there is much more for healthcare professionals to teach, and it is more difficult, than for patients with type 2 diabetes who do not use insulin,” he said.
 He added, “Even when treatment combines a CGM with an automated insulin delivery device, patients need training on how to use the devices and interpret blood glucose data.” He said, “The pilot home-care program should be made a regular program so that data review, consultations and monitoring can be provided on an ongoing basis.”
 Professor Kim also presented classification criteria for severe diabetes that assess metabolic grades alongside complications, stressing the need for support tailored to disease severity and a specialized care system.
 “The purpose of classifying disease severity is to connect patients who need specialized care with appropriate treatment and support,” Professor Kim said. “There needs to be a system for referring patients with severe disease and difficult-to-control blood glucose to specialized care, then referring them back to primary care once their condition is stable.” 
[email protected] Jung Myung-jin, Medical Correspondent Reporter