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This year’s American Diabetes Association Scientific Sessions didn’t disappoint with a great deal of research presented on diabetes medications, device development and other notable info about exercise management.

Here’s a quick summary:


1. A new type of infusion set – Capillary Bio:  angled 13.5 mm set,
This set is a Steel-reinforced cannula meant to help prevent kinking. It has 4 “holes” for insulin to drip out with a flexible tube and appears to provide less inflammation to surrounding tissues with a larger insulin delivery area.

2. DIY HCL Outcomes  (university of Bern) Diabetes Center Berne
Using Open APS, Android APS, Loop with 80 DIY users with a collective 53 years data.

    • 77.5% in-range, 18% high, 4.5% low
    • +9.3% after switching to DIY  (similar daytime & nighttime)
    • -1.2% in low range
    • Reduction in daytime lows, not nighttime lows

3. 670G Experience – Dr. Lal, Stanford

  • 79 patients (peds & adult) started on 670G, followed for 1 year
  • Baseline A1c approx 8%, 60% time in –range
  • Automode discontinuation was common and by 75% of the way through the study 44% had stopped using the system.
    • 3 mo 31%
    • 6 mo 40%
    • 9 mo 44%
  • 12 mo 46%  (32% used it at least 70% of the time)
  • Those who were more likely to discontinue use included younger age and those with a higher A1c with reasons including:  sensor (60%), supply issues (17%), fear of lows (10%), prefer MDI (7%), sports (7%)

4. Gen 3 iLet

  • Dual-chamber with both Insulin & glucagon delivery
  • To start the system only requires an entry of body weight entered and there is no run-in period or training provided
  • If no CGM data is available the system delivers basal based on history and user boluses
  • CGM used with the system includes both Dexcom G5 or Eversense
  • The study with 34 adults w/T1, starting A1c <11, on either injections or pump therapy
  • Target set to 120 on device
    • Mean (days 3-7):  162 (usual tx), 155 (ilet)
    • In-range (days 3-7): 62%, 70%  (significant)
    • Low (days 3-7): .6%, .6%
    • Overnight lows:  .4%, 0%
  • Sensor MARD is greater w/Dexcom and time in low range was higher with Eversense

5. i-Let Insulin Only Bionic Panreas

  • CGM system used includes dexcom G5 or Eversense CGM
  • User only enters their weight with no run-in or training period
  • Compared to mix of MDI/traditional pump users (iLet vs usual care):
    • Avg 155 vs 162 (no diff)
    • Time <54:  .7% vs .7%
    • Time <70:  2.8% vs 3.2% (nonsignificant)
    • Time in-range:  70% vs 61% (significant)
    • Overnight avg:  148 vs 163 (significant)
  • Eversense users spent more time in hypoglycemia, perhaps d/t sensor differences


Ultrarapid Lispro (URLi) improves post meal blood glucose

  • Excipients:  Treprostinil (vasodilator), citrate (increases vascular permeability) helping to provide a 10-min earlier onset with 3-fold increased action in first 30 minutes.
  • 43% less exposure after 3 hrs
  • Studied were done in adults with T1D & T2D.  3 groups:  mealtime URLi, mealtime humalog, 20-min post meal use of Urli. Findings included:
    • A1c of post meal URLi group ended up .2 higher than other groups
    • No change/difference in total insulin doses, basal or bolus
    • Post meal excursion with URLi was about 30 points lower compared to Humalog with no diff with 20-min post meal URLi
    • No differences in hypoglycemia rates, except at >4 hrs Post meal (less hypo for mealtime URli, none for 20min postmeal URLi)
    • A negative to use is that there appeared to be more injection site reactions with URLi.

Glargine u300 vs. Degludec

  • Impaired kidney function present in >20% of T2s, risk factor for hypoglycemia due to reduced insulin clearance
  • As eGFR increases, benefit of Gla-300 over Ideg increases (particularly at eGFR <60). 
  • A1c reduction is 0.4 greater
  • Fingerstick glucose is lower
  • No change in hypoglycemia risk


Everyone is racing to have the best artificial pancreas for people with diabetes to use.

The overview of those that are in the works include:

International Diabetes Closed Loop (Tandem Control IQ)

  • Study at University of Virginia
  • 6 month randomized multicenter controlled trial, Tandem X2, Dexcom G6
  • Sensor-augmented pump vs. Control IQ closed loop
  • The system includes automated correction boluses in addition to basal modulation and Hypo prevention system
  • Gradual intensification of overnight control to slowly move to a target of 110-120 fasting
  • Study included 168 participants, Ages 14+, no restriction based on previous mgt, control, severe lows
  • All statistically significant outcomes:
    • TIR  59% vs 71%, results achieved immediately & maintained (nighttime TIR 59% vs 76%)
    • Those w/A1c <6.5 at baseline, achieved 85% TIR.
    • Mean  166 vs. 156
    • A1c  7.39 vs. 7.06
    • Time <70  1.93% vs 1.40%
    • Time < 54  .24% vs. .21%
  • 97% CGM use; avg .21 fingersticks per day
  • 92% of time in closed loop mode
  • No severe lows occurred
  • Ease of use score 4.7/5; desire to continue use 4.8/5
  • Meal announcement still required
  • Users CAN extend boluses
  • Uses the user’s preferred basal profile as the starting point
  • Potential launch:  4th qtr 2019

Use of control IQ in children

  • More glucose variance among kids age 7-12 than any other age group
  • Best outcomes when used 24/7, not just at night.
  • 82% of time in-range overnight, 2% low.
  • Time <70:  3.9% vs 2.8%
  • TIR 59% vs 71%

Horizon (OmniPod HCL) – Stanford

  • Uses standard smartphone (app-based)
  • 73% time in-range
  • Algorithm updates regularly based on previous data
  • “Hybrid” basal rates – similar to but not exactly the same as user’s previous settings
  • Meals must be announced
  • Potential launch date:  3rd-4th qtr 2020

Medtronic announcements

      * Partnership with Tidepool announced. Goal is to develop and “interoperable automated insulin pump for managing diabetes”

      * New trials – “Bluetooth Enabled MiniMed(TM) 780G Advanced Hybrid Closed Loop System Designed to Automate Correction Bolusing”

             “Pivotal Trial for Next-Generation Guardian(TM) Continuous Glucose Monitoring Sensor”.


CGM Must meet the following criteria:

  • >87% of all values within 20% of YSi
  • >80% within 15% of YSi when above 180 AND no values < 70
  • >70% within 15% of YSi when 70-180
  • >85% within 15 mg/dl when below 70 AND no values >180
  • Similar performance in adults & peds required
  • ROC accuracy guidelines also established
  • No clinically significant data gaps allowed


Dual-hormone (insulin with glucagon) HCL

  • Castle et al, Diabetes Care Vol 41, July 2018
  • Achieved best control during and after 45min of exercise compared to use of single-hormone HCL and open-loop
  • Incidence of lows:  3.4% (dual hormone); 8.3% (single hormone HCL); 7.6% (PLGS)

Fasting vs PM exercise

  • Jane Yardley, University of Alberta
  • 10 adult participants
  • 24 min HIIT session (Twelve 10-sec sprints) plus 10 min warmup, 11 min cool down
  • Fasting (7am):  rose 32 mg/dl (1.8 mmol) during exercise, rose another 7mg/dl (0.4mmol) 1 hr later
  • Afternoon (5pm) 1 hr after glucerna bar:  fell 7mg/dl (.4 mmol during), another 21mg/dl (1.2mmol)  1 hr later
  • (p= .039 1h post)

Does daily activity or exercise affect insulin sensitivity more? (poster)

  • Mano et al, Kyoto University, Japan
  • In people with lower BMI (<23), exercise habits (to “sweating point”) correlated most strongly with reduced insulin resistance.
  • In people with higher BMI (?23), non-exercise activity (walking at least 1hr/day) correlated most strongly with reduced insulin resistance.

Benefits of exercise frequency in T1D (poster)

  • Ridell Mike, York University, Toronto
  • Type1 Diabetes Exercise Initiative Pilot Study
  • 33 Adults w/T1, exercising at least 30 minutes, with a mix of aerobic, resistance & interval training, twice weekly.
  • 24-hr period from start of exercise:  TIR 57%; non-exercise days:  TIR 48%.  No differences based on exercise type.  Time above 180 33% on exercise days vs 44% on non-exercise days.  Time below 70:  4.5% on exercise days  vs 3.8% on non-exercise days.
  • Difference between groups started to fade 16-20 hours after the exercise sessions.
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