The American Diabetes Association 2004 Scientific Sessions were held in Orlando, Florida from June 4-8, 2004 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. We also hosted members of our Diabetes Team who could attend ADA to dinner at Epcot Center.
Ellen Ullman Staffing CWD Booth
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The DTeam Members at Epcot
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Research and Poster Presentations
- Continuous Glucose Monitoring in Interstitial Adipose Tissue Reflects Excursions in Cerebral Cortex reported on the work of a team from Denmark which demonstrated the glucose level in interstitial fluid correlated more closely with the glucose level in the brain than did the glucose level in blood, even though this team confirmed the time delay in blood sugar excursions seen in interstitial fluid compared with blood. This has potentially positive implications for the many of the continuous sensors under development that use interstitial fluid and may help explain why someone who has experienced a low blood sugar still feel low for many minutes after their blood glucose has returned to normal levels.
- In Continuous Automated Insulin Delivery Based on Subcutaneous Glucose Sensing and an External Insulin Pump, Medtronic MiniMed reported the latest data on their closed loop system that combines a CGMS with a Paradigm insulin pump. In this study, delivery of insulin from the Paradigm was controlled by measurements from the CGMS for 28 or 30 hours. While the post-prandial glucose rises demonstrated the difficulty of bringing down post-meal spikes, the overnight measurements from the CGMS were essentially all within a narrow, normal range of about 80 to 120 mg/dl. Since the test subjects could not pre-bolus in anticipation of meals, this very small study may show the difficulty of achieving a fully closed loop system that operates during the day using today's technology. However, the success of the system in keeping blood sugars steady overnight clearly shows the potential of the system.
- Dr. Bruce Buckingham presented Extended Use of a New CGMS Glucose Sensor with Wireless Data Transmission. In this study, a new wireless sensor for the Medtronic MiniMed CGMS was evaluated. After a mid-study correction to the sensor wiring, 67% of sensors were transmitting "optimal" signal data on the seventh day of wear. Test subjects -- all children with diabetes -- wore the sensors during normal, everyday activities, including sports and showering. These activities did not effect the performance of the sensor. Afterwards, most test subjects thought that wearing the sensor was OK. Based on the performance data, Dr. Buckingham remarked that wearing the sensor for six days was fine.
- In Alarms Based on Real-Time Sensor Glucose Values Alert Patients to Hypo- and Hyperglycemia and Reduce Glycemic Excursions: Results of a Randomized Multicenter Study, Dr. John Mastrototaro from Medtronic MiniMed reported on tests of MiniMed's Guardian system, which received FDA approval for marketing in the United States in January 2004. In the study trials, patients use the Guardian for two weeks. The "alarm" group ran with the alarms turned off in week one and on in week two. The control group had alarms off for both weeks. Summarizing the data, there were more hypoglycemic events in the alarm group in week two, but the time spent low was reduced because patients could treat the lows more quickly. There was essentially no difference in hyperglycemic events or duration of hyperglycemia. The biggest challenge in the usefulness of the Guardian is likely to be the very high false alarm rate for hypoglycemia. When the Guardian is configured to alarm at 70 mg/dl, 47% of the alarms are false alarms. The false alarm rate drops to 31% when the low threshold is increased to 80 mg/dl. Dr. Mastrototaro noted in response to questions that scientists and engineers are still learning how to deal with the vast amount of data generated from continuous sensing devices and that adjustments to the alarm algorithms have the potential to reduce the false alarm rate.
- Safety of Insulin Glulisine Compared with Insulin Aspart Administered by Continuous Subcutaneous Insulin Infusion (CSII) reported on a trial of the new fast-acting insulin analog insulin glulisine, marketed as Apidra by Aventis. In this study, insulin glulisine was as effective as insulin aspart in managing blood sugars and resulted in a similar of site reactions. Pump users can look forward to another insulin option as soon as Apidra is available in their area.
- In Inpatient Psychological Consultation of Adolescents Newly-Diagnosed with Diabetes: What Are We Measuring?, researchers reported on a study that examined several psychological aspects of teens when they were diagnosed and looked at how those factors impacted blood glucose control and acceptance of diabetes at three and six months after diagnosis. As would be expected, those teens with higher levels of depression and lower measures of self-concept had poorer results at three and six months. Also notable was the fact that teens who indicated that they were not going to tell at least one friend about their diagnosis also had poorer control at three months. The researcher suggested that teens who withhold information about their diagnosis do not have as complete of a social support group as teens who freely tell of their diagnosis.
- In The Blood Sugar Monitoring and Communication Survey (BSMCS): A New Measure of Affect Related to Blood Glucose Monitoring Behaviors in Youth with T1DM, researchers reported that more frequent blood glucose monitoring (BGM) is associated with lower HbA1c and better glycemic control. Despite emphasis on BGM in recent years, overall markers of glycemic control are relatively unchanged. The degree of emotion or "affect" associated with BGM is a major factor in quality of life and clinical outcome. Children and adolescents feel a sense of failure associated with high blood glucose (BG). Interactions with parents during high BG are often emotionally charged compared with interactions with parents during low BG. Fear of parental disapproval for high BG is one impediment to more frequent testing. Children and adolescents don't test or don't test as frequently as they should because of risk of parental disapproval, shame associated with high BG ("poor control") and feeling of lack of efficacy (in anticipation of a high or "bad" BG reading). BGM is fertile ground for family conflict. BGM "affect" (heightened emotional response or energy) may be one factor that can be modified in a child or adolescent life that could have a disproportionate beneficial affect on family dynamics, quality of life and glycemic control. It's important to break cycle of poor glycemic control, shame, blame, less testing and then worse glycemic control, more shame, blame and less testing still. More effort in clinics on addressing the BGM "affect" issue might reduce the inevitable HbA1c increase associated with middle to late adolescence.-- Tom Peyser
- In Accuracy of Repeated Meal Carbohydrate Content Estimation by Persons with Type 1 Diabetes Using Continuous Subcutaneous Insulin Infusion, Dr. Guido Freckmann from the Institute for Diabetes Technology in Ulm, Germany presented results from a 2 year study where 144 test participants were given 8 test meals on 3 separate occasions for a total of 24 meals of varying carbohydrate content. Carb estimation data was gathered at baseline, 9-12 months, then 2 years. Training and practice with a registered dietitian was scheduled in between visits. Results showed an improvement in estimation as the study progressed: 68% average accuracy at baseline, 82% average accuracy at second visit, 83% average accuracy at end of study. Study Conclusions were as follows: 1. The larger the carbohydrate content at a meal, the larger the errors in calculation. 2. Most errors were underestimation of carb content (largely due to fear of resultant hypoglycemia with overestimation of carbs) 3. Underestimation in carbs was commonly compensated by adaptation of the subject's insulin to carb ratio 4. Repeated training produced significant and lasting improvement in carbohydrate estimation.-- Mike Schurig
- In The use of Glargine insulin in children with T1D, Dr. Rubina Heptulla found that mixing NovoLog or Humalog with Lantus immediately prior to injection had no effect on blood glucose control. The small study was conducted after Dr. Heptulla discovered that some of her teens were mixing Lantus. For details, see the online presentation The use of Glargine insulin in children with T1D.
- In Role of Amylin and Glucagon in Postprandial Glycemic Excursions in Pediatric Type 1 Diabetes, Dr. Rubina Heptulla found that pramlintide appears to have great clinical potential in decreasing post-prandial hyperglycemia in teens with type 1 diabetes. For details see the online presentation Role of Amylin and Glucagon in Postprandial Glycemic Excursions in Pediatric 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 some selected highlights:
1. Abbott Diabetes Care exhibited for the first time combining the MediSense and TheraSense diabetes care products. The first new product to be shown is a new, much smaller Precision Xtra meter. The new Xtra still combines blood glucose and ketone testing in one meter. The product is expected to be available later this year.
Poster showing the new Precision Xtra.
2. Smiths Medical Deltec proudly showed their newly-FDA-approved Cozmonitor, a blood-glucose monitoring device that attaches to the Cozmo pump and which uses the Freestyle test strips. A Smiths Medical representative indicated that all Cozmo users will receive the Cozmonitor for free.
The Smiths Medical Deltec booth with a poster of the Cozmonitor.
For Additional Information
Last Updated: Saturday July 03, 2004 20:16:02
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