The 11th Annual Advanced Technology and Treatments for Diabetes (ATTD) was held at the Austria Centre, Vienna from the 14-17th February 2017. This report presents some general observations about the conference
Scientific Programme – Key Points
Wednesday 14th February: Opening Ceremony
Continuous glucose monitoring (CGM), whether in real time or intermittently viewed, reflects the daily variability of glycaemic control, whereas measurement of HbA1C doesn’t reflect intra and inter day variability of glycaemic excursions (International consensus on use of CGM” Diabetes Care 2017;40:1631–1640 https://doi.org/10.2337/dc17-1600)
Thursday 15th February
Plenary Session: Coping with Glucose variability
- Reversibility of Brain Changes in Diabetes – Impaired awareness of hypoglycaemia (IAH) carries a high risk of hypoglycaemia; pump technology and CGM can improve awareness. HARPdoc study of hypoglycaemia awareness restoration programme for problematic hypoglycaemia despite optimised self-care ongoing
- Nasal glucagons – Launch in 2018 (Lilly). 3mg dose safe and effective across the entire age spectrum for T1D in pivotal studies
Friday 16th February
Industry Symposium (Cellnovo)
- Over 300 conference delegates attended the symposium chaired by Boris Kovatchev, University of Virginia. Dr Julian Shapley began the symposium by outlining the history of the Cellnovo Diabetes Management System (DMS), particularly its unique real-time data capture. Dr Olivia Hautier-Suply then presented the clinical characteristics and glycaemic outcomes of the recent analysis of real-time, real-world System user data from the Cellnovo Online Platform (Hautier-Suply O, Friedmann Y, Shapley J. A retrospective review of the clinical characteristics and blood glucose data from Cellnovo System users using data collected from the Cellnovo Online Platform. European Endocrinol. 2018;14(1)). This showed some significant glycaemic improvements. The benefits of accessing users’ real-time data were reflected in the presentation ‘Real-life experience of the Cellnovo System: The clinician and user perspective’ from Peter Kelly, a diabetes nurse specialist, and Sally Read, diabetes nurse specialist and Cellnovo System user.
- The symposium finished with a round-table discussion based on the topic: ‘The Cellnovo System: a platform for Future Innovation’. Moderated by Dr Shapley, the panel members included Dr. Daniel Cherñavvsky, Assistant Professor of Research, University of Virginia, Chief medical Officer, TypeZero Technologies, Charlottesville, Virginia, Dr. Pau Herrero, Faculty of Engineering, Imperial College, London, Member of PEPPER Project, Dr. Beatriz Lopez, University of Girona, Spain, Member of PEPPER project, and Mr. Chad Rogers, CEO, TypeZero Technologies, Charlottesville, Virginia.
Parallel Session: Closing the Loop
- The International Diabetes Closed-loop (iDCL) trial – Four iDCL study protocols:
- Feasibility study n=126 Roche combo spirit + Dexcom G5 + TypeZero algorithm, ongoing
- EU pivotal trial of the Roche-Senseonics-TypeZero 180-day closed loop system expected to begin soon
- Tandem t:slim X2/Dexcom G6/TypeZero Control IQ embedded system study (May 2018)
- Harvard’s “Enhanced Control-to-Range (eMPC)” algorithm on a mobile device controlling either Tandem’s t:slim X2 or Insulet’s Omnipod (TBD), with input from Dexcom CGM (end 2018)
- Dan05 study of closed loop (modified Medtronic 640G, Enlite 3 CGM, and Cambridge control algorithm on Android phone) in children and adolescents – to determine whether 24/7 automated closed-loop glucose control combined with low glucose feature will improve glucose control
- Beta Bionics pancreas studies – automated insulin and glucagon delivery in the same device; pivotal study finishes end of 2019
Roche Plenary Session: Fit for the Future – Merging Technology and Digital Solutions for Integrated Diabetes Management
- AP provides better overnight control; need daytime closed-loop system. Values beyond HbA1c should be used. Appropriate patient populations should be defined and used in studies
- Integrated solutions to overcome ‘clinical inertia’ (Only 6% of PWD in Europe achieve their time-in-range target). Working in partnership with MySugr using app to log data automatically , improve outcomes and support patients
- Eversense CGM can be left in situ for up to 6 months – works by fluorescent sensing. Has smart transmitter, on-body alerts and sends readings to the app every 5 minutes – shows trends and alerts and can be viewed remotely. Sensor outer cover has to be changed daily. Data from studies have informed algorithm and shown good results. Second trial in US underway.
Sanofi Plenary Session: Casting New Light on Basal Insulin
- Outlined evolution of GM and CGM, the latter proving to better than SMBG in all glycaemic parameters and is recommended as a tool to reduce HbA1c in adults. However, which metric is best indicator of glucose management – need standard metrics for analysing CGM
- Administration of GLA-300 vs GLA-100 with CGM decreased nocturnal hypoglycaemic events and less glucose variability in T1D
- Next generation of insulin (Deg-100) gives flatter glycaemic profiles which are more stable in T1 pts
Parallel Session: Ispad Session Challenges with Diabetes Technology in Paediatrics
- Diabetes Technology in Adolescents and Young Adults – improving adherence to treatment, self-care through Apps/software, simplified CGM, pump data uploading, reminders and easy access to treatment and transition by telemedicine
- Future projects (apps, software, telemedicine): advanced dose decision making systems, virtual diabetes clinics, advanced diabetes coaching, multi-device interface (CGM, activity tracker, insulin pump), analysing meal, activity patterns and nutrition. But need user friendly systems, smaller devices, single site; better informed systems, activity trackers, physiologic inputs. Customised treatments for adolescents
Saturday 17th February
Parallel Session: Diabetes Technology for T2DM
- OPT2MISE study – continuous subcutaneous insulin infusion (CSII) with monitoring and lifestyle modification for T2. QoL improved, mean glucose lowered and no significant weight gain. Better control seen in those who had not responded to MDI
- Retrospective CGM results can promote lifestyle changes, particularly increasing activity. Real-time CGM (rtCGM) with lifestyle counselling can increase exercise, time-in-range vs SMBG.
- rtCGM supports initiation of insulin compared to SMBG. Cost-effective. Can help detect glucose variability. In France suggestion that it should replace SMBG.
Parallel Session: Pumps, Sensors and FGM – Where do we Go?
- Comparing outcomes between pumps and MDI difficult as too many variables for each. High baseline HbA1c creates barrier to improved control on CSII. Pts using CSII need on-going education/support as some deteriorate clinically after 2-3 years
- Administration of bolus 10-20 mins before meal should be standard practice
- Work more with ‘non-responders’ to identify reasons why – what is their ‘Locus of Control’ – external or internal? Once determined HCP can personalise education/support etc
- Flash Glucose Monitoring (FGM) has been proven to achieve better glycaemic control than SMBG in a number of studies (inc IMPACT trial, IHART trial), with greater user satisfaction and more engagement
- FGM should be used for intensive insulin treatment to replace SMBG, whereas CGM is best suited to pump therapy