The American Diabetes Association 1999 Scientific Sessions, held in San Diego in June 1999, offered an opportunity to learn about the latest in diabetes research, meet with researchers and clinicians, and meet with industry representatives. Children with Diabetes had a booth at the meeting. Here is our report.
Research and Poster Presentations
There was general agreement among the doctors and nurses from the Diabetes Team that the primary focus of the 1999 Scientific Sessions were on Type 2 diabetes and its complications. However, the following research reports and poster presentations might be of interest to parents of children with diabetes.
- Dr. Fran Kaufman presented Use of Insulin Pump Therapy at Night Only for Pre-Teen Children with Type 1 Diabetes. This study showed that insulin pump therapy overnight may be a viable option for children who are not developmentally capable of managing the pump during the day when there is no adult supervision. Read the report from the Diabetes Team.
- Tim Wysocki, PhD presented information on an ongoing study of Intensive Therapy and Children. The study aims to determine if the findings of the Diabetes Control and Complications Trial (DCCT) apply to younger kids. Read the report from the Diabetes Team.
- Glycemic Control and Insulin Requirements at a Diabetes Summer Camp, by Laurie T. Quinn, Mita Sass, Barbara Berger, Mary Kreiter, Barry Rich, and Josephine Volgi from Chicago, Illinois, showed that maintaining camp insulin doses closer to home insulin doses results in better blood glucose control without a significant increase in pre-meal hypoglycemia. Since many kids are placed on lower insulin doses at camp, this study should be of particular interest to parents who are sending their children to camps. The large number of instances of night-time hypoglycemia supports vigilant monitoring during the night, which is typical of diabetes summer camps. (Poster 362)
- Clinical Factors versus Autoantibodies in the Classification of Diabetes Type aimed to improve the clinical classification of diabetes using a scoring system and to compare a clinically based classification system with autoantibody anaylses. For the study, 764 newly diagnosed patients in Sweden were tested. The study concludes that classification of diabetes by clinical signs and symptoms is insufficient, with over 10% of patients being mis-classified. Both clinical signs and antibody analysis is needed for classification of diabetes in young adults. (Poster 382)
- Is Good Metabolic Control associated with Quality of Life? sought to determine if the rigors of intensive management, which are essential for good control, have negative effects on quality of life. Previous studies yielded controversial data from relatively small numbers of test subjects. In this study, 2,103 adolescents with diabetes from 17 countries, speaking 14 languages, were enrolled. The study showed that lower HbA1c is associated with better quality of life for adolescents and their families. HbA1c was also found to increase with age, and that quality of life correspondingly decreased. Based on the results, the authors conclude that good metabolic control is associated with better quality of life for adolescents and their parents, and therefore good diabetes control should be promoted as a quality of life issue. (Poster 396)
- The Use of Specialist Care by Patients with Type 1 Diabetes: Characteristics and Outcomes by Janice C. Zgibor and Thomas Songe, Pittsburgh, PA, reported on a study that sought to determine the differences in the characteristics and outcomes related to the use of specialists in caring for patients with Type 1 diabetes. Patients who reported using specialists were more likely to have higher education and income, had increased rates of participation in self-care, and had better glycemic control. Patients with higher education and income also showed better glycemic control. The authors conclude by stating that efforts aimed at preventing diabetes complications should improve access to specialists to those of lower socioeconomic status, and coordinate care between generalists and specialists. (Poster 825)
- Cow Milk Insulin as a Trigger of Cellular and Humoral Immunity to Insulin in Infants with Genetic Risk for IDDM by Johanna M. Pronen, Hans K. Akerblom, Outi Vaarala from Helsinki, Finland, examined infants with first-degree relatives with Type 1 diabetes who had an increased genetic risk for developing Type 1 diabetes. The infants were given formula with or without specific cow's mile proteins. At the age of three months, cellular responses to bovine insulin found in cow's milk were elevated in infants exposed to cow's milk formula compared with those who were not. Subsequently, infants who had developed antibodies to bovine insulin also developed antibodies to human insulin. The authors conclude that primay cellular immunization to insulin may occur in infants by oral exposure to bovine insulin found in cow's milk formula. (Poster 898)
- One Third of HLA DQ2 Homozygous Patients with Type 1 Diabetes Express Celiac Disease Associated Transglutaminase Autoantibodies, by Fei Bao, Liping Yu, Sunanda Babu, Tianbao Wang, Yongsoo Park, Cynthia Uhlhorn, Edward J. Hoffenberg, and Henry A. Erlich, from Denver, Colorado and Alameda, California, aimed to evaluate celiac-disease associated antibodies in patients with diabetes, their relatives, and the general population. The study screened 1,071 patients with diabetes from the Barbara Davis Center in Denver, 381 siblings and children, and 752 people from the general population. The data showed that one-third of patients with Type 1 diabetes who are HLA DQ2 homozygous also express antibodies associated with celiac disease, compared with 10.4% in all patients with Type 1 diabetes, 5% in relatives, 1.3% in the general population. (Poster 902)
- Gluten-Free Diet Prevents Diabetes in NOD Mice by David P. Funda, Anne Kaas, Troels Bock, Helena Tlaskalova, and Karsten Buschard from Prague, Czech Republic, reported on a study that showed that NOD mice, which develop diabetes like humans with Type 1, have a reduced incidence of diabetes when fed a gluten-free diet compared with NOD mice fed a standard diet with gluten. The experimental mice were fed a diet free from gluten, but with a similar total protein content as the control animals. The gluten-free diet both delayed and prevented diabetes in NOD mice (incidence dropped from 65% to 22%). The authors suggest that certain dietary proteins might be capable of shaping the immune system in a way that leads to Type 1 diabetes in genetically susceptible animals. (Poster 935)
- Impact of Humalog Insulin on HbA1c Values in Insulin Pump Users by Satish K. Garg, James Anderson, Lori Gerard, and Peter Chase from the Barbara Davis Center in Denver, Colorado, reported that use of Humalog instead of Velosulin insulin resulted in improved glycemic control as evidenced by lower HbA1c readings (7.4 +/1 0.1% with Humalog compared with 7.9 +/- 0.1% with Velosulin, p<0.001). In addition, the mean total insulin dose (U/kg/day) was significantly lower for the Humalog group. Further, improvement in glycemic control was not associated with increased hypoglycemia. [Editor's comment: In a poll about insulin regimen, 60 pump users reported using Humalog compared to only 4 using Regular (Velosulin)] (Poster 977)
Products and Exhibits
Many companies showed new products or products under development that have the potential for improving the lives of children with diabetes. Several companies have continuous blood glucose sensors under development. Once available, these products will provide hypoglycemic alarms, freeing parents, as well as older kids and adults, from the need to awaken during the night to perform finger-stick blood tests. Here are some of the products that you might find interesting.
- The Children with Diabetes booth drew a lot of attention. John Ratzenberger, our Chairman, chatted with the crowd and signed photos and Humpty Dombrowski hats. We showed the site, live on the Internet, to hundreds of medical professionals, researchers, and vendors. Over and over, doctors and nurses told us that we were the only diabetes-related web site that they trusted enough to recommend to their patients. And everyone wanted a Humpty Hat!
The CWD Booth and Team: President Jeff Hitchcock, Steph Schwartz, Medical Director Bill Quick, Joyce Mosiman, Director Donna Coffey, Virginia Valentine, Heather Speer
Chairman John Ratzenberger and the Pump Girls
- Animas (www.animascorp.com/index.html) had a large booth to promote their investigational insulin pump. The company was reluctant to discuss specifics about the product, other than to say they hope to make an FDA submission within the next few weeks and to have their insulin pump on the market in 2000.
Animas booth, before the show opened
- Chronimed (www.chronimed.com) showed their Personal Lasette laser lancing device. Smaller and more affordable than the original Lasette, the Personal Lasette is designed for home users, rather than health care professionals. Many users report feeling less discomfort with the Lasette compared with traditional steel lancets.
The Chronimed Personal Lasette
- Cygnus (www.cygn.com) showed the GlucoWatch, their non-invasive continuous blood glucose monitoring system. Cygnus is preparing for their late-June 1999 presentation to the FDA, so they were very cautious about what they said and did at the show. We were not allowed to hold a GlucoWatch, for example. Cygnus has a clinical study report about the GlucoWatch on their web site. You can also read the news release on the ADA website and the report on the CNN website.
The Cygnus booth, where you could see but not touch the GlucoWatch
The GlucoWatch. Image from the Cygnus web site.
- Disetronic (www.disetronic.com) showed their new insulin pen, which uses any insulin because you fill it from an insulin vial. We will review the Disetronic pen in the coming weeks. Disetronic also showed their DiaPort percutanous port system, in which a catheter is inserted either into the umbilical vein or the peritoneal cavity for delivery of insulin from the Disetronic insulin pump. With a permanent insertion site, pump users would be free from periodic site changes. This device is under study and is not available in the United States.
The Disetronic intraperitoneal delivery system delivers insulin into the umbilical vein.
The Disetronic Pen uses insulin from a vial, rather than pen cartridges.
- Metrika (www.metrika.com) showed their HbA1c single-use monitor, a product currently under development. This product is designed to provide rapid test results (several minutes), so patients could discuss their HbA1c reading with their diabetes team during their quarterly visit. The company hopes to have the product approved for sale in the US in 2000.
The Metrika HbA1c monitor
- MiniMed (www.minimed.com) showed off their newly FDA approved Continuous Glucose Sensor. The device is currently available only to physicians, who use it to collect blood sugar information from their patients for up to three consecutive days. The blood sugar data from the device is analyzed by the physician and is not available to the patient. The company hopes to evolve the product into a device that provides a continuous readout of blood sugar level to the patient and includes hypo- and hyperglycemic alarms.
The MiniMed Booth, before the show floor opened
The MiniMed Continuous Glucose Sensor
- ReCall Services (www.recallrx.com) showed the HealthWatch 100, a medical reminder watch with multiple alarms. Unlike other watches with multiple alarms, the HealthWatch 100 keeps track of which alarms are cancelled by the wearer, and uses that information to indicate that the alarmed event has been taken care of (blood test performed, etc.). The watch is programmed using a special cradle that interfaces with a PC (no Macintosh support is available).
The HealthWatch 100
- Sooil (www.sooil.com) showed their DANA Diabecare insulin pump. The DANA pump is available in Korea and other Asian countries, but not the US. The company hopes to complete an FDA submission in 1999 and obtain permission to market the pump in the US in 2000. The DANA was the smallest insulin pump shown shown at the 1999 ADA show.
The Sooil Booth, before the show floor opened
DANA Diabecare Pump
- SpectRx (www.spectrx.com) showed their prototype for a continuous glucose monitoring system, currently undergoing investigation. The system uses a small laser to create an array of micropores in the outer layer of dead cells in the skin, through which interstitial fluid flows. Glucose in the fluid is measured by a sensor within the patch worn over the micropores. The sensor connects to the monitor, which can be worn like a pager on the belt. Blood glucose readings are continuously displayed. While at the show, SpectRx was recruiting physicians to participate in clinical trials.
The SpectRx Booth, before the show floor opened
The SpectRx monitor, worn
The SpectRx sensor head. Click for a larger view.
- TheraSense (www.therasense.com) showed two investigational products, the Freestyle meter and a Continuous Monitoring Device. The Freestyle is designed to use 0.3 microliters of blood, or one-tenth of the amount of blood used today by the Glucometer Dex, Glucometer Elite, LifeScan FastTake, and Medisense Precision QID. According to the company, such a small blood volume requiement will allow sampling from areas other than the finger tips.
The TheraSense Booth, before the show floor opened
Updated June 25, 1999
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Last Updated: Thursday August 29, 2002 21:04:40
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