The 2015 Advanced Treatments & Technologies for Diabetes (ATTD) conference took place in Paris last week, and while we weren’t able to cross the pond ourselves, we had some keen eyes and ears trained on the action.ATTD 2015 Paris banner

I’m happy to report that Rem Laan, executive director of the William Sansum Diabetes Center in Santa Barbara, CA, acted as our correspondent. With some help from his colleague pediatric endo and researcher Dr. Jordan Pinsker, he’s compiled this great report on the “big takeaways”:


A Guest Post by Rem Laan

The annual ATTD conference in Europe continues to grow in size and importance. I attended my first meeting in Basel, Switzerland, in 2010 with fewer than 800 participants. This year’s meeting in Paris had more than 2,500 participants and the presentations and discussions were excellent. ATTD is now clearly the premier Rem Laan Sansum Diabetesconference for diabetes technology in the world.

Although there were no “breakthrough” new products on display, Ypsomed, the successor company by the founder of Disetronic, is preparing to launch a new insulin pump. It is a simple but very attractive design based around the new Novo 1.6 ml Novolog pump cartridge. Ypsomed is currently the Insulet distributor in Europe and a major distributor of diabetes supplies to Roche pump customers.

Results for pre-clearance studies of two new insulins were announced. The first was U300 Lantus, which provides less glucose variability with a trend toward fewer hypos than U100 Lantus, whether injected in the morning or the evening. There were studies in both MDI and basal only patients with more or less similar results.

The other new insulin was ultra-fast-acting Aspart (Novolog). The time to peak is only a bit shorter but the area under the curve postprandially is reduced by almost 1/3 compared to regular aspart. This is statistically significant and represents an improvement approximately equal to the difference between traditional Novolog insulin and regular insulin. We are looking forward to testing this faster-acting insulin in closed loop studies.

Other key themes were as follows:

  • Pumps for Type 2s – There was lots of discussion about the OpT2mise Study, which showed that pump treatment is favorable for type 2 patients achieving poor control on injections. Also, makers of the CeQur PaQ three-day wear patch pump showcased new data demonstrating the effectiveness of that device; in a small 12-week study of six patients using the pump for 12 weeks, participants showed an average reduction in A1c of 1.8 points. The product is approved in Europe, but has not yet cleared FDA.

Cequr Insulin Patch Pump

  • Next-Gen “Hybrid Closed-Loop” Device - There was also some discussion about the FDA regulatory pathway for the Medtronic 670G which seems to be pretty straightforward. (This is the next-gen that can both reduce insulin for lows and also increase insulin delivery when blood sugar is high). Medtronic has publicly stated they plan to launch the 670 first in the U.S. and to do so in 2017. Clinical trials are already ongoing in Australia.
  • Design Talk - There was a lot of discussion about the importance of human factors and psychosocial research, both in Artificial Pancreas development and CGM. Dr. Kath Barnard has received a grant from Helmsley Charitable Trust to start a study group (of which Sansum will be a participant). Aaron Kowalski, head of JDRF’s Artificial Pancreas Project also talked about this at several sessions. There was also a great deal of discussion about why people either don’t start using CGM or start and then stop. The key issues for both devices are: interest, expectations, burden, and accuracy/trust.
  • Infusion Set Advances - BD had two presentations about their new infusion set, which has been submitted to the FDA for clearance. It will be available with leur lock and paradigm type fittings. They did not disclose the catheter material or design but they did present very interesting data on “silent occlusions,” comparing the major pump brand manufacturers’ infusion sets with the new BD infusion set. Anyone who has ever used a pump realizes that the infusion set is the weak link and this work by BD, partially funded by JDRF, represents the first real research into an improved infusion set in my 15 years in the pump business.
  • Abbott Libre Flash Glucose Monitor system – The Abbott booth was packed. Dr. Tim Bailey presented some results of a pilot study he conducted prior to the pivotal study that is currently ongoing for FDA clearance. Several people reported to me that demand is so great that Abbott cannot make product fast enough and that it is currently selling above list price on the secondary market. This product has the potential to significantly reduce the market for fingerstick blood glucose monitoring among patients on intensive insulin therapy.

Abbott Libre Flash Glucose Monitor

  • Artificial Pancreas Algorithms - The battle of which is best continued. There must be at least 20 research centers and companies developing AP algorithms. My takeaway is that they are all pretty good as long as the user announces meals (and boluses for them) and announces exercise. {TEXT AMENDED FOR CLARIFICATION 2/26/15} The one surprise for me was that in Dr. Roman Hovorka’s presentation in which he compared the Cambridge system (insulin only) to the Boston University (insulin + glucagon) system, he said that both provide approximately equal increases in time in range and rates of hypoglycemia but the BU system appears to use considerably more insulin and about .72 mg of glucagon per day. A rescue dose of insulin is 1mg. For me, this presentation also highlighted the need for funders (NIH, Helmsley, and JDRF) to stipulate a set of consistent metrics for these AP studies, so they become easier to understand and compare.
  • Glucagon Nasal Powder – New research was presented on this by T1D Exchange. The short summary is that intranasal glucagon was found to be “non-inferior” to intramuscular glucagon injection. The glucose-raising speed is a bit slower at first but catches up within the 30-minute time frame of the study. A new research project is being initiated to determine if and how quickly third-party caregivers can properly administer intranasal glucagon. I believe this will be compared with administration using a traditional glucagon kit. I wonder if they will be trained beforehand? The only major side effect was significantly greater “fascial discomfort” (headache) after use but the patient does not really have a say in this. The real test will be the feedback from third-party caregivers.


Gotcha Rem, thank you for this excellent overview! And for those interested, ATTD 2016 will be held in Milan, Italy.

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