ADA Scientific Sessions 2018: Gary’s Top-5 Observations

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My thoughts on the American Diabetes Association’s 78th Scientific Sessions

American Diabetes Association’s 78th Scientific Sessions

As usual, this year’s American Diabetes Association Scientific Sessions didn’t place much emphasis on a healthy lifestyle.  There was food everywhere, and trust me, we’re not talking fruits & veggies.  And given the oppressive Orlando, FL summer climate, the only running we did was to get a seat near the a/c.

But there was a great deal of research presented on diabetes medications and devices. 

Here’s a quick summary:

  1. Enough is enough! There were dozens of oral presentations and research posters on the subtle differences between the multitude of long-acting insulins, SGLT-2 inhibitors (oral meds that facilitate the loss of glucose through the urine), and GLP-1 agonists (injectables that slow digestion, invigorate functioning beta cells, and blunt both appetite and glucagon secretion).  To me, this is much more a quest for profit than meaningful clinical outcomes and improving patients’ quality of life.  Let’s move on.
  1. Finally, the pharmaceutical industry is paying some attention to the needs of the type-1 community. Results of a one-year randomized study showed that liraglutide (a GLP-1 agonist) produced significant reductions in A1c, average blood glucose, blood pressure and weight – all without any increase in hypoglycemia.  Data was also presented on use of sotagliflozin, an SGLT-1 and 2 inhibitor, in people with type-1.  SGLT-1 inhibitors blunt the absorption of glucose through the upper-GI tract, thus delaying the glucose rise after meals; SGLT-2 inhibitors block the reabsorption of glucose by the kidneys, thus leading to excretion of glucose in the urine.  The two together seem to have a synergistic effect, producing a significant reduction in A1c, post-meal glucose peaks, weight, and bolus insulin requirements.  Users saw their “time in-range” (as measured by CGM) increase from 56% to 68%.  Sanofi submitted sotagliflozin to the FDA for a type-1 indication in May, and hope to have approval some time in 2019.
  1. For the first time ever, there were more companies promoting CGM systems than traditional glucose meters. Senseonics’ Eversense implanted sensor received a great deal of attention, as it appears to produce accuracy close to that of the Dexcom, and the sensor implantation process is a lot less invasive than everyone imagined.  Abbott was busy selling the merits of its Libre system as a replacement for fingersticks, particularly for the type-2 market.  And Dexcom proudly showed off its new calibration-free G6 system with one-button sensor insertion.  Even Medtronic got into the act with its new Guardian Connect freestanding CGM system, preferring to place greater emphasis on its pattern-detection software than on the sensor itself.
  1. Insulin pump therapy was completely overshadowed by hybrid closed loop (hcl) technology. The only real innovation with the pumps themselves involved Insulet’s recently-approved Dash programmer, a cell-phone-like device that will replace the bulky, old-school PDM for controlling the OmniPods.  But there was greater excitement over data on Insulet’s Horizon hcl system.  Safety and performance data on the system’s personalized, model-predictive control algorithm showed an increase in time spent in-range (from 64% to 74%), a reduction in time spent in a hypoglycemic range both overall (from 5% to 2%) and overnight (from 6% to less than 1%).  Tandem presented data on its recently-approved predictive low glucose suspend feature, which suspends basal insulin delivery any time glucose levels are projected to dip below 80 mg/dl within the next 30 minutes.  Basal delivery resumes as soon as glucose levels rise at all.  The feature runs in the background – it does not disturb the user and turns basal insulin off/on automatically.  While reducing the incidence of hypoglycemia by 31%, it was not associated with any increase in average glucose.
  1. The whole “To Carb or Not to Carb” debate rages on. An Australian study comparing the effects of a low-carb (and low saturated-fat) diet to a traditional high-carb diet in people with type-2 diabetes showed the following:
  • No difference in weight loss
  • No difference in A1c
  • No difference in blood pressure
  • No difference in renal (kidney) function
  • No difference in cognitive (brain) function
  • No difference in LDL cholesterol
  • Less glycemic variability (lower post-meal peaks) with the low-carb diet
  • Lower insulin and medication requirements with the low-carb diet
  • Better HDL levels with the high-carb diet

Although the low carb approach doesn’t seem to do any real harm (and may help in a few areas) for those with type-2 diabetes, the same cannot be said for low-carb diets in children.  Data revealed that kids following low-carb diets are more prone to stunted growth, family emotional conflicts, iron deficiency, high cholesterol, eating disorders, hypoglycemia, and a diminished response to hypoglycemia.

fun facts

A few other “fun facts” obtained at the conference:

  • In the US, there is 1 diabetes educator for every 367 people with diabetes, and one diabetes-focused psychologist for every 3,367.
  • People with diabetes who analyze their own data for patterns experience far less hypoglycemia than those who do not.

exercise barbell

Experiments in Exercise:

  • People with alzheimers and diabetes may be able to improve their memory by performing regular cardiovascular exercise; enhanced insulin sensitivity is believed to be involved.
  • For those who experience elevated blood sugars after high-intensity exercise, normal correction doses of insulin (rather than decreased doses) appear to work fine.
  • Individual responses to exercise vary, but early morning (fasting) high-intensity exercise produces an average blood sugar rise of approximately 70 mg/dl (4 mmol/l).
  • The risk of hypoglycemia during and immediately after moderate-intensity cardio workouts can be reduced by approximately one-third by plugging intermittent sprints (4 seconds every 2 minutes, or 10 seconds every 20 minutes) into the workout.


Technology Trials:

  • People with diabetes who download their devices and analyze their own data for patterns experience far less hypoglycemia than those who do not.
  • Users of the Freestyle Libre glucose monitor saw improvements in overall glucose control as the number of daily “scans” (data reads) increased, with the best control at 9-12 “scans” per day.
  • Multiple-port infusion sets produce wider and more even distribution of insulin in the subcutaneous space.
  • By combining Humalog (lispro) insulin with Biochaperone (hyalaronidase), the insulin starts working an average of eight minutes earlier, peaks 10 minutes earlier, and stops working 22 minutes earlier than ordinary lispro.  It also shows greater action one hour after injection and a shorter duration of action compared to Fiasp (utra-rapid) insulin.


Pregnancy Platitudes:

  • Use of the type-2 diabetes drug metformin during pre-pregnancy may help reduce weight gain during pregnancy in overweight women.
  • Women with diabetes who have multiple unsuccessful pregnancies are at an increased risk of health problems and death than women who have successful pregnancies.
  • Sleep apnea is common during pregnancy, and correlates with increased blood sugar levels during the third trimester.
  • A hybrid closed loop system developed by the University of Cambridge did a great job of managing blood sugars in type-1 women during and after labor; could have implications for using other closed-loop systems.

And in conclusion…

Apparently, praying to the “Ice Gods” at the Orlando Ice Bar, even with the combined efforts of myself and JDRF President Aaron Kowalski, does not guarantee a speedy cure for diabetes. (see image below).

By |2018-07-31T16:13:08+00:00July 24th, 2018|July 2018 Newsletter, Thinking Like A Pancreas Blog|8 Comments

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  1. Cathy Alger August 9, 2018 at 12:45 pm - Reply

    Thank you for posting this. I often wish I could attend such conferences. I appreciate the summary.
    Questions: hyalaronidase: seems to be a great benefit. Worth it? Long term effects?
    My son is “lower carb” and for sure higher carb affects his ability to control BG and therefore A1C. We are not interested in LC diet but acknowledge that many have great success with LCHF diets to achieve normal A1C. (I find it too restrictive and T1D teen son wants to eat normally.) But they found no benefit in T2D? No weight loss? I find hard to believe study. T2Ds in my life report back to me that eating higher carb results in higher BG.

    Again thanks for the summary.

  2. RD DIKEMAN August 9, 2018 at 5:47 pm - Reply

    You’ve lost the plot on point number 5. Our study published in PEDIATRICS and discussed in the NY Times showed unprecedented glycemic outcomes from 300+ T1Ds following a VLC diet (about 30g to 50g) a day. The cohort included a large fraction of children who showed no adverse effects and above average stature. BGL ave was 104 mg/d with low glycemic variability, healthy BMI, very low adverse effects including hypoglycemia and dka when compared to standard rates, high levels of overall health and satisfaction, remarkable lipids including TG:HDL ratios of about 1:1. As Maria Muccolli points out in her excellent article in diabetes daily recounting the ADA presentation you are referring to in point 5, most of deBocks claims are speculation and do not hold up to rigorous examination.

  3. Jim August 9, 2018 at 6:47 pm - Reply

    My personal experience seems to suggest a low carb approach to diabetes is the only current way to live a long complication free life with normal bg’s. Then again if you preached it, and they listened, you’d have to find a new line of work.

  4. Susy Jones August 9, 2018 at 6:51 pm - Reply

    Two kids with T1 here and nearly 2 years following a low-carb diet as per Dr Bernstein:
    – both their weights are normal at the 30th-50th centiles – half of children here are obese
    – HbA1cs consistently 4.7%-5.2% (big difference from the 8.2% average for Paediatrics here)
    – no retinopathy or other complications where many on high carb diets will have signs within the first 10 years after diagnosis
    -good HDL to LDL ratio for both

    Luckily we aren’t paying any attention to the Australian study which looked at the grand total of 7 children.

  5. Angela Baird August 9, 2018 at 11:44 pm - Reply

    We are grateful we found a low carb diet for our type 1 teenager. When he ate less carbs, his growth took off and he grew an inch in 3 months.

    • alicia downs August 29, 2018 at 3:25 pm - Reply

      The information shared was that of studies presented at the ADA scientific sessions. Like they say on TV “individual results may vary”. One child’s growth and nutrition may vary widely from that of another and each family should work with a licensed dietitian to ensure that their child is getting the nutrition they need to grow.
      WE do find that it is possible to achieve good blood sugar stability on any number of dietary models and that carb restriction is not a requirement for good stability.

  6. Jill Roberrs August 10, 2018 at 7:16 am - Reply

    I would like to say that your claims about low carb diet not being suitable for children due to stunted growth and emotional issues have not proven to be true in our experience.
    My son was diagnosed at age 9 and at the time had followed 75tg centile for height all his life (as had his older brother) he initially followed a high carb diet with lots of pasta and rice but by the age of 13.5 his height had dropped to 50th centile and he was having lots of behavioural problems at school. We change to a low carb diet following Dr Bernstein’s protocol and within 18 months on his 15th birthday his height was on 91st centile and he has cintinued on that line and at 16 he was the tallest male in the family and still growing (his father and brither are both 75th crntile). His behaviour at school also improved dramatically once his blood glucose was under better control.
    I have given him the option to go back to eating high carb seversl times but he does not want the rollercoaster BG that goes with it

    • alicia downs August 29, 2018 at 3:24 pm - Reply

      The information shared was that of studies presented at the ADA scientific sessions. Like they say on TV “individual results may vary”. One child’s growth and nutrition may vary widely from that of another and each family should work with a licensed dietitian to ensure that their child is getting the nutrition they need to grow.
      WE do find that it is possible to achieve good blood sugar stability on any number of dietary models and that carb restriction is not a requirement for good stability.

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