Advanced Technologies & Treatments for Diabetes (ATTD) 2013
A report on the most exciting developments in diabetes technology.
By Margaret Nguyen, Adam Brown, and Kira Maker, diaTribe
In March, we were privileged to attend the Sixth Annual International Conference on Advanced Technologies & Treatments for Diabetes (ATTD). The conference was held against the beautiful backdrop of Paris, France, and we had a terrific time learning about new diabetes technology and research. The meeting discussed a great number of studies on the artificial pancreas as well as new continuous glucose monitoring (CGM), blood glucose monitoring, and insulin pump technologies, plus a variety of other topics related to diabetes medication and the treatment of complications. The following is our report on the most exciting developments, including new products from Medtronic and CeQur. As a reminder, the artificial pancreas (or "closed loop") takes readings from a CGM, processes them through a mathematical algorithm, and directs insulin pump dosing.
Artificial Pancreas At Home Studies
Though we have learned about a few overnight and at-home artificial pancreas studies in the US, some ambitious and exceptional studies are being carried out internationally. Three of the most interesting came from Dr. Roman Hovorka's group at the University of Cambridge in the UK and from the DREAM consortium (Diabetes WiREless Artificial Pancreas ConsortiuM), a group of researchers from three hospital centers in Israel, Slovenia, and Germany.
30,000 Hours of Closed-Loop System Data
Dr. Roman Hovorka presented the Cambridge team's work on three home studies using the FlorenceD closed-loop system. FlorenceD uses a first-generation Abbott FreeStyle Navigator, a Dana R Diabecare pump (with Bluetooth), the Companion (an investigational device to communicate with the pump), and a small tablet running a predictive algorithm. The CGM sends data every minute and automated insulin adjustments occur every 12 minutes. The team's at-home studies began in July and importantly, have patients wearing the closed-loop system over long periods of time – two of the overnight trials range from three to four weeks (one with adolescents and one with adults) and a third day and night trial lasts for a week. Surprisingly, there is no remote monitoring during the home studies! To ensure safety, Dr. Hovorka and his team conducted extensive computer simulations prior to beginning the studies. Additionally, the participants are extensively trained on how to respond if errors occur during the experiment.
The preliminary results from the study are encouraging. While Dr. Hovorka did not share any statistics on time-in-range (which we were dying to get), the individual patient glucose profiles showed good control with in-range blood sugars. We were impressed, especially given the length of the studies. The system has a few important real-world limitations including the need to carry a tablet, limited battery life, and the need to stop closed-loop control in order to deliver a bolus. We look forward to discovering the studies' final results and learning how the Cambridge team will improve upon its system and perhaps eliminate these limitations.
The DREAM Team's Investigations of the Artificial Pancreas
On day one of ATTD, the prestigious New England Journal of Medicine released a publication from Dr. Moshe Phillip (Tel Aviv University, Petah Tikya, Israel) and colleagues' DREAM 3 study, an artificial pancreas study at an overnight diabetes camp. We first covered this study at last year's ATTD. It reported significant reductions in hypoglycemia and hyperglycemia when patients were on the closed-loop overnight compared to sensor-augmented pumps (SAP). The closed-loop system is called the MD-Logic Artificial Pancreas System (MDLAP), and consists of the Medtronic Paradigm Veo pump, Medtronic Enlite continuous glucose sensor, Bayer Contour-Link blood glucose meter, and a real-time remote monitoring system.
At this year's ATTD, Dr. Revital Nimri (Schneider Children's Medical Center of Israel, Petach Tikvah, Israel), presented results from the ongoing DREAM 4 trial. The study advances on DREAM 3 by taking the MDLAP into patients' homes. Initial results show significantly fewer nocturnal hypoglycemic events: participants using MDLAP spent just 0.6% of their night in hypoglycemic ranges while those on standard pump/CGM therapy had low blood sugars for 9% of the night on average. Time in the range of 70-140 mg/dl was also significantly higher on closed-loop therapy: 57% versus 40%.
We're pleased to see closed-loop studies moving out of controlled hospital settings and into the real world. We believe the artificial pancreas has significant potential to improve glycemic control (especially hypoglycemia) while minimizing the burden placed on patients and caregivers. In short, less time thinking about diabetes, and more time living life!
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