The American Diabetes Association’s Scientific Sessions is here! Until June 16, scientists will present some of the most updated topics, from beta cell replacement to regeneration and glucose and complications trials, all with the result to change things for the type 1 diabetes (T1D) community. Here are Drs. Martin de Bock, Brigitte Frohnert, Matthias Hebrok and Linda DiMeglio share their key takeaways from day 1, with their commentary in the video and below:
Martin de Bock, FRACP, Ph.D.
Pediatric Endocrinologist, University of Otago, New Zealand
The Next Generation of Automated Insulin Delivery Systems for Persons with T1D—Four New Clinical Trials
In an all-star line-up, featuring Bruce Bode, M.D., Richard Bergenstal, M.D., Bruce Buckingham, M.D., and him, he outlined the next generation of artificial pancreas, also known as automated insulin delivery, systems: Medtronic 780G and Omnipod Horizon. He starts with what should be known: innovation continues with the artificial pancreas systems, and blood sugar outcomes and user experience continue to improve! Let’s take the artificial pancreas systems that he outlined:
The Medtronic 780G, in the pivotal U.S. trial, time-in-range was around 75% (more than the previous Medtronic systems), and it automatically corrects, therefore, there is no sustained high blood sugar (hyperglycemia), as seen in the 670G, which, Dr. de Bock says, will make a lot more people benefit from this feature. In the FLAIR study, we got to compare the 670G versus 780G, in a real-world setting. The population, before the trial, had an HbA1c of 7.9%, and the time-in-range was less than 60%, but on the trial, their time-in-range was greatly improved, and there was a dramatic improvement in the correction of hyperglycemia, for adolescents in particular. In the New Zealand trial—which was aimed for European Regulation approval (and if you didn’t already hear, they got it this week!), the median age was 20 (de Bock: “This is the population most challenging [in type 1 diabetes], they are most likely to be going out, not blousing.”) and they had a time-in-range, before the study, of 59%. On the trial, they had a time-in-range of 73%, they had an improvement in sleep quality and a really high acceptance of the technology. What does this mean for the T1D community: more freedom.
The Omnipod Horizon—which pairs its disposable insulin pump (which you can change every 3 days) with a Dexcom continuous glucose monitor (CGM)—got a time-in-range of more than 70%. This means more choice, especially for those people who don’t want wires all around them.
Brigitte I. Frohnert, M.D., Ph.D.
Pediatric Endocrinologist, Barbara Davis Center for Diabetes, Denver, CO
Expanding the Use of Continuous Glucose Monitoring in Pediatric Settings
CGMs have been a really exciting tool for people with T1D, and Dr. Frohnert talked about where we are with children on a CGM. Dr. Frohnert discussed how children with stage 2 disease—when there are autoantibodies (antibodies that attack your own body) there and there are blood-sugar abnormalities, but there is no clinical disease, yet—who have a CGM, allows pediatricians to predict when they will have T1D, which can mean a lot for the family. In Australia, where CGM is part of the universal program for health care, CGM at the time of diagnosis results in them continuing to use this technology at 2 years. Gregory Forlenza, M.D., who is a Breakthrough T1D Early-Career Patient-Oriented Award recipient, talked about CGM use in hospital settings. Says Dr. Frohnert: “He took a really interesting angle: the emerging use of CGM in the context of COVID-19.” It used to be that it was hard to get CGM use in hospitals, because of concerns about new technology and safety, but hospitals are now using CGMs, because a nurse does not need to put on gear for him/her to read the CGM, e.g., on a tablet screen. This is a tremendous benefit for managing people with COVID-19 and diabetes.
Matthias Hebrok, Ph.D.
Director of the Diabetes Center, University of California, San Francisco
Functional Cure of T1D—Where Shall We Take Islet Cells From?
Adolfo Garcia-Ocaña, Ph.D., who works with Andy Stewart, M.D., at Mount Sinai, has developed a technology by which they can expand, or regenerate, beta cells, with the drug harmine. The data presented yesterday: Treatment with harmine led to a significant expansion of beta cells, and functional studies are ongoing. Dr. Hebrok, in his presentation, has optimized technologies to be able to generate stem cells into beta cells, but, upon transplantation, you face immune rejection. But he has modified the HLA genes (which are responsible, in part, for T1D), and has projection from immune attack.
Linda DiMeglio, M.D., M.P.H.
Pediatric Endocrinologist, Indiana University School of Medicine
Combination Immunotherapy to Preserve Beta Cell Function in T1D
Peter Gottlieb, M.D., discussed what has—and has not—worked for T1D, from the bad (sirolimus-IL-2), to the neutral (mycophenolate mofetil-daclizumab, exenatide-daclizumab), to the good (low-dose ATG, Edmonton Protocol). Dr. DiMeglio said that neither monotherapies or combination therapies proposed to induce tolerance or preserve insulin secretion have produced robust, durable effects and outlines the broad paradigm shifts that have to be taken into account: T1D is a syndrome, not a single disease; T1D changes within individuals over time; T1D is not just an autoimmune disease, there is a real role of the beta cell itself and the pancreas as well; and clinical trial designs need to take all of this into account. But, she says, “Overall, immunotherapy has not been straight….but we’re making real progress.”
