Artificial Pancreas Tril Updates (Continued)
Impressive Data from the T1D Exchange
One of the other major highlights from ATTD was a full session on the T1D Exchange, a cohort of 25,000 people with type 1 diabetes in the US. The registry was launched through a $26 million grant from the Helmsley Charitable Trust and gathers data on patients from 67 clinical centers across the United States. The T1D Exchange will also include "Glu" (https://www.myglu.org/), which will serve as a social networking site for people with type 1 diabetes once it is launched in the coming months.
One of the major ideas behind the T1D Exchange is to gather "real life" data to help answer which treatments and practices actually improved patient outcomes, and perhaps to even challenge or confirm many of the assumptions held about diabetes care. Of course like any observational dataset, the Exchange cannot directly address important questions of causality (e.g., is therapy X beneficial, or is it just more likely to be used by the type of patients who would somehow have achieved better outcomes anyway?) – but some very, very strong associations do jump out just from looking at the data. For example, patients who tested their blood glucose 10 times versus 0-2 times per day were seen to have nearly 2.0% better A1c. This relationship was maintained when results were broken down by age group and insulin delivery method. Insulin pumps and CGMs were associated with notable benefits as well, including better A1c (0.5%) and lower rates of severe hypoglycemia and DKA.
The exchange also revealed areas where diabetes care and technology can improve. For instance, only about 2% of patients over 13 years old perform weekly downloading of data. CGM use was also quite low in the dataset – at most 3% in patients under 25 years and 14% in patients over 26 years (we believe actual use nationally is even lower). Rates of severe hypoglycemia and DKA were also quite high in the Helmsley dataset, suggesting that diabetes care and technology still has ample room to improve the day-to-day lives of those with type 1 diabetes. We are grateful for the brainpower put into the T1D Exchange thus far, and we look forward to seeing how the data will benefit future patients, physicians, and researchers, particularly in shaping policy and payments.
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NOTE: This information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.
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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