American Diabetes Association's Scientific Sessions
The latest from the ADA on the artificial pancreas, faster insulins, and the results of the ORIGIN trial.
By Adam Brown
The American Diabetes Association's (ADA) 72nd Scientific Sessions brought over 17,000 attendees to Philadelphia in early June for one of the year's largest diabetes conferences. The five-day gathering featured 160 sessions, more than 380 oral presentations, over 1,500 posters, and more than 185 companies in the exhibit hall. Here are some of our biggest takeaways from our trip to Philadelphia.
The Newest on Blood Glucose Monitoring, CGM, and the Artificial Pancreas
ADA gave us encouraging updates on all things diabetes technology. In blood glucose meters, we saw a real focus on new products, including Sanofi's iBGStar, Abbott's FreeStyle InsuLinx, and Bayer's new highly accurate and precise Contour Next strips (expected this summer in the US). In particular, we noticed a real emphasis on software, especially making it easier to download results from meters and interpret what are often overwhelming data reports. This is long overdue and very good news for patients and healthcare providers.
In continuous glucose meters (CGM), one of the most notable presentations included new accuracy data from a 72-patient study of Dexcom's G4 sensor. Compared to the current Seven Plus, the G4 was found to be around 20% more accurate and significantly better at reliably transmitting data to the receiver. Dexcom's new device was recently submitted to the Food and Drug Administration (FDA) and the company hopes for approval before the end of 2012. Medtronic also had a poster on its new Enlite CGM sensor at ADA (recently submitted to the FDA along with the US version of the Veo insulin pump). The Enlite sensor is over 20% more accurate and 69% smaller in sensor size by volume compared to the current Sof-Sensor. More broadly, we also heard many discussions at ADA on why some patients do not continue using CGM (e.g., frustration, alarms, information overload); how to measure glycemic variability and if it matters (the jury is still out on both, though we believe the proper trials have not yet been conducted); and how to interpret CGM download reports (one speaker advocated taking a "macro-micro" approach, first using the modal day report to look for broad trends and then looking at individual days.)
Last but certainly not least, the artifical pancreas created plenty of buzz. There was clear focus on making it possible, especially as studies move outside the hospital. Dr. Ed Damiano (Massachusetts General Hospital, Boston) discussed his team's work on developing an insulin/glucagon (bi-hormonal)artificial pancreas. He piqued the audience's interest by showing off the system that will be used in an upcoming study — the hardware consists of two Tandem t:slim insulin pumps delivering insulin and glucagon, an iPhone to run the controller algorithm and communicate with the pumps (no laptop or tablet required), and a Navigator or Dexcom G4 CGM. Dr. Damiano was actually wearing a CGM during the presentation and showed the audience his streamed, real-time glucose information on the iPhone — very cool!
We also relished the chance to attend a closed-loop research meeting sponsored by the Juvenile Diabetes Research Foundation (JDRF) and the National Institutes of Health. The greatest minds in the field presented updates on their research and showed off their increasingly portable systems. We're glad to see so much emphasis on making the artificial pancreas patient-friendly; certainly, no one with diabetes wants to be tethered to a laptop computer! Finally, we saw the first data on Animas' Hypoglycemia-Hyperglycemia Minimizer System, which consists of a Dexcom Seven Plus CGM, a OneTouch Ping insulin pump, and a controller algorithm running on a laptop computer (for now...). The system aims to keep patients within the zone of 90-140 mg/dl — this means that if glucose is trending too high or too low, insulin infusion will automatically be increased or decreased to keep the user "in zone." Encouragingly, the system kept patients in the zone of 70-180 mg/dl nearly 70% of the time, with only 0.2% of the time spent in hypoglycemia. This was despite two high-carb meals and deliberate under- and over-bolusing (in some cases up to 50%). We look forward to seeing further studies of the device, especially when it becomes easier to carry around.
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Well maybe not so much a furor as a controversy. The question, bluntly put, is whether or not a single HbA1c reading should be sufficient and adequate to diagnose diabetes — and whether the conditions under which the test was conducted should have any bearing on the diagnostic or non-diagnostic value of the test. The lede from