Five Things You Need To Know From The ADA 74th Scientific Sessions
July 2014 — While there were many interesting and important findings that were presented at the American Diabetes Association's 74th Scientific Sessions, here are the top five that I believe all people with diabetes should know.
1. New Position Statement for Type 1 Diabetes Changes The A1C Target Recommendations for the Type 1 Pediatric Population
Type 1 and type 2 diabetes, while sharing many complications, are different diseases, each requiring different treatment regimens. Dr. Ann Peters, MD, FACP helped developed the new position statement for the standards of type 1 diabetes. She states: "Our goal here is to present a position statement that looks specifically at the needs of people with type 1 diabetes across the age spectrum."
Previous recommendations used 8.5% A1C for children under the age of six, 8.0% for children six to twelve years old, and 7.5% for teenagers. The authors of the new position statement explained that those targets were chosen due to concerns over complications due to hypoglycemia. The research has shown, however, the greater risk is prolonged hyperglycemia leading to early development of serious complications in childhood. New tools to monitor potential hypoglycemia are also available, leading the authors to issue a target A1C of 7.5% for the entire pediatric population.
It is important to note that despite the new lower recommendation, a recent study showed that only 32% of the type 1 pediatric population met the previous ADA targets for their age group.
2. "Diabetes Distress" for Type 2s and Increased Mortality for Type 1s
It's no secret that there is a strong correlation between diabetes and depression, but Dr. Lawrence Fisher, PhD, ABPP believes that many individuals with type 2 diabetes suffer from "diabetes distress," and not clinical depression. Diabetes distress is the feelings associated with living with the daily burden of a chronic, complex disease.
Fisher states: "Many of the depressive symptoms reported by people with type 2 diabetes are really related to their diabetes, and don't have to be considered psychopathology. So they can be addressed as part of the spectrum of the experience of diabetes and dealt with by their diabetes care team." His study placed individuals who scored high on a Patient Health Questionnaire into three intervention groups: an online diabetes self-management program; an online individualized assistance program; and an education by mail program. All showed significantly reduced distress over a 12-month period.
While Dr. Fischer did not research diabetes distress in the type 1 population, a separate study presented an alarming result — those who exhibit the highest level of depressive symptoms are most likely to die prematurely. This group was studied over a 25-year period using the Beck Depression Scale, with all diagnosed between 1950 and 1980.
Cassie Fickley, the lead author, said: "For every one point increase on the Beck Depression Inventory Scale, participants showed a four percent increase in mortality risk — after controlling for other factors that might increase the risk of death." Results from this study show that the diagnosis of depression in the type 1 population and intervention of some type is crucial.
3. The Diabetes Online Community Presented (and Represented)
For the first time, a panel made up entirely of representatives of the Diabetes Online Community, spoke about the importance of peer social support for the health of those living with diabetes. Jeff Hitchcock, Kerri Sparling, Manny Hernandez, and Scott Johnson, all icons in the DOC shared their thoughts, answered questions from clinicians, and gave important advice on ways to engage with the community.
Kerri Sparling stated, "The Diabetes Online Community helps us integrate medical advice into our real lives," with Scott Johnson adding his thoughts about the way that diabetes brings a feeling of isolation that the online community helps to alleviate. The audience was engaged, excited, and interested in the patient perspective, and it is hoped that this will be the first of many patient presentations at ADA.
4. The Bionic Pancreas Outperforms Insulin Pumps
The latest research regarding the bionic pancreas, a system using insulin and glucagon pumps to regulate blood glucose levels based on data from a continuous glucose monitor, should come as no surprise to those following this exciting next step in diabetes management.
Two studies have shown that, "[The bionic pancreas] far exceeded our expectations in terms of its ability to regulate glucose, prevent hypoglycemia and automatically adapt to the different needs of adults — some of whom were very insulin-sensitive — and adolescents, who typically need higher insulin doses, " said Dr. Edward Damiano. "There's no current standard-of-care therapy that could match the results we saw."
Next steps for the bionic pancreas trials will involve longer periods of home use and the addition of larger multicenter trials, eventually leading to what the researchers hope will be FDA approval of this system within the next few years.
5. Does Cow's Milk Trigger Development of Type 1 Diabetes?
Speculation ran rampant for years about whether early exposure to cow's milk acts as a trigger for type 1 diabetes, with many type 1 parents choosing to breastfeed or use soy-based formula to lessen the chances of offspring developing type 1 diabetes. A randomized controlled study separated infants into two groups: a cow's milk-based formula group and a hydrolyzed protein formula group.
The researchers found no difference in the development of type 1 antibody markers between the groups, leading to the conclusion that cow's milk is not a trigger. However, the children participating in the study will be followed until age ten to determine if they develop type 1 antibody markers and/or type 1 diabetes.
*Please note: My airfare and hotel accommodations were paid by Diabetes Advocates, a program of the Diabetes Hands Foundation, allowing me to attend the ADA 74th Scientific Sessions as press.
dLife's Viewpoints columnists are not all medical experts, but everyday people living with diabetes and sharing their personal experiences, most often at a set point in time. While their method of diabetes management may work for them, everyone is different. Please consult with your diabetes care team before acting on anything you read here to find out what will work best for you.
Citrus-Mint Tea Roast Chicken in Foil Roma Tomatoes with Chevre and Basil Pesto Molho Cru (Portuguese Pickle) Easy Clam Linguine Almond Spiced Chicken Butter Banana Bread Asian Gingered Brisket Green Beans with Prosciutto and Onions Savory Mushrooms and Barley Soup
Many people say that depression is a side effect or complication of diabetes. Without discounting the association of the psychological condition with the physical one, I'm not convinced that our high and/or unstable glucose levels are directly responsible for that change in our mental state. My belief is that the unrelenting need for self-care, for following the sort of care schedules that can drive licensed, professional caregivers crazy, is what overwhelms us...