Today marks the start of the 2012 American Diabetes Association (ADA) Scientific Sessions, being held this year in Philadelphia. I’ll be heading over there later today to check out what’s going on and live-blogging my experience (and sending Twitter updates via catherine_price, hashtag #ADA2012).
5:32 p.m. Checking out of CGM
Very interesting symposium, but my Dexcom and I have to check out to make a meeting with John Mastrototaro, VP of research and development for Medtronic’s diabetes business unit. An update soon (but perhaps after blogger happy hour!).
5:23 p.m. Glycemic Variability is Higher in Type 1 Diabetic Patients With Microvascular Complications Irrespective of Glycemic Control
Talk subtitle: Catherine’s fear — namely, that variability in blood glucose levels could be damaging. In other words, having a good A1c is fine and good, but if you‘re bouncing around all over the place in your quest to achieve said good-looking average, you’re causing oxidative stress that itself can cause microvascular complications.
Ugh, ugh, ugh.
5:05 p.m. A Comparative Analysis of Three Continuous Glucometers: Not All Are Created Equal
Here’s a talk about a study that compared the closed-loop performance of the Abbott Freestyle Navigator, Dexcom Seven Plus, and Medtronic Guardian. The test was 48 hours long and included six meals and about 30 minutes of exercise, and it seems to me like the closed-loop test itself went pretty well — they achieved an average daytime glucose level of 158 mg/dl, and a mean nighttime glucose level of 123 mg/dl.
As for the sensors themselves, it seems that the Navigator was the most accurate, then the Dexcom, then Minimed. The Navigator did well with lows, but tended to misread highs more frequently than the other brands.
So what about the next generation sensors? They somehow managed to look at the Navigator, the Medtronic Enlite (which works with the Veo), and Dexcom G4.
The new Medtronic gets closer to the Navigator but not quite.
Dexcom G4 has dramatically improved over the previous version. (BRING IT!)
When all three were compared in a very short study, the Dexcom G4, like cheese, got better over time, whereas the Navigator and Minimed, like milk, did not.
My conclusion: I miss my Navigator, and I want the new G4. Now. Please. Thank you.
4:51 p.m. Inaccuracy/Accuracy of CGMS — Comparing Abbott and Dexcom
Okay, still obsessing over where I lie on the glycolator scale, but the symposium has moved on to the question of how accurate current CGMs are and what impact that has on the possibility for a closed loop system. They used Dexcom SEVEN PLUS and the ill-fated Abbott Navigator, both of which I have been on (Abbott till they pulled it, Dexcom now). Conclusions:
-Navigator slightly better in numerical accuracy, but not by much
- For “large sensor error,” Dexcom’s were “twice, three times higher” than Navigator’s
4:45 p.m. Continuous Glucose Monitoring
Here’s something to blow your mind/make you crazy: not only is there no one standardized definition as to the correlation between A1c and mean glucose levels (JDRF says 1% = 24.4 mg/dl, ADA says 28.7), but different people have different correlations. For example, if you are a “high glycolator” (more glucose sticks to your hemoglobin than the average) you can have a relatively high A1c but a low mean glucose. The speaker gave the example of a patient who had a 8.2% A1c, but a mean glucose of 159 mg/dl (he was speaking using the generally accepted idea that 7% roughly equals a mean of 154 mg/dl). Treat him more aggressively, and you’ll end up with hypos. And if you’re a “hypoglycolator,” it’s the opposite.
I’m freaking out here a bit. . . .
4:15 p.m. - Sedentary Behavior/Physical Inactivity: Implications for Diabetes
If I had to summarize the take-home message of this session from the 2012 American Diabetes Association Scientific Sessions in one sentence, it would be easy: you should stop reading this blog post and go for a walk.
According to all four speakers (Frank W. Booth, John P. Thyfault, Carl J. Lavie and Sheri R. Colberg-Ochs, should you want to look them up) exercise is very important in (Type 2) diabetes prevention and in controlling blood glucose in both Type 1 and Type 2. Like, extremely important. So much so that I myself am feeling guilty about sitting here typing, and am kind of wishing I had one of those cool treadmill desks so that I could be writing and walking at the same time.
The session started with the straight-talking Frank W. Booth, PhD, who firmly believes that Americans’ laziness, as he puts it, is hurting our health. He pointed out that the human genome has changed very little over the past 40,000 years. There’s been so little change, in fact, that he believes that 100 percent of the increase in prevalence in Type 2 diabetes and obesity in the United States over the latter half of the 20th century can be attributed to our changing environment and activity levels, and how those changes have interacted with our genes. In other words, our genes are the same, but the forces acting on them or not. And the result is diabetes, on a massive scale.
As a follow-up, he showed a slide illustrating the combination of inactivity and genetics. Basically, it was a graph of kids who had a parent with Type 2, and kids who did not. The children were sorted from highly inactive to highly active, and the graph showed the relative levels of diabetes in each group of the kids (got it?). Bottom line: inactivity increased the kids’ Type 2 diabetes risk whether or not they had a parent with Type 2. HOWEVER, the inactive kids with a Type 2 parent had roughly double the risk of Type 2 as inactive kids without a Type 2 parent. To put it bluntly, if you’ve got a parent with Type 2, you’d better get active.
The following speakers made similar points, but one that really stuck out to me was one by Thygood, who believes that physical inactivity doesn’t just contribute to insulin resistance; it is the primary cause of insulin resistance. In other words, if you are physically active – even if you’re fat – you will not become insulin resistant. That seems both controversial, and completely logical to me. And definitely inspires me to walk home from this conference.
Now it’s time for a talk on CGM, but here are the experts’ conclusions and recommendations of what we all should be doing:
-Take 10,000 steps/day
-Break up sitting every 20 or 30 minutes with 2 minutes of moving around (even just a quick walk to the bathroom is helpful)
-Do at least (ideally more) than 150 minutes per week of moderate to vigorous aerobic activity, combined with resistance training 2-3 times a week (resistance also helps insulin sensitivity)
-Exercise a minimum of every other day (in other words, once a week is not enough because just several days of inactivity can cause insulin resistance)
-For post-meal blood glucose control, taking a walk after you eat is better than taking a walk beforehand (good to know!)
As they pointed out, though, these are general, one-size-more-or-less-fits-all recommendations. As personalized medicine further develops, it may be possible to measure your own reaction to exercise and figure out exactly the right combination and duration for you (yes, your doctor could actually prescribe Zumba). But in the meantime? Get off your butt.