ADA 2018 Recap – Part 4: Diabetes Education

June 22-26, 2018 marked the American Diabetes Association’s 78th Scientific Sessions, taking place in Orlando Florida. Each year, the ADA conference brings together scientists, researchers, endos, clinicians, the diabetes industry and advocates to share in learning from the best of the best. Through 3000 original research presentations over 5 days, there’s a lot to absorb. We were there to learn all we could about the latest in Type 1 diabetes.

OMNITIME TYPE 1 EXERCISE STUDY

WHAT’S NEW

We always get excited when we see members of the Type 1 diabetes community at a conference – you can imagine how great it was to get to see one of them presenting! Dessi Zaharieva presented at the 78th Scientific Sessions the outcomes of the OmniTIME study, focused on basal reduction and suspension of insulin during moderate exercise. The findings: Reducing your basal rate by 50% or 80% 90-minutes pre-exercise will result in significantly fewer low BGs during exercise than suspending when you start moving.

STUDY BASICS

There were three groups in the OmniTIME study:

  • One group suspended their pump at the onset of exercise
  • One group reduced basal rates by 50% 90 minutes prior to exercise
  • One group reduced basal rates by 80% 90 minutes prior to exercise

All groups resumed regular insulin at the end of exercise and had a meal 30 minutes later, bolusing 75% of their regular dose.

A total of 17 participants took part in this study.

Exercise 1 hour in length and was moderate in intensity walking with short breaks between 15-minute bouts

All individuals participated in each of the study groups.

There were 7 lows experienced by the suspending group (41%), compared to 1 in the 50% reduction group (6%) and 1 in the 80% reduction group (6%).

Each participant wore an Omnipod insulin pump and used a Dexcom CGM.   

BGs had returned to near pre-exercise levels at 2 hours post-exercise. This was 3.5 hours after the temporary basal rates were set for the 50% and 80% groups.

APPLICATION

This study is particularly interesting, not only because it was one of the few specifically related to Type 1 diabetes and exercise presented, but it provides further information to help mitigate one of the greatest reported fears related to diabetes and exercise – going low.

Interestingly, the study found that you are much more likely to go low if you suspend your pump when you start exercising, which, as a community, we have found to be a strategy some use.

We were excited to see that there was no significant spike in BGs following basal reductions in either group.

DIABETES APPS - LOOKING FORWARD

WHAT’S NEW

Adam Brown presented at ADA on the Diabetes Apps and whether they can make our lives easier as people living with Type 1 diabetes. Adam discussed the current state of apps (who is using them, what ones are being used), what make an app a good one (in the diabetes world, and beyond!) and some of the trends to watch out for.

WHAT MAKES AN APP USEFUL

The most popular apps were grouped into 6 categories:

  1. CGM (Continuous Glucose Monitoring);
  2. BGM (Blood Glucose Monitoring);
  3. Data;
  4. Exercise;
  5. Food, and;
  6. Pharmacy.

Leading the charts in each of these categories were Dexcom (CGM), OneTouch Reveal App (BGM), MySugr (Data), Apple’s Activity App (Exercise), MyFitnessPal (Food), and CVS (Pharmacy).

Adam discussed the important things necessary to make any app successful and looked at what apps are hitting it out of the park in these categories. He suggested that the two most important things for an app to be are:

  1. Radically convenient and frictionless; and
  2. Providing compelling decision support.

For an app to be radically convenient and frictionless it would need to replace physical objects and processes, save time, and money (think Lyft and Uber, Spotify and Apple Music, Netflix, or Amazon). In order to provide compelling decision support, the app needs to be personalized, real-time, responsive, and better than a human (think Google Maps and Waze).

TODAY & IN THE FUTURE

Adam took his above ideas around what makes an app useful and applied them to the world of diabetes. He specifically looked at apps that replace physical objects, replace processes, and save time/money. He also looked at decision support related to basal insulin, bolus insulin, predictive BG trends, pump setting adjustments, and MDI (multiple daily injections) users. Here are some of the apps to learn more about:

  • Apps that replace physical objects – The idea: Get rid of one-function only devices: 
  • Apps that replace processes – The idea: Get rid of cords, cables, and high-hassle downloading of data: 
  • Apps that save time and money – The idea: Stop having to physically visit the pharmacy to pick up test strips/supplies or a physical doctors office for advice: Subscription service and online coaching apps:
  • Apps that help with basal insulin decisions– The idea: Look at my trends, make recommendations for me. 
  • Apps that help with bolus insulin decisions – The idea: Look at my trends, make recommendations for me. 
  • Apps that help predict future BG trends – The idea: Look at what happened last time plus everything that is currently happening in my diabetes care and make a smart prediction. 
  • Apps that help with pump setting adjustments – The idea: Look at my data, and tell me what I need to change.
    • Glooko

To see Adam’s presentation slides in full, click here. (Thanks Adam!)

THE DIABETES DIY MOVEMENT

WHAT’S NEW

There were some exciting presentations featured at ADA around the Diabetes Do-It-Yourself movement. We had the chance to learn from Dr Jason Wittmer, Dr Lorenzo Sandini, and DIY pioneer Dana Lewis (founder of the #WeAreNotWaiting movement). The session dug into the data that drives the DIY movement, along with recommendations for HCPs (Health Care Providers) who have DIYers under their care. If you’re just starting to learn about DIY diabetes, start by checking out #OpenAPS and Loop to get oriented.

KEY LEARNINGS

DIY is not for everyone. Presenters discussed what makes a great DIY candidate and suggested someone who is: moderately tech-savvy, loves the attention to detail, is open to active troubleshooting, and has a problem that is not being solved with today’s tech.

Requests were made to HCPs on behalf of the DIY community including Don’t reflexively dismiss DIY, consider who candidates may be – they can do their own research, listen to DIYers needs (supplies/prescriptions may be different than you’re used to), and advocate with industry regarding what problems patients are solving through DIY – This could help drive the future of diabetes technology to be truly patient-centred.

One of the most exciting results from users on DIY systems so far? A1Cs dropping from 7.1 to 6.2%, time in range from 51-81%, and improved sleep quality.

There are currently estimated to be over 700 people world-wide who are using their own DIY systems. That’s 5.2 million hours of DIY looping experience.

LEARN MORE

We suggest checking out the following resources if you are interested in learning more about or becoming involved in the DIY movement:

Looping: http://www.diabettech.com/looping-a-guide/
OpenAPS: https://openaps.org/
Nightscout: http://www.nightscout.info/
Spike App: https://spike-app.com/

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