The American Diabetes Association 2007 Scientific Sessions were held in Chicago from June 22-26, 2007 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 and several volunteers to help show our web site and share information about our conferences to the thousands of attendees.
Research, Abstracts and Poster Presentations
- On Saturday, June 23, Irl Hirsch presented Sensor Augmented Pump Therapy: Results of the First Treat-To-Target Study (STAR1). The results were disappointing, unfortunately. STAR1 was a six month, seven center study that compared the Medtronic Paradigm 722 sensor augmented pump with the regular 715 pump. 138 people participated, aged 12 to 80 years old. 29% were adolescents. Overall, there was no change in HbA1c in the Paradigm 722 group compared with the Paradigm 715 group, though more people using the sensor augmented pump were able to reach the target HbA1c of 7% or less (38% vs. 19%).
- A poster entitled Sensor Augmented Pump Therapy in Adolescents: Results of the First Treat-To-Target Study, by Bruce Buckingham, Mary Halvorson, Elizabeth Kunselman, and Francine Kaufman, reported on the 40 adolescents in the STAR1 study. Of particular note is that frequency of sensor use was a major indicator of HbA1c decline, with those who used the sensor 80-100% of the time (five or more days a week) experienced a average decline of 1.0% in HbA1c (p=0.0008). Author Bruce Buckingham, MD, stressed that study participants who used the sensor could achieve considerable reduction in HbA1c.
- In a poster entitled Patient-Reported Outcomes (PRO) for an Integrated Real-Time Continuous Glucose Monitoring/Insulin Pump (RT-CGM/CSII) System, Mary Peyrot and Richard Rubin report on a 16-week, two center study looking at the impact of the Medtronic 722 Sensor Augmented Pump on a patient's perception of diabetes and diabetes care. The results were very positive, including a reduction in reported blood glucose monitoring burden (-28.6 vs. 3.8 change from baseline, p=0.36), a significant increase in perceived blood glucose control (34.3 vs. 14.2 change from baseline, p=0.001), a significant reduction in worry (-21.1 vs. -5.7 reduction from baseline, p=0.009), and a significant reduction in social burden (-21.1 vs. -5.7 change from baseline, p=0.001). These data point out clearly that the increased awareness of blood glucose data as provided by a continuous glucose monitoring system has a profoundly positive impact on patients living with diabetes.
- In Reliability of A1CNow+ in a Pediatric Endocrine Setting, a team from Children's Hospital of Orange County (CHOC) in Orange, California (include CWD DTeam Member Heather Speer), reported that the new A1CNow+ from Metrika was sufficiently accurate for use in a clinical setting. This marked a significant improvement over the original A1CNow. In Relative Inaccuracy of the A1cNow in Children With Type 1 Diabetes (Diabetes Care 30:135-137, 2007; see also the graph from the report), clinicians reported just 67% of samples run by office staff using the original A1cNow were within +/- 0.5% of a laboratory reference value. The new A1CNow+ is much improved, as noted by the graph from the CHOC poster.
The CHOC team also reported that the A1CNow+ results were biased high compared with laboratory comparisons, which was also noted by CWD staff members who tried the product on the exhibit hall floor (see below). CHOC reported that the DCA2000+ was slightly biased toward lower readings. Given the low cost of the A1CNow+ (about $10 to $15 per use) and the importance of immediate HbA1c feedback during clinic visits 1, 2, 3, the A1CNow+ can be very useful for families who don't have access to a DCA2000+ or who are unable to obtain insurance coverage for a test using the DCA2000+. The bias toward higher results in the A1CNow+ must be taken into account if you use more than one method of measuring your HbA1c.
- The Effectiveness of Glucose, Sucrose and Fructose in Treating Hypoglycemia in Children with Type 1 Diabetes by Allison Husband, Lorraine Lau, Susan Crawford, and Daniele Pacaud, reported that the candy Skittles was just as effective as glucose tablets in treating hypoglycemia, but considerably less expensive per dose ($0.20 versus $0.90 for tablets). For families who are looking to save money, Skittles are a good choice -- just be sure to keep them for treating low blood sugar! You can read the poster in PDF format.
- In Quantifying the Impact of Disconnecting Insulin-Pump Infusion Sets on Glycemic Excursions, Howard Zisser, MD, from the Sansum Diabetes Research Institute reports that "... even short term interruptions in insulin delivery can result in disruption in glucose homeostatis." A graph on the poster showed that a 30-minute interruption resulted in over three hours of elevated glucose levels (+ 30 mg/dl). The 19 study participants used a variety of pumps and infusion sets. This poster emphasises the importance of not interrupting the delivery of basal insulin and of re-connecting quickly when you disconnect for showering, etc.
- In Impact of Insulin Pump Therapy and Blood beta-OHB Ketone Monitoring on Glycemic Outcomes in Youth with Type 1 Diabetes (T1D), authors Elise Bismuth, Britta, Svoren, Lisa Volkening, Deborah Butler, and Lori Laffel reported that patients who had been prescribed blood ketone monitoring had a lower A1c than those who had been prescribed urine ketone monitoring (8.3 +/- 1.2 vs. 8.9 +/- 1.7%, p<0.0001). In addition, 40% of pumpers who used blood ketone monitoring achieved their A1c goals compared to just 23% of pumpers using urine ketone monitoring (p<0.05). This adds to the evidence supporting the use of blood ketone monitoring instead of urine ketones.
- In Effects of Prior Hypoglycemia and Hyperglycemia on Cognition in Children with Type 1 Diabetes Mellitus, authors Dana Perantie, Audrey Lim, Jenny Wu, Patrick Weaver, Stacie Warren, Michelle Sadler, Neil White, and Tamara Hershey reported on cognitive impairment in children caused by both hypoglycemia and hyperglycemia. As might be expected, repeated hypoglycemia results in various deficits, including worse spacial analysis, worse verbal memory, and worse location memory. The authors report for the first time that higher exposure to hyperglycemia results in a lower IQ compared with siblings. Parents thus must not only work to reduce the risk of low blood sugar, but also to reduce overall exposure to high blood sugar levels.
Products and Product News
Like 2006, there was surprisingly little new in the way of diabetes products shown at the 2007 Scientific Sessions. Among the few newsworthy items were:
New Strips for Paradigm Link
Users of the Medtronic Paradigm insulin pump who like their Paradigm Link glucose monitor will be happy to learn that new test strips will soon be available. The strips are sold by Nova Biomedical and are called NovaMax Glucose Test Strips. The new test strips are all set to the same code, so Paradigm Link users will no longer need to worry about coding their meter to each new box of test strips. The new test strips are backward compatible with all BD Logic and Paradigm Link meters.
In addition to the new test strips, Nova will be selling a new meter called the Nova Max, which uses the new test strips and offers a no-coding solution. Sample size remains 0.3 microliters with a 5-second test time.
The NovaMax glucose meter. Click for a larger image.
Two CWD staff members decided to check the new A1cNow+. One CWD staff member reported an A1c of 6.1% at two different exhibitor booths using the DCA2000+, but reported 6.5% using the A1cNow+. Another CWD staff member reported an A1c of 5.4% using the same two DCA2000+ systems and 5.8% using the A1cNow+. Thus both CWD staff members reported a +0.4% bias in the A1cNow+. Anyone who uses the A1cNow+ should be aware of this bias toward values that are higher than those reported by the DCA2000+. Note that the poster from Children's Hospital of Orange County, referenced above, also noted a bias towards higher results.
The A1cNow+. Click for a larger image.
Glucose Meter For Dogs and Cats
If your dog or cat has diabetes, most people will use a glucose meter designed for humans. The AlphaTRAKTM is a meter from Abbott Animal Health specifically designed for monitoring blood glucose levels in dogs and cats. Compared to a veterinary laboratory device, the AlphaTRAK produced results that were significantly more accurate than two human glucose monitors, according to product literature. The AlphaTRAK, based on the very popular and successful FreeStyle meter, requires just 0.3 microliters of blood and uses test strips that are calibrated to dog or cat blood characteristics.
The AlphaTrak glucose meter for pets. Click for a larger image.
Last Updated: Sunday June 15, 2008 13:39:07
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