Better Insulin, Redefining Diabetes, & Good Glucagon

You may have read a headline or two about the success of Boston University’s artificial pancreas trials, announced at the 2014 ADA Scientific Sessions. There was a lot more going on at the 4-day event in San Francisco. Each year, more than 15,000 experts in the field of diabetes convene at the American Diabetes Association’s Scientific Sessions to hear the latest news in diabetes research, medical devices, and clinical practices.

At Insulin Nation, we’ve summed up 7 additional big ideas at this year’s sessions:

New Recommendations For Children with Diabetes

The ADA finally released care guidelines just for people with Type 1 diabetes; in the past, Type 1s were lumped together with Type 2s. With those recommendations came new A1C guidelines for children with diabetes. Previously the guidelines stated that an A1C should be less than 8.5% for children aged under 6 years, less than 8% for 6-year-olds to 12-year-olds, and less than 7.5% for 13-year-olds to 19-year-olds. Now, the ADA is recommending an A1C under 7.5% for anyone under 18 years, and under 7% above 18 years.

The new guidelines reflect the capabilities of new technologies like CGMs and insulin pumps, but data shows that less than a third of children with Type 1 were able to meet the previous target A1Cs. It remains to be seen how teens can get to the lower target when the higher target seemed so out of reach.

Better, Faster Insulin?

European company Adocia released results of a small-scale study of 36 people with diabetes using their ultra-rapid BioCherone Lispro insulin. The results showed a faster onset of action and a faster return to baseline blood sugars post-meal compared to Humalog. The study showed that BioChaperone Lispro got to work in the body 33% faster than Humalog.

Long-acting Insulins

Lilly and Sanofi both announced the results of clinical studies on new long-acting insulin. With Lantus coming off-patent in 2015, Sanofi is working on a new long-acting glargine insulin, called Toujeo. Sanofi reports positive results from their Phase III trial that showed patients using their long-lasting insulin experienced fewer hypoglycemic events than patients on Lantus.

For their part, Lilly, and Boehringer Ingelheim, released results showing their new long-lasting insulin, currently named LY2963016, is biologically equivalent to Sanofi’s Lantus. Lilly is also working on an entirely different long-lasting, or glargine, insulin, called basal insulin peglispro.

New Gadget For Glucagon

Biodel held a series of lunch briefings to introduce their Glucagon Emergency Management (GEM) System, currently still in development. The new GEM delivery system would provide clear, step-by-step instructions written on the device, rather than on a separate instruction sheet. The labeling would allow the user to quickly understand how to reconstitute and use the glucagon during crisis situations. Biodel will be conducting small clinical trials later this year or early next year to prove it’s the equal to the glucagon device currently produced by Lilly. The company hopes to file with the FDA by the end of 2015.

New Industry Partnerships

A couple of partnerships were announced during the sessions. The first is between Medtronic Diabetes and Sanofi, which announced they would be working to develop new devices and products. Although no specific plans were formally announced, Medtronic execs said they would be working on developing new products for people with Type 2 diabetes.

A second partnership was announced between Dexcom and Insulet, which previously worked together to develop an integrated CGM-insulin pump system. Unfortunately that original project isn’t moving forward, but Dexcom is taking the lead on a new collaboration by developing a mobile app that will integrate data from both Dexcom CGMs and the Omnipod insulin pump.

Tracking Diabetes

The Joint ADA/JDRF Symposium on Diabetes featured a couple of presentations on new ways to identify diabetes in adults. It was a very in-depth scientific look at the biological markers for different types of diabetes.

Diabetes researcher Dr. Stanley Schwartz shared his belief that our current way of thinking about a diagnosis is too imprecise. He argues that the term “Latent Autoimmune Diabetes of the Adult” does not have a clear, established definition. This designation creates overlap between Type 1 and Type 2 diabetes, so it remains a rather ambiguous definition with a lot of exceptions.

Dr. Schwartz advocated a “beta-cell-centric classification” approach to diagnosing diabetes, because all forms of diabetes affect the beta cell production of insulin. A variety of tests can examine a person’s genes, insulin production, insulin resistance, inflammation, and possible environmental triggers. Schwartz believes such a shift in thinking can lead to a better use of available therapies.

Less Lecturing from Doctors

Bill Polonsky, a noted certified diabetes educator, received the Richard R. Rubin Award, which honors those working in behavioral medicine. Dr. Polonsky is the founder of the Behavioral Diabetes Institute and specializes in working with people with diabetes and their families.

During his talk, Dr. Polonsky shared his philosophy that trying to promote behavior change can actually be harmful, because patients don’t return to the offices of doctors or diabetes educators if they feel pushed. Motivational interviewing can actually make things worse because patients feel rushed to make big changes, he argued. The problem, Polonsky feels, is that medical professionals often want big changes, rather than focusing on smaller changes that can help lead to healthier habits. He says the biggest obstacle to good diabetes self-care isn’t usually depression or a fear of lows, but indifference, or, as he calls it, the feeling of “meh”.

Dr. Polonsky called for a larger focus on actions that get the biggest bang for your buck, such as knowing your numbers. Not all changes in behavior are equal, he says. Tackling the more meaningful ones can have a bigger impact in health.

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