The American Diabetes Association 1998 Scientific Sessions, held in Chicago, offer an opportunity to learn about the latest in diabetes research, meet with researchers and clinicians, and meet with industry representatives. children with DIABETES was well represented at the meeting, with several members of the Diabetes Team, as well as the editor of the web site, in attendance. Here is our report.
Researchers host symposia or make oral presentations about their research topic. Questions from the audience bring to light both opposing views and supporting research.
- Three research groups presented brief papers about the use of inhaled insulin. Based on the results presented, it is safe to say that inhaled insulin is as effective as injected insulin in managing blood sugars in people with both Type 1 and Type 2 diabetes. More research must be performed before inhaled insulin is commercially available, however.
- A Comparison of the Pharmacokinetics and Pharmacodynamics of Inhaled Insulin Administered as Different Strength Solutions to Healthy Volunteers, presented by Dr. Aidan McElduff, reported on a system called AERx which uses disposable blisterpacks of insulin and a computer-controlled inhalation system. The AERx system was tested on healthy adult men without diabetes to determine the effectiveness of an inhalation system in delivering insulin. The results were very good, with the AERx inhaled insulin system delivering insulin to the blood slightly sooner than but presenting an action profile otherwise identical to subcutaneous insulin injection. Dr. McElduff concluded by stating that the study showed that insulin was rapidly absorbed from the lung, that aerosol insulin was not more effective than injections, and that inhaled insulin was not significantly different than insulin lispro in its action profile.
- Treatment of Type 1 Diabetes Mellitus With Inhaled Human Insulin: A 3-Month, Multicenter Trial, presented by Jay Skyler, M.D., reported on a study that involved 70 adults (age 35 +/- 9 nears) with Type 1 diabetes, 35 of which were randomized to inhaled and 35 to injected insulin. Fasting and two-hour post prandial blood sugars were measured for a period of three months. Subjects in the inhaled group injected Ultralente before dinner as a basal and inhaled insulin before each meal. The test results showed that inhaled insulin managed blood sugar almost identically to injected insulin. Furthermore, the study found no impairment of pulmonary function. 28 of 35 subjects elected to continue using inhaled insulin for a one-year extension of the study. Smokers and people with asthma were excluded from the study.
- In Treatment of Type 2 Diabetes Mellitus With Inhaled Human Insulin: A 3-Month, Multicenter Trial, William T. Cefalu reported essentially identical results to those presented by Dr. Skyler. Inhaled insulin proved just as effective as injections for patients with Type 2 diabetes who required insulin. 23 of 25 subjects using inhaled insulin continued into the one year study extension.
For additional information about inhaled insulin, see:
- Inhaled insulin at the Diabetes Monitor
- ABC News Story, including an interview with Brenda Hitchcock
- First Results of Phase IIb Inhaled Insulin Trials from Inhale Therapeutic Systems, maker of an insulin inhaler system under study. The web site of Inhale Theraputic shows the size of the inhaler system.
- Inhaling Insulin
- Allo Islet Cell Transplantation--Does It Work?, moderated by R. Paul Robertson, MD, featured presentations by David E.R. Southerland, MD, PhD, and Camillo Ricordi, MD on pancreas and islet transplantation as a cure for Type 1 diabetes.
- Stating that "islet transplantation is the most frequently broken promise in medicine," Dr. Southerland argued for whole pancreas transplantation for patients with Type 1 diabetes who want insulin independence. He pointed out that islet transplantation is not effective (in the absence of encapsulation), even with immunnosuppression, while whole pancreas transplants are. There is some thinking that lymphatic tissue must accompany an islet cell implant to help the islets survive.
- Dr. Ricordi described his labs' successes in allo islet transplants done in non-human primates that were accompanied by anti-CD40L, a monoclonal antibody. Allograft rejection was prevented, and the recurrence of autoimmunity, which would destroy the implanted islets, was also prevented. Furthermore, in a baboon, when apparent islet rejection was detected, anti-CD40L reversed the rejection and return the animal to normal glycemia. He also noted that in allografts, approximately 50% of the implanted islets die within the first month after transplant. If this sudden die off can be prevented or reduced, islet implants will have a better chance of success (defined as insulin independence).
- In Adherence to Intervention Protocol to Prevent Nocturnal Hypoglycemia in Children, Sandra Puczynski, of Toledo, Ohio reported on her protocol to prevent nighttime hypoglycemia in kids. Of the 31 kids who participated, 26% had experienced severe hypoglycemia with loss of consciousness. In the protocol, the kids were randomized to a control group (just blood tests) and an intervention group (test plus extra snack). All kids were tested at 10:30 pm. If intervention kids had a blood sugar below 120 mg/dl, they were given 0.3g of carbohydrates per kilogram of body weight. Kids in the intervention group had significantly less nighttime hypoglycemia than control kids. Insulin regimen and number of shots had no effect on the outcome.
Researches present results of studies by posting papers, graphs and charts on a large vertical board (see picture of poster). Authors are available to discuss the poster at a preset time.
- John Holcombe, Philip Raskin, William Tamborlane, and John Malone compared the use of lispro with buffered Regular in pump users. Reporting in Humalog® versus Velosulin® BR in Continuous Subcutaneous Insulin Infusion Pumps, the authors conclude that "lispro is a safe and effective alternative to phosphate-buffered regular insulin in external infusion pumps." (Poster 356)
- In Comparative Study of Insulin Lispro and Regular Insulin in Prepubertal Children with Type 1 Diabetes, authors John H. Holcombe, Rocco Brunelle, Sunita Zalani, and Larry Deeb studied 61 children with diabetes, ages 2.9 to 11.4 years. From their study, the authors concluded that insulin lispro given before meals controls postprandial blood sugars, that lispro is well tolerated by young children, that adminstering lispro after meals is also effective, and that lispro is safe and effective for prepubertal children. Further, they found no difference in HbA1c readings or incidence of hypoglycemia between kids using lispro and kids using Regular. (Poster 375)
- Vitamin E Treatment Normalizes Retinal Blood Flow and Improves Renal Function in IDDM Patients: Results of a Double Masked Crossover Clinical Trial by Sven Bursell, et al, set out to determine whether Vitamin E can help with retinal and renal complications. Their study of 46 diabetics and 13 non-diabetic controls concludes that "Vitamin E treatment appears to be effective in normalizing retinal and renal hemodynamics in diabetic patients with less than 10 years duration of diabetes despite a lack of glycemic control." (Poster 391)
- A Recent Assessment of Continuation Rates for Continuous Subcutaneous Insulin Infusion (CSII), by Bruce Bode, et al, of the Atlanta Diabetes Association, studied 203 patients who started using an insulin pump between January 1992 and May 1998. They found a low rate of discontuniation (3%) and that patients who continued showed a marked reduction in both HbA1c levels and frequency of severe hypoglycemia. Patient age was 34 +/- 12 years. The author believes that improvements in pump technology have eliminated many of the problems and concerns that caused people to discontinue pump use in years past. (Poster 392)
- In Defective Counterrgulation During Nocturnal Hypoglycemia in Prepubertal Children with IDDM, authors Krystyna Matyka, Elizabeth Crowne, Peter Havel, Ian MacDonald, and David Dunger report that "nocturnal episodes of hypoglycemia, which are both profound and prolonged, are common in prepubertal children with IDDM on conventional insulin regimens." 17 of the 29 children with IDDM tested had espisodes of nocturnal hypoglycemia. The mean low glucose (nadir) was 36 mg/dl (range 21.6 to 59.4) with a median duration of 225 minutes (range 30 to 630 minutes). Their conclusion is that there is "an alarmingly high prevalence of profound asymptomatic nocturnal hypoglycemia in prepubertal children with IDDM." They postulate that the cause is defective counterregulation caused by previous undetected episodes of hypoglycemia. Finally, they state that these results demonstrate the danger of undertaking intensive control in children of this age group. (Poster 422)
- In Impaired Hypoglycemia Awareness and Its Relationship to Severe Hypoglycemia in IDDM Children and Adolescents, Laszlo Barkai and Ildiko Vamosi from Miskolc, Hungary, report that impaired hypoglycemia awareness is associated with an increased risk of severe hypoglycemia. (Severe hypoglycemia is defined as hypoglycemia that requires help from someone else for treatment.) Kids six years old or less with impaired awareness experienced coma or seizure at the rate of approximately 58 episodes per 100 patient years, while kids without impaired awareness experienced had almost none. Further, they found that one-third of severe hypoglycemic episodes had no warning signs or symptoms. They conclude that "more cautiousness is needed to set blood glucose control in pre-school diabetic children and avoidance of hypoglycemia should be a priority in this age group." (Poster 433)
- Risk Factors for Hypoglycemia in Young Individuals with Type 1 Diabetes by Catherine Allen, et al, studied 418 kids and young adults with Type 1 diabetes. The study concluded that both duration of diabetes and number of injections per day increased the risk of hypoglycemia. Further, they study concluded that the risk of frequent hypoglycemia is higher in younger children with better control. (Poster 602)
- Kids will be happy to learn that Jennifer Cleveland, Emily Loghmani, Karyl Rickard, Naomi Fineberg, and Gary Freidenberg report No Glycemic Difference in High vs Moderate Sucrose-containing Foods in Children with Diabetes. Their study of ten children concludes that high sugar foods at breakfast and mid-morning snack do not cause an increase in blood sugar compared with foods with moderate sugar. (Be sure to stay within your carbohydrate target!) (Poster 1202)
- Symptoms of Depression are Important for Adaptation and Metabolic Control in Children with Type 1 Diabetes demonstrated that kids with diabetes who had symptoms of clinical depression had higher HbA1c levels than kids with diabetes who did not have symptoms of depression. Furthermore, the kids with symptoms of depression showed poor adaptation to life with diabetes and were at increased risk for psychological and medical difficulties. (Poster 1257)
- Reproductive Health in Adolescents with Diabetes: What They Don't Know Can Hurt Them, by Denise Charron-Prochownik, et al, from the University of Pittsburgh reports on a study of 31 adolescent women with Type 1 diabetes, ages 16 to 21. The study's goal was to determine understanding of reproductive health and the implications of diabetes to pregnancy. 65% of the subjects said that they had never discussed how diabetes affects pregnancy with their diabetes team, and 52% said that they were never told by any health care professionals to seek out special medical care and advice before planning a pregnancy. Of those who reported being sexually active, 44% had early and unsafe sexual practices with a high risk for unplanned pregnancy. Given this significant information gap, the study concludes that, starting at puberty, all women with diabetes should informed about the effects of diabetes on pregnancy, the risk of complications, the importance of planning a pregnancy with pre-conception planning, and how to prevent pregnancy. (Poster 1258)
- Lipohypertrophy with Self-Injection of Human Insulin in Children/Adolescents with IDDM, by Doreen Radjenovic, reports on a study performed at the Florida Camp for Children and Youth with Diabetes. Lipohypertrophy was found in 35 out of 144 (24%) of the kids injecting human insulin who were responsible for their injections all the time. Kids without lipohypertrophy had help doing injections, at least some of the time. This study reiterates the importance of site rotation and continued parental involvement in the care of children with diabetes. (Poster 1260)
160 companies and not-for-profit organizations involved in diabetes, one way or another, shared the show floor. All the major players were there, as well as many small companies introducing new technology.
For More Information
The AccuCheck Complete blood glucose meter now has an optional fax/modem which connects directly to the meter. Using the fax/modem, your meter can transfer blood sugar data directly to your health care team. The image to the right shows the fax/modem next to an AccuCheck Complete.
Last Updated: Thursday August 29, 2002 21:04:40
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