ISPAD 2024: For the 50th anniversary, a paradigm shift in how diabetes in children should be managed
In 1974, the International Society for Pediatric and Adolescent Diabetes (ISPAD) was founded as a professional
organisation to promote science, research, education and advocacy in childhood and adolescent diabetes.
50 years later, the Annual ISPAD Conference 2024 reflected the fundamental changes in the ways type 1 diabetes
is perceived and treated today.
The 50th conference of the International Society for Pediatric and Adolescent Diabetes (ISPAD) was held from the
16th to 19th of October 2024, in Lisbon, Portugal. “We had the largest conference ever, with almost 2,000 members
dedicated to the care of children with diabetes,” recounts Conference President Catarina Limbert, Professor of
Paediatrics at the NOVA Medical School and Senior Consultant at the Paediatric Endocrinology and Diabetes Unit,
Hospital Dona Estefânia in Lisbon, Portugal. Participants convened from 106 countries, representing a
multidisciplinary group that included nurses, psychologists and other professionals in addition to physicians
and researchers.
The Declaration of Lisbon
ISPAD took the opportunity of the 50th anniversary to renew its commitment to children, adolescents and young
adults with diabetes. The first declaration, called the “Declaration of Kos,” had been launched in 1994.
“This was dedicated to making sure that all children have access to insulin, glucose monitoring and so on,”
explains Sabine Hofer, Professor of Paediatrics at the Medical University of Innsbruck, Austria, as well as
member of ISPAD’s Executive Board. The Declaration of Kos has now been replaced by the Declaration of Lisbon,
which was published in
The Lancet Diabetes & Endocrinology
on the 15th of October 2024.
ISPAD and the European Association for the Study of Diabetes (EASD) have a long-standing history of collaboration
ranging from joint meeting sessions to consensus papers endorsed by both societies. “The children we are taking
care of today will be adults tomorrow,” Hofer expounds on the rationale for the cooperation with societies such
as EASD, adding that it is important “to make sure that the focus stays the same after the children have grown
up and transitioned to adult care.”
Inclusion: challenges due to global inequity
The motto of the ISPAD 2024 conference was “Inclusion & Innovation in Pediatric Diabetes”.
Limbert calls attention to the fact that access to technology and even insulin as well as to equipment
for blood glucose monitoring is unequal across the globe. “There are still children dying because they have
no access to insulin.” However, this is not just a problem of less developed areas of the world, as huge inequality
is present even within high-income countries that lack public healthcare systems, such as the United States.
Limbert emphasises the importance of interoperability of technological systems, which could contribute to
diminishing inequity. “Devices should talk to each other, and industries should be aware of that.”
In terms of innovation, automated insulin delivery (AID) systems enable massive improvement of glucose control a
cross countries and age groups. As Hofer points out, ISPAD and EASD very recently have
presented a joint
position statement on AID use around physical activity and exercise in type 1 diabetes.
Monitoring and treating an evolving disease
An important focus of ISPAD 2024 was the change of paradigm that has taken place as type 1
diabetes is now considered a disease evolving in stages. Screening programmes are being developed in
countries such as Italy, Israel and the US. Monitoring and treating children with islet autoantibodies and
dysglycaemia will be the future of diabetes care, Limbert notes.
Treatment at the presymptomatic stage is possible by using disease-modifying compounds, such as the
anti-CD3 antibody teplizumab that has been shown to preserve beta cell function, thus delaying the need
for insulin. Adjunctive therapies, including anti-thymocyte globulin and baricitinib, can be added according
to the stage. Other topics discussed at ISPAD 2024 included cell therapies and the use of artificial intelligence (AI).
Limbert refers to the example of a fast and effective AI programme for monitoring retinopathy in the clinic.
“We have to move from technology only to precision medicine and AI.”
Author: Judith Moser, MD. Any opinions expressed in this article are the responsibility of EASD e-Learning.
