The American Diabetes Association 2003 Scientific Sessions were held in New Orleans in June 2003 and 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 small booth to show our web site to the 18,000 people who attended from all over the world. CWD also sponsored a roundtable discussion. Below is our report about some of the activities at the Scientific Sessions.
Research and Poster Presentations
- Oral Insulin Fails to prevent Type 1 Diabetes
On Sunday, June 15, 2003, Dr. Jay Skyler, Lead Investigator for the DPT-1, announced the results of the oral insulin arm of the DPT-1. As happened with injected insulin, results showed that taking oral insulin does not alter the chances of developing type 1 individuals at high risk. However, once again it was possible to identify those individuals at risk. (See Injected Insulin Fails to Prevent Type 1 Diabetes.) Researchers will continue to seek other means of possible prevention.
- Continuous Glucose Sensing in Children with Diabetes
Dr. Bruce Buckingham of Stanford University reported preliminary results of studies looking at the effectiveness of the Glucowatch 2 and new Medtronic MiniMed CGMS system. While individual glucose readings from both the Glucowatch and CGMS were less accurate than individual readings from traditional finger-stick glucose meters, Dr. Buckingham noted that the availability of real-time trend data from these devices offered the potential to improve care by detecting highs and lows sooner than would be otherwise possible.
- Pumps vs. MDI with Lantus in Children with Diabetes
Elizabeth Boland from Yale reported preliminary data from a study comparing pump therapy to MDI with Lantus as a basal insulin. In the Yale study, kids using MDI with Lantus showed a drop in HbA1c from an average of 8.5 to 8.1 after 16 weeks, while the kids on pumps showed a drop from an average of 8.0 to 7.2. 42% of pump patients achieved an HbA1c under 7%, while only 12% of the kids on MDI with Lantus did. When asked by Jeff Hitchcock from CWD if, based on the success of this data, she was ready to recommend that kids be placed on pumps at diagnosis, Elizabeth Boland replied that the Yale team put kids on pumps 8 weeks after diagnosis.
- Elevated C-Reactive Protein Indicates Progression to Type 1 Diabetes
Sonia Cooper, president of the Children with Diabetes Foundation, reported on a poster from DAISY that demonstrated that elevated levels of C-Reactive Protein indicates progression to type 1 diabetes in kids who are genetically at risk. Since CRP is an indicator of inflamation, it is hoped that anti-inflamatory drugs can help reduce CRP levels and potentially reduce the risk of developing type 1 diabetes. View the poster.
- The Dual-Wave Bolus Feature in CSII Control Prolonged Post-Prandial (PP) Hyperglycemia Better Than Standard Bolus in Type 1 Dibaetes (T1DM)
The authors report on a study of 10 patients with type 1 diabetes who use an insulin pump, comparing an extended bolus (the "dual-wave") versus a standard bolus to cover a high-fat meal (53% fat vs. control meal at 24% fat). The extended bolus resulted in significantly better control from 5 to 14 hours after the mea without increasing the risk of hypoglycemia.
- Comparison of Continuous Subcutaneous Insulin Infusion (CSII) With Flexible Multiple Daily Insulin (FMDI) Regimen Using Insulin Glargine in Pediatric Type 1 Diabetes Mellitus
A team from the Medical College of Wisconsin compared pump therapy (CSII) to injection theray with Lantus as a basal (FMDI) in 40 pediatric patients with type 1 diabetes. In their study, they found that pump therapy resulted in a significant improvement in HbA1c for 60% of pump users, while only 37.5% of the FMDI patients saw an improvement. Both groups also showed a decreased rate of hypoglycemia. View the poster and the conclusions.
- Stability of Insulin Aspart (NovoLog®) in Insulin Infusion Pumps
Novo Nordisk reported on a study they conducted that examined the quality of NovoLog in pumps for six days. The study found that NovoLog insulin maintained full potency during this period, and while there was a 3-12% decrease in preservative, enough remained to meet USP requirements. This study suggests that pump users can safely use a cartridge for more than the currently approved 48-hour time period. View a scan of the poster reprint. Zoom of left side. Zoon of right side.
- (a) Type 1 Diabetes Patients Can Temporarily Switch From Continuous Subcutaneous Insulin Infusion With Insulin Aspart to Basal Bolus Therapy With Insulin Aspart adn Insulin Glargine and (b) Switch to Multipel Daily Injections (MDI) With Insulin Glargine (Lantus®) and Insulin Lispro (Humalog®) From Continuous Subcutaneous Insulin Infusion (CSII) With Insulin Lispro--A Randomized, Open-Label Study Using Continuous Glucose Monitoring System (CGMS)
These two studies both demonstrated that users of pumps, whether they pump NovoLog (insulin aspart) or Humalog (insulin lispro), can safely take a break from pumping by using MDI therapy with Lantus as a basal insulin while using the same fast-acting insulin to cover carbs. Both studies found a unit-for-unit conversion of basal dosage to Lantus. View Aspart study. View Lispro study.
- Cost Effectiveness of Use of the GlucoWatch® Biographer in Children and Adolescents with Type 1 Diabetes: An Analysis Based on a Randomized Controlled Trial
In a study conducted at the Barbara Davis Center, kids who used the GlucoWatch Biographer experienced a reduction in HbA1c (average dropped from 9% to 8.4% in the group). This poster looked at the effect of lifetime use of the Biographer based on the impact of that reduction in HbA1c and concluded that use of the Biographer would increase life expectancy by 1.9 years and increase quality of life years by 2.4 years. The authors also concluded that the cost effectiveness ratio of using the Biographer was similar to other interventions recommended for people with type 2 diabetes. View the poster.
- Effect of Topical Corticosteroid Pre-treatment on Skin Irritation and Performance of the GlucoWatch® G2TM Biographer
Skin irritation has been an issue for some people using the GlucoWatch Biographer. This poster reported on the effectiveness of a topical corticosteroid cream in reducing irritation without adversely impacting the performance of the Biographer. The results were encouraging, with two different creams showing a significant reduction in skin irritation without causing any problems wth the Biographer. View the poster.
- Comparison of Insulin Aspart and Lispro: Pharmacokinetic and Metabolic Effects
A team from Temply University School of Medicine compared insulin aspart (NovoLog) and insulin lispro (Humalog) and found them to be essentially identical in effect. View the poster.
- Patients with Type 1 Diabetes Mellitus Fail to Awake in Response to Hypoglycemia
A team from Germany tested 18 adults with type 1 diabetes, and 16 people without diabetes, and found that 10 of 16 controls but only 3 of 18 patients with type 1 awoke in response to induced nighttime hypoglycemia. View the poster.
- Lenghening of the QT interval during clinical episodes of nocturnal hypoglycaemia in adults with Type 1 diabetes
Exploring the impact of nighttime hypoglycemia on heart function, a team from the University of Sheffield in the UK demonstrated a lengthening of the QT interval as a direct result of hypoglycemia. They suggest that this lengthening may be the cause for the "dead in bed" syndrome. View the poster.
- Abstracts about diabetes in kids include1:
- A Two Center Randomized Controlled Trial of Insulin Pump Therapy in Young Children with Diabetes.
- Can Coping Skills Training for School-Aged Youth and Their Parents Improve Psychosocial Well-Being and Metabolic Control?
- Adolescents with Type 1 Diabetes Prefer Ketone Testing in Blood.
- Celiac Disease (CD) in Pediatric Patients with Type 1 Diabetes: Younger Age at Diabetes Onset and Reduced Height in 127 Biopsy-Positive CD-Patients Compared to 19,535 Diabetic Subjects without CD.
- Abnormal Day/Night Ratio May Not Be a Predictive Marker for Microalbuminuria in Adolescents with Type 1 Diabetes Mellitus.
- Carotid Artery (CA) Structure and Function in Young Adults with Type 1 Diabetes (T1DM).
- Abtracts related to hypoglycemia include:
- Patients with Type 1 Diabetes Mellitus Fail To Awake in Response to Hypoglycemia.
- Counterregulation during Spontaneous Nocturnal Hypoglycaemia in Adolescents with Type 1 Diabetes Mellitus.
- Incidence of Hypoglycemic Blood Glucose Values Versus Severe Hyoglycemic Events in Well-Controlled Patients with Diabetes Mellitus Type 1.
- Lengthening of the QT Interval during Clinical Episodes of Nocturnal Hypoglycemia in Adults with Type 1 Diabetes.
- Neuropsychological and Neuroimaging Evidence of Hippocampal Damage in Type I Diabetes: A Pilot Investigation.
- Effect of Weekly Hypoglycemia on Subsequent Cognition.
- Predicting Occurrence of Severe Hypoglycemia (SH) over the Next 24 Hours Based on SMBG Data.
- Reduction of Risk for Severe Hypoglycemia (SH) through Psychobehavioral Intervention.
- The Influence of Risk Factors on Hypoglycemia in Type 1 Diabetes Assessed by Continuous Subcutaneous Glucose Monitoring.
- Severity of Hypoglycemia and Hypoglycemia Unawareness Are Associated with the Extent of Unsuspected Nocturnal Hypoglycemia.
- Defective Glutamine Removal during Hypoglycemia in Type 1 Diabetes Mellitus.
- Caffeine Restores Disordered Brain Activation Patterns Associated with a Memory Task in Acute Hypoglycemia but Fails To Support Function.
- The Relationship between Glycemic Control and Hypoglycemia Using Insulin Glargine Versus NPH Insulin: A Meta-Regression Analysis in Type 2 Diabetes.
- Abstracts about eye care and retinopathy include:
- Retrospective Trial of Daily Wear Contact Lenses in Diabetic Patients.
- Hemoglobin A1c Influence upon Retinopathy Progression.
- Improvement or Stabilization of Advanced Diabetic Retinopathy after Pancreas Transplantation.
- Automated Detection of Diabetic Retinopathy in Digital Retinal Images.
- Determinants of Retinal Blood Flow in Patients with Type 1 Diabetes.
Products and Product News
Companies that make products for people with diabetes often introduce new and updated products at the ADA conference. Here are a few selected highlights:
1. Senior Disetronic representatives reported that the FDA has issued an embargo on importation of new Disetronic insulin pumps into the United States as a result of a problem with documentation of the manufacturing processes of the company. The embargo means that new patients cannot be started on Disetronic insulin pumps. The FDA action does not affect the ability of Disetronic to provide support to existing pump users. The embargo is expected to remain in place for several months. Further information will be reported as it is available. 2. TheraSense introduced three new products: Flash, which is a small, enhanced version of FreeStyle; Pappillion, which is similar to FreeStyle but it for the non-US market; and CozMonitor, a blood glucose meter that attaches to a Cozmo insulin pump and integrates its data within Cozmo. The photograph to the right shows the FreeStyle (left), Flash (center), and CozMonitor (right). The CozMonitor combines a Cozmo insulin pump with a glucose sensor from TheraSense (photo).
TheraSense products. Click for a larger image.
3. Animas announced the ezSet Infusion System, a new angled infusion set, available in two canular lengths (13mm and 17mm). Also available will be the ezSerter, a mechanical inserter that offers one-handed insertion of the new set. The needle is of a trocar design, which is a three-angled cut and results in a needle that is sharper and therefore easier and less painful to insert. The new infusion set should be available in the fourth quarter of 2003.
Poster showing the ezSet Infusion System with inserter device. Click for a larger image.
4. Pelikan Technologies showed a prototype for their new lancing device called the Pelikan Sun, which incorporates 50 lancets into a high-tech lancing device. The Pelikan Sun is electronically controlled to provide more precise lancing, allowing more precise penetration depth and significantly reducing pain compared with current lancing technology. Pelikan will show their technology at the upcoming Friends for Life: Orlando 2003 conference.
A mock-up of what the final Pelikan Sun lancing product will look like. Click for a larger image.
Other Links About ADA 2003
- Official ADA site for the 2003 Scientific Sessions
1 Links to abstracts may expand your browser to full screen. To return your browser window to it's normal size, press ALT + F4.
Posted June 15, 2003
Updated July 5, 2003
Last Updated: Sunday July 20, 2003 15:44:30
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