Last week I was very lucky to attend the ATTD2024 conference in Florence, the biggest diabetes technology conference in the world, as a diabetes advocate and #dedoc voice. Here are my top 10 takeaways at a glance - keep reading to find out more about the discussions, the presentations, the controversies and the tweet threads! 👇
1. The Tech Fair was a mixed bag with some standouts
There’s a bit of a craze for non-invasive glucose monitoring solutions but I am yet to be convinced by these - they might not need to pierce the skin but they are often large, cumbersome, uncomfortable and/or not very accurate. There were some novel insulin delivery systems like implanted insulin ports (eek) and long-delivery insulin patches (interesting...), as well as ideas for peripheral neuropathy screening and treatments.
Here are all the Tech Fair presenters:
My favourite exhibit in the Tech Fair was the T2D screening tool from Glyconics that uses infrared spectroscopy to analyse the fingernail in moments to identify those at risk – no blood needed. Could be an excellent tool to take into the community that’s quick, easy and painless. The company reps said it could be set up at sports matches, shopping centres, churches, community centres, doctors offices and pharmacies to make it easier for people to have a quick check. Sounds good.
Outside the Tech Fair I was also impressed by the AI assisted retinopathy screening offered by iCare– no dilation drops and instant results. This is an improvement on the unpleasant and time consuming screening process we currently have. I tried it out and got a report of the results to take away with me without needing to wear sunglasses for the rest of the day and wait for a letter in the post in several weeks' time!
These screening companies just need to remember that there is a person on the other end of their screening process receiving (sometimes worrying) information and an AI assisted piece of software is not going to be enough on its own to deliver this service. Proper training is needed so real people overseeing these tools can sensitively handle and communicate the results to the people being screened.
2. Hybrid closed loops work – now to fully close them
The evidence for use of hybrid closed loops (HCL) is compelling and, happily, the UK is a world leader in adopting this technology as the standard of care for people with diabetes going forward. I’ve been using a Medtronic 780G hybrid closed loop (HCL) for 3 years and I love it, but it doesn’t do everything (read more about the 780G here). Now the challenge is to fully close the loop in these systems by removing the need to enter carb intake when eating. This is already a reality for some people in the DIY looping community and I’m sure the commercial HCL systems won’t be too far behind.
3. New CGMs being launched, the competition is fierce
I was very excited to finally get to try the new Medtronic Simplera CGM. This is a big step forward for Medtronic and brings their CGM offering much more into line with the competition. It was a smart move by Medtronic to give diabetes advocates at ATTD the chance to wear a Simplera – LOTS of us were wearing it by the end of the conference and I'm loving mine so far. Click here to read more about the Simplera Sync (the version that works with the Medtronic 780G) .
Roche also announced they will be launching their own CGM, Dexcom and Abbott are fighting it out for market share and the makers of non invasive CGMs are trying to get in on the action as well.
4. Exercise is still tricky to manage despite new technology
Hybrid closed loops are great but, as I said before, they can’t do everything and one of the challenges that remains is managing blood sugar and exercise. It’s a delicate, individualised balancing act that still needs the person with diabetes to put thought into and ideally plan for in advance so hypos and spikes can be avoided.
I really appreciate it that researchers are trying to help us figure out the practical steps we can take to manage exercise and blood sugars better. I came across a recent paper on exactly this topic, specifically for the Medtronic 780G and found the practical tips did really help (access the paper here).
5. Time in Tight Range was a controversial topic – do we want it?
Time in Range has become a well understood “thing” with the advent of CGMs and now researchers and technology companies are exploring the benefits of targeting Time in Tight Range (3.9-7.8mmol/l or 70-140mg/dl). The general feedback from people with diabetes in response to a tweet about this was quite negative – on the face of it, moving the goal posts to make things even more challenging to maintain would increase the stress and burden.
This really needs to be carefully thought through before adding this to the measures we have to track.
6. More talk about using tech for people with T2D
Tech for people with T2D felt like a bigger conversation at this conference. The benefits of CGMs and the potential for those on insulin to use HCL systems were on the agenda but obviously as a much bigger patient population the costs of adoption are much higher so widespread coverage is not likely to happen any time soon until there is a firm evidence base. I noticed the EASD have launched a call for a guideline development panel on CGM use in people with T2D so we’ll be hearing much more about this in future.
7. Too many people around the world lack access to basic care
During the conference I heard about the two extremes of diabetes care:
Alicia Jenkins from Insulin for Life Australia told us about the challenges getting diabetes supplies into conflict zones and the impact that people on the ground can make with distributing them. Too many people still can’t access basic care.
#Dedoc friend Hamidah from Uganda talked about access challenges in Africa.
Meanwhile at the Tech Fair we heard from GluCare.Health which is developing a new online and offline care model for people with diabetes in the UAE. Despite being a wealthy country, outcomes for people with diabetes have been poor and they think this could be turned around if the care model is improved to make diabetes care more appealing and convenient to people with diabetes – beautiful clinics, the best equipment, all services under one roof and comprehensive virtual care between appointments. What they described sounded wonderful, but it was a completely different world from the stories told by Alicia and Hamidah.
8. Research and technology still not meeting women’s needs
It was good to see the “gender differences in glucose control” sessions making an appearance at ATTD again (I loved the sessions last year at ATTD2023).
The fundamental message was the same: the menstrual cycle and menopause affect glucose control. It’s harder to manage diabetes if you’re female. Exercise is more complicated to manage if you’re female with diabetes. We’ve known this for a long time but what are we going to do about it? To read more about this session, click the image below.
We need more research to fill the gaps and we need technology that caters to our needs. This was echoed on social media too! We have exercise mode on our insulin pumps, why can't we tell them about our menstrual cycles?
9. Hope remains for a cure for T1D
This is where the science got much more technical -but in summary, the discussions were about a) the case for wider population screening for T1D:
b) the treatments available that can delay the onset of type one diabetes:
c) potential 'cures'
There has also been much more discussion over the last year around beta cell therapies that can restore the ability to produce insulin within the body. The challenge is protecting these new insulin producing cells from the immune response that brings on T1D in the first place. Vertex for example is working on a solution that encapsulates the cells and this space is developing rapidly - I'm looking forward to seeing how things develop but I'm not expecting a cure very soon.
10. Lived experience perspective is essential
Someone on twitter said I should have put this as the #1 point on my list, and I think they are right.
I had a lot of conversations with the representatives in the Tech Fair and there was a variation in how many of them had really involved people with diabetes in the process of developing their innovations. I couldn't help but think - just because it's possible to make it, doesn't mean we really want it! What a waste of resources if there is no demand. And at the same time, there are things we are crying out for that don't get prioritised. Things like algorithms that can take account of the menstrual cycle, or ways to recycle more of the plastic waste that comes with our pumps and CGMs.
Whether in research, innovation, policy, or communication generally, the lived experience perspective must be factored in. And I mean, not just at the end as a 'what do you think of this thing we've done?' sort of thing but co-creation and involvement throughout.
There also needs to be more recognition of the labour involved from people with diabetes giving their time, energy, emotional resources and expertise to contribute to things. It seems to be the norm that people with diabetes are expected to give their time and input as volunteers but often they are working with researchers who are being paid through their research grants, or industry folks who are working for profit making enterprises. It wouldn't take much for them to allocate resources from their budgets to properly fund their engagement work - some do a good job of this already - but I wish it was more widespread so the efforts of people with diabetes were properly recognised more often.
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I've only scratched the surface of what was covered at the conference so do check out the other #dedoc voices posts across social media too. We covered a lot of ground between us!
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Thanks to dedoc!
Thanks to Dedoc for the opportunity to attend ATTD - they paid for my flights, accommodation and access to the conference. These are all my personal views.