• Michelle Law

EASD 2022 Wednesday roundup



Today has been about technology, giving birth with diabetes, and climate change.


It's been exhilarating and hopeful. As someone living with Type 1 Diabetes I am so grateful to all the people who spend their professional lives trying to make a difference to our lives. Researchers and innovators, I salute you!


This update will follow the same format as yesterday's roundup - a summary of the presentations I attended today and some personal reflections.


It's been a bumper day, watching 12 presentations across three topics:


Diabetes technology and glucose monitoring

  • Moshe Philip - are we becoming robots?

  • Richard I. G. Holt - Telemedicine

  • Steven Russell - the next best thing in digital diabetes technology

  • Lori Laffel - gaps in treatment targets despite technology

  • Morten Hasselstrom Jensen - Flash monitoring in Denmark

  • Fraser Gibb - comparing Libre and Libre 2

  • Jean Pierre Riveline - skin reactions to diabetes tech adhesives

  • Shay Speeksman Brown - cost effectiveness of CGMs

Giving birth with diabetes

  • Natalia Asatiani - complications in women with microalbuminuria

  • Louise Fritsche - different glucose tolerance test profiles and outcomes

Diabetes and climate change

  • Fiona Adshead - diabetes, climate and global health

  • Lutz Heinemann - diabetes technology waste recycling


Summary of the sessions I joined today


First up, the technology sessions.


Moshe Philip - are we becoming robots?


This was an exciting talk that showed results from users of hybrid closed loop technology around the world. He shared results from the 780G and the Control IQ system. Conclusion was that TIR increases, hypos stay the same or reduce, and results are seen across countries.


He also talked about the potential to use AI tools to support HCPs and acknowledged that reviewing diabetes data takes up a lot of time - if this could be done by AI it would free up HCP time to talk about other things with the patient. This benefit was recognised by the HCPs surveyed.



Richard I. G. Holt - Telemedicine


Next up was a talk about telemedicine and its strengths and limitations in diabetes care. Many of us have moved to virtual consultations and while that's convenient, it isn't suitable for all people or all their needs. When we do have remote consultations, they often don't meet the "nirvana" set out in the slide below (causing a knowing chuckle in the audience when the slide went up).


Good remote consultations need both parties to make the effort to get the most out of them.


Steven Russell - the next best thing in digital diabetes technology


This was the presentation that got me really excited. Results from the iLet bionic pancreas were shared and they were very impressive and reviewed in detail, and even more excitingly, don't require carb counting.


Russell then discussed how to make automated insulin delivery systems even better through faster insulins, glucose-responsive insulins and microdosing glucagon - but more research is needed to develop these. He said that with these improvements it could be feasible to get 90% of people with Type 1 Diabetes meeting treatment targets.




Lori Laffel - gaps in treatment targets despite technology


After the last two presentations talking up the benefits of diabetes technology, this speaker presented data showing that lots of people still miss treatment targets even though they have advanced diabetes technology. More work needs to be done to understand why. Technology is not a "silver bullet".




Morten Hasselstrom Jensen - Flash monitoring in Denmark


The title of this talk gives away the findings which aren't too surprising as they support what we have seen in other places - that "intermittently scanned continuous glucose monitoring is associated with a long term glucose lowering effect for type 1 diabetes patients in poor glycaemic control".


What I found the most interesting part of the talk was the description of the current status of access in Denmark. Sadly there's a postcode lottery.





Fraser Gibb - comparing Libre and Libre 2


This study looked at the impact of moving patients in Scotland from Freestyle Libre to Freestyle Libre 2 with the biggest impact being the improvement in time below range.




Jean-Pierre Riveline - skin reactions to diabetes tech adhesives


I was pleased to see this study look at skin reactions to diabetes technology adhesives. It turns out it is a very common problem with 25% of users experiencing skin reactions when using insulin pumps or CGMs/flash glucose monitors. Most people use avoidance strategies to lessen the effects and there is a very low rate of device discontinuation (2-3%).


Interesting to see such a high proportion of people experiencing reactions and just working around it as best they can.




Shay Speeksman Brown - cost effectiveness of CGMs


This was a really thought provoking presentation. No matter how great something is for the user, the numbers have to stack up. If CGM treatment costs came down further they could go from being cost effective (which they are now) to being cost saving.


This was a health economics focused presentation that was really well explained and followed by good Q&A which touched on indirect treatment costs like training and supporting HCPs to deliver the technology and who should bear those costs.




 

Next was a set of talks about giving birth with diabetes. I tuned into two talks in this session:


Natalia Asatiani - complications in women with microalbuminuria


This was the first time today where the findings presented in a talk were negative and quite shocking. I think it's tough to talk about them as a PWD as they prompt a lot of questions that the talk didn't have a chance to cover. Without the full picture this could be scary and upsetting for women with microalbuminuria who are pregnant or planning to have children. What do you do with this information?




Louise Fritsche - different glucose tolerance test profiles and outcomes


This talk was interesting - by breaking down the glucose response patterns during a glucose tolerance test in pregnancy, expectant mothers were divided into different classes and outcomes for them and their babies were measured. Women in class 3 weren't diagnosed with gestational diabetes but they had the highest risk of having big babies and gestational weight gain. This study suggests they might benefit from therapy to prevent this. Sounds like this could have real world application and benefits.




 

Finally, right at the end of the day were the talks on diabetes and climate change.

Fiona Adshead - diabetes, climate and global health


This was a more general talk about the role that healthcare has to play in the fight against climate change. The speaker touched on the supply chain, using digital tools, designing lower impact clinical trials, reusable equipment, recycling and new materials. It's an ongoing programme of work across all aspects of healthcare.





Lutz Heinemann - diabetes technology waste recycling


I had been looking forward to this talk since I first saw it on the programme. People in the diabetes online community often share photos of diabetes technology waste and complain about it. It's uncomfortable throwing so much plastic away every week, it just feels wrong. It was good to see this acknowledged in the presentation and hopefully it will prompt industry change.


As the speaker points out, that is not going to be easy. These devices are complicated and made of lots of different materials. Maybe we can do better with the packaging and the transportation of these things? Maybe we can use biodegradable plastics?


I applaud the speaker for calling for action and urging us to work together. Blaming and industry bashing doesn't get us anywhere.


 

Personal reflections


How do I feel at the end of all this?


Hope! Gratitude! I felt quite emotional a few times during the day. Life with Type 1 Diabetes is getting better. Technology is improving all the time. Extremely dedicated, smart people from all sorts of disciplines are working on it. Access is gradually improving.



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I also wanted to take a minute to appreciate the researcher etiquette around giving comments on people's presentations. It has made me smile!


Before asking their questions in the Q&A, people said things like this to the presenters...


"That was a very elegant study"

"Thank you for sharing your lovely data"

"A clear and elegant presentation"



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What lovely things to say about people's work!


More from me tomorrow, thanks for reading!