Our DiabetesMine team is heading once again to the huge annual American Diabetes Association Scientific Sessions event that's held every June, gathering roughly 17,000 diabetes researchers and clinicians, industry leaders, and advocates.
This year, the event is taking place in downtown San Francisco -- the Bay Area backyard of 'Mine founder and editor Amy Tenderich, who's been attending this conference for 14 years running!
The 2019 ADA Scientific Sessions run from Friday, June 7, through Tuesday, June 11. We're also hosting our #DData ExChange technology forum nearby on Friday, though it's not ADA-affiliated and is held off-site from the massive convention center.
* This year's official SciSessions hashtag: #ADA2019 (yep, the org before year) *
It's always an action-packed five days, with hordes of attendees constantly on the move from sunrise programs straight through to the many after-hours receptions and parties late into the evening. Seriously, we hardly have a moment to sit down at these huge gatherings, where hundreds of presentations are happening alongside a sprawling exhibition hall, not to mention a section with scores of research posters displaying the latest science.
We expect a ton of medtech buzz this year, given the impending boom in Closed Loop / Artificial Pancreas / AID (Automated Insulin Delivery) technology. No matter what you call it, there's no doubt we're on the verge of actually seeing a robust set of these connected systems come to market. We expect to see various prototypes of these under-development, pre-FDA-approval systems being displayed at the Expo Hall under glass (no kidding, that's how they do it!) We also expect to see some exciting near-term tech updates like Abbott Diabetes Care adding optional alarms to its second-generation FreeStyle Libre Flash Glucose Monitoring system here in the U.S.
Naturally there will be a lot of talk on economic and large-scale health policy issues, led by the current Insulin Pricing Crisis, as well as how the diabetes care profession can better work with health insurers to bring new tools and treatments to patients more efficiently.
Hot Topics Expected at #ADA2019
Some of the highlights we're looking forward to are:
Artificial Pancreas / Closed Loop Systems
This has been a super hot topic in recent years, and the 2019 SciSessions is no different. New systems are expected soon not only from Medtronic (which currently sells the first and only early system), but from Dexcom, Bigfoot Biomedical, Beta Bionics and of course the Insulet / Tidepool Loop Project that’s actually morphing a DIY app into a commercial product.
The conference agenda includes a bevy of sessions on closed loop technology, especially this big overview on the Path Forward. The presenters will look at progress in interoperability, the increase in companies collaborating in this space, and studies focusing on how these AP systems can benefit specific populations of patients, including pregnant women with diabetes.
Tandem's Control-IQ Research
Tied into the AP topic is the much-anticipated first look we'll get of Tandem Diabetes Care's new Control-IQ feature, that will make its t:slim pump-CGM connected system function like a real closed loop. Tandem's current Basal-IQ feature only tackles auto-adjusting of background basal insulin, but does nothing to address bolus doses for food or corrections; Control-IQ will add the bolus-dosing functionality.
At the ADA event, the company will be presenting early clinical data and first reports of large-scale trials of this new feature, which is expected to get through FDA and launch commercially by the end of 2019 -- after a software bug delayed the original launch date.
Smart Insulin Pens
We also expect a lot of buzz about new, Bluetooth-enabled insulin pens that can capture and share dosing data. Companion Medical, makers of the new InPen, have in fact just made two exciting announcements:
- A new partnership with Glooko that will let InPen users easily integrate their data into Glooko's D-data management system and mobile app.
- A collaboration with Dexcom that will enable two-way data-sharing between the InPen smart pen and the Dexcom CGM and it's CLARITY software platform. This InPen/CLARITY report integration will be previewed on the ADA exhibit floor.
We're also wondering if Eli Lilly will get regulatory approval for its first-ever connected smart pen that's currently being reviewed by the FDA.
There is sure to be more new stuff on this front unvieled at the conference!
Affordability and Access
Obviously, this is a HUGE topic that's on everyone's mind in the diabetes universe -- whether you're talking affordability of life-sustaining insulin or other essentials, or access to new technologies and tools to help manage blood sugars.
There's a standout "Making Insulin Affordable" session planned for 8-10 am on Sunday, June 9, that will focus on the supply chain and the many different aspects of this crisis. We also know at least one of the big three insulin manufacturers (Novo Nordisk) is planning an on-site meeting with experts and advocates to discuss this issue and "hear from community voices" on it.
We're also interested in checking out a still-embargoed presentation titled "Trends in Life-Threatening Hyperglycemia-Related Complications among Commercially-Insured Diabetes Patients Before and After the 2010 Rise in Insulin Prices." Hmmm. This could embody some of the critical evidence needed to put pressure on payors, PBMs (pharmacy benefit managers) and other players involved in setting insulin prices. If patients with decent commercial health insurance are experiencing dangerous high blood sugars due to skyrocketing prices, what about the masses of under-insured and uninsured?
In terms of raising awareness on the struggles patients face IRL, the new documentary "Touch of Sugar" will be aired at the conference. It is narrated by Viola Davis and "showcases real people united in their struggle to manage their diabetes."
Seniors and Technology
As our diabetes community ages and more of us hit those "golden years," the array of technology and digital tools we use -- and our access to them -- is becoming a more pressing topic.
Medicare coverage is an issue all on its own, and that will be addressed in various conference sessions.
One session that caught our eye in this space is a study being unveiled at 6:10 pm on Sunday addressing "wireless innovations for seniors" with diabetes. The study, called the WISDM trial, looked at how real-time CGM can help reduce hypoglycemia in older adults with diabetes age 60 or older. The session description notes that participants had an average 57% Time in Range (TIR) at the start of the study, so we'll be keen so see how using CGM changed that for seniors -- who were previously not considered a key target audience for CGM use.
We're happy to see the ADA conference again highlighting the behavioral side of life with diabetes, tackling pyschosocial issues across the spectrum. A highlighted session called "Making a Difference in 5 Minutes" will cover everything from overcoming "pyschosocial insulin resistance" to strategies around tackling weight loss in a positive way and coping with burnout. That session will be led by Dr. Larry Fisher of UCSF, a well-known expert on the relationship between diabetes distress and clinical depression with glycemic control. (He's worked closely with Bill Polonsky of the San Diego-based Behavioral Diabetes Institute over the years.)
Another key session in this topic area is a panel moderated on the emotional toll of complications by Dr. Korey Hood of Stanford, featuring four patients sharing their personal experiences. Two of those are beloved diabetes bloggers and advocates Kerri Sparling (SixUntilMe) and Chris Aldred (The Grumpy Pumper).
Another session happening Sunday will explore "Alternative Delivery Approaches for Psychosocial Care in Diabetes," including web-based and video conferencing programs aimed at coping strategies and behavior change.
Words are important, particularly in healthcare and with diabetes doctors who often use terms like "non-compliance" when referring to how people with diabetes handle their own care. While not all may see this is a big issue, it directly impacts how many PWDs manage their own health, engage with healthcare professionals, and how the public learns about diabetes. If PWDs are feeling judged, blamed and stigmatized about their diabetes care, why would they turn to people or products that just make them feel more of that?
This Sunday session featuring type 1 and CDE Jane Dickinson touches on this topic from a healthcare provider's POV.
Also, if this topic interests you, be sure to check out hashtag #languagematters.
Diabetic Foot Complications
Foot ailments remain one of the most devastating and costliest diabetes-related complications, so we shouldn't be surprised that this year's conference will feature no less than a dozen sessions on this topic alone.
One of the most interesting new studies that will be showcased was outlined in a recent article in the Journal of Diabetes Science and Technology (May 2019 edition), titled: "Measuring Plantar Tissue Stress in People with Diabetic Peripheral Neuropathy: A Critical Concept in Diabetic Foot Management.”
An international team of researchers examined the concept of Plantar Tissue Stress (PTS) as a major cause of diabetes-related foot wounds, ulcers in particular. PTS is a new concept that integrates several well-known foot damage factors into one measure, including plantar pressure, shear stress, daily weight-bearing activity, and time spent in prescribed offloading interventions (meaning how well patients follow doctors orders to take pressure off their feet).
Some new tech tools to prevent diabetes foot complications on the horizon include a new pressure-sensing "smart insole" and a "SmartMat" foot scanner.
Heart health is always well represented at the ADA conferences, given that cardiovascular disease is the biggest killer of people with type 2 diabetes. In particular, there is ongoing concern about the impact of various T2 oral drugs on patients' hearts, and which add-on drugs may reduce risk.
We will be watching a handful of big studies on this – the CAROLINA clinical trial that looks at DPP-4 inhibitor Tradjenta and how it impacts cardiovascular outcomes for those with T2D; the PIONEER 6 study that explores the pill-form of Ozempic (semaglutide) in T2D; and the REWIND trial focused on heart health effects of Lilly’s Trulicity GLP-1 agonist drug.
There's also a Saturday morning "expert insights" session and poster display planned on the results of the landmark REDUCE-IT trial, an 8,179-person cardiovascular outcomes study completed in 2018. The data showed a significant reduction in adverse cardiovascular events in high-risk patients using triglyceride-lowering therapy along with statins -- when statins alone were not doing the trick. The winner in this trial was Amarin's oral drug Vascepa.
Kidney Disease and Precision Medicine
There will be DOZENS of sessions touching on diabetic kidney disease. Notably, a Sunday featured joint symposium from the ADA and the American Society of Nephrology on Kidney disease will offer an overview of advances in treatment. In the spotlight will be results from the CREDENCE trial, the first randomized, double-blind clinical trial designed to assess the effects of an SGLT2i and canagliflozin drug on major kidney outcomes.
The first presenter in the lineup, Dr. Alice Cheng of the University of Toronto, is expected to talk about how Precision Medicine is offering many potential new therapies to address diabetic kidney disease, and allowing providers to match the right treatments to the right patients.
Precision Medicine itself is a fascinating topic that was well-publicized during the Obama years. At ADA, of course the angle is how it specifically applies to diabetes management and even potentially to cure research. There is a two-hour session on this topic beginning at 1:45 pm Saturday, led by Dr. Paul Franks of Lund University Diabetes Centre in Sweden. That will cover defining "Precision Medicine" and the deep science of "Genotypic Diabetes Classification and Diagnosis."
- "Islet-on-a-Chip" from Dr. Cherie Stabler of the University of Florida
Highly multiplexed imagingfrom Dr. Garry Nolan of Stanford University Electromagnetic controlfrom Dr. Sarah Stanley of Mt. Sinai Medical Center
- Patch-Seq from Dr. Patrick MacDonald of the University of Alberta
On the transplantation front, more than 15 sessions will cover everything from the latest studies on pancreas transplantations from pediatric donors to islet transplantation vs. "standard of care" for type 1 diabetes to using CGM to track islet transplant recipients with long-term insulin independence.
One cure researcher we will NOT see presenting at this year's conference is Dr. Denise Faustman, following the controversy last year in which she was admonished for violating ADA embargo dates. There's been no public announcement of what came from all that, but rumor had it she would be officially banned from the conference this year. Just FYI.
So that's what's on our initial radar. Stay tuned for our post-conference coverage, and be sure to keep tabs on our social media channels on Twitter, Facebook and Instagram for updates from this seminal event!