ADA Scientific Sessions – Live Update – Day 2

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I’m at the 2012 ADA Scientific Sessions and am keeping a live blog about my experiences (here’s a link to my day 1 coverage of the ADA scientific sessions). I’m also tweeting about from at catherine_price, at hashtag #ADA2012. 

Included in this round: an interview with John Mastrototaro, Vice President of Research, Technology & Business Development for Medtronic’s diabetes division, about the FDA submission of the 530G insulin pump (aka the Veo), Minimed’s MySentry system, their newest CGM sensor (sold in Europe as the Enlite), their work on redundant sensors that could be used in a closed loop system, and the future of Connected Care (i.e. “smart” diabetes devices). Phew!

-The launch of the t:slim, the new touch- and color-screen insulin pump from Tandem Diabetes Care — the sexiest thing to come to diabetes management since, well, ever. 

-An update on the anti-CD3 monoclonal antibody (teplizumab) in not-so-newly diagnosed patients with Type 1.

I also posted many more details from my twitter feed (catherine_price) — check it out.

4:32 p.m. Tandem’s t:slim Pump Launch

All right, here’s some news many people have been waiting for: what’s the word on Tandem Diabetes Care’s brand new insulin pump, the t:slim? Well, having just attended their product theater at the ADA Scientific Sessions, I can tell you about it. First off, here’s a picture: 

Note diminutive size, and a screen that is not just color, but also touch. Hello, world’s first insulin pump that can inspire iPhone-esque technological lust! I mean, this thing is sexy. 

And yes, I understand the apparent oxymoron of “sexy diabetes gear” — but inasmuch as that term can exist, it applies to this pump. It is small, it is slim, and its interface is well enough designed that I believe it when they claim that — much like Apple products — you don’t need a user guide to figure out how it works. 

With that said, here are a few specific details on how it actually works. First off, it has a 300 unit reservoir capacity, and it’s compatible with any of the luer-lock infusion sets (i.e. pretty much anything but MiniMed). It’s water resistant for 30 minutes at up to 3 feet. It has a rechargeable battery that supposedly can last 7 days and takes between one and two and a half hours to charge (more on that in a minute). It has what looks to be a very cool and well designed PC- and, yes, Mac- compatible software program called T-Connect, yet to be approved by the FDA but in the works, which actually displays data in a useful way (including being able to upload data from many common brands of glucometer and overlay that info with your insulin history). And there are plans to integrate the t:slim with the Dexcom CGM. All great things. 

For me, the biggest advantage of the t:slim — besides its upcoming software — is its design: these are people who care about making products that people actually want to use. Too often it seems like companies forget that, at the end of the day, there’s going to be a real person using their product who wants something that’s both easy to operate and that actually provides useful information. Tandem clearly has not forgotten that. 

As far as the pump’s actual functions, they’re not remarkably different than the other pumps on the market — there are options for extended boluses, temporary basals, automatic bolus calculation, etc. One thing that did stand out, though, is how easy it is to set up an alternate program — say, for days you go to the gym versus days you don’t. The t:slim can duplicate all the settings you’ve got for your normal program, which  means that all you need to do is change the parts you want to change. Much easier than having to enter everything in again by hand. 

My main concern, which I voiced during the conference, was the battery: how do you have an insulin pump (which you’re supposed to wear all the time, yes?) with a rechargeable battery?  Does that mean that I either need to stay in one spot while the thing is charging, or temporarily disconnect? 

In a word, yes. And that is annoying. I do not like having to be dependent on an unremovable rechargeable battery as my pancreas. But the t:slim staff did try to allay my concerns, pointing out that you can recharge it with any micro-USB cable (the type that Android phones use), and that they recommend continuously topping it up during times when you’d have it disconnected anyway, like while you take a shower. They also pointed out that it can be charged in a car, an outlet, or on a computer, meaning that as long as you stay close to one of those power sources — and carry the cable — you should be fine. They also assured me that the rechargeable battery lasted for a long time — longer than the four-year warranty period, in fact. I am now about 75 percent convinced that I’m okay with that. But the 25 percent knows how annoying the rechargeable battery of my Dexcom is (I’d much rather just suck it up and buy batteries), and what a disaster it would be if I were to lose the cable in a place where replacements were not readily available. I don’t like my pump being dependent on my remembering to pack a particular cable. 

All that said, though, I was very impressed — especially looking ahead to what the future might hold. The pump itself is beautiful but, more than that, I loved the idea that the company puts such an emphasis on the user experience. I hope to get a chance to try out the pump and software soon, but for now, let’s just say I’m excited and intrigued. 

 

2:20 LADA is Not a Distinct Form of Autoimmune Diabetes – Richard Leslie

As if LADA weren’t confusing enough, I just sat in a talk with the above title. I’m cloudy on all the details of the specific autoantibodies but his basic point was that the current definition of auto-immune diabetes refers to age of onset, need for insulin therapy, and autoantibodies – and he aims to change that definition. To quote: “We conclude that autoimmune diabetes is on a spectrum with the children’s version well characterized. . . . All of the features are different from Type 2 diabetes and, in the case of auto-antibodies, categorically distinct from patients with classic Type 2 diabetes.”

There were several questions about that last point.

Off to Tandem’s t:slim demo!

2:12 p.m. The Day So Far

Dear lord, there’s a lot going on. Just sat in on a talk by my first-ever endocrinologist, Dr. Kevan Herold (now at Yale) giving an update on teplizumab, an anti-CD3 monoclonal antibody that I was lucky enough to be in a trial for right when I was diagnosed. (If teplizumab and anti-CD3 monoclonal antibodies leave you scratching your head, here’s a lay-person explanation I did for Popular Science a couple years ago, and an update on a still-enrolling prevention trial using the same drug). Without getting too technical, the idea of the drug is to “reprogram” the immune cells that are responsible for killing off the beta cells, in hopes of preserving some beta (insulin-producing) cell function. Originally it was assumed this would only work for newly diagnosed patients, but Herold explained that they’d done a study showing that it was also effective (albeit not as much) at people who received it 9-12 months after being diagnosed. Very inspirational — I hope it gets FDA approval soon. Now for more LADA!

10:32 p.m. Interview with John Mastrototaro, Vice President of Research and Development for the diabetes business unit at Medtronic

Okay, so I technically met with John — who helped develop the first approved CGM — at 5:45 p.m. of day one. But then came the blogger happy hour, and then came dinner, and then came desperately trying to catch up on stuff, and I am only now getting to write a brief update on our conversation (which I hope to follow with a more extended post). 

If I had to describe one of my long-time dreams as a person with diabetes on an insulin pump (in my case the Minimed Revel), it would be to meet a person who actually designs insulin pumps. Sure, I’ve got my pie-in-the-sky requests (can you just close the loop NOW?) but I’m also genuinely curious about what it’s like to develop these systems — what the challenges and hurdles are, what their hopes and dreams might be, and what’s standing in the way. So it was a real treat to come straight out of the CGM update and meet with John, on the very same day that Minimed announced that it’s applying for FDA approval for its 530G pump — the American version of the Veo, which has been out for several years in Europe. 

I asked John to explain to me what made this new system special, and it turns out there are a couple exciting things. First, the new Enlite sensor — and I really should use “new” in quotation marks because it’s been available in Europe for about a year — is much more comfortable than previous Minimed sensors (which I’ve heard referred to as “the harpoon”), and more accurate. Second, the pump itself — known in Europe as the Veo, where it’s been available for several years — has a glucose suspend feature, meaning that if the Enlite sensor detects your blood glucose is below 70, it can stop insulin delivery on its own. I love this idea and personally think it’s a no-brainer — after all, you can override it if you’re conscious enough to disagree, and it only suspends glucose for a maximum of two hours. At its best, it saves your life. And at its worst, it contributes to a high for a couple hours. No harm, no foul, maybe an avoidance of a really nasty hypoglycemic episode. Sounds like a win to me. 

To anyone who’s been following the Veo, the news here is purely that Minimed has finally been able to submit the application to the FDA, which required the company to do new testing in the US to prove its safety before allowing it to move forward. Still, it’s exciting. (And FYI, later generations will likely include a *predictive* low glucose suspend feature.)  But what I really found exciting about my conversation with John — besides the fact that he is an extremely smart and dedicated person who is devoting his career to making my life easier — is the stuff that the future might hold. 

I recently moved into a new house, and my husband and I decided to get a security system. It comes with a smartphone app that allows me not just to control its status from afar, but also to see a detailed record of who went in and out of the house all day, using which doors and at which times. (Think of that the next time you consider breaking in.) I bring this up because according to John, that might be similar to the insulin/sensor systems of tomorrow. Perhaps you’ve heard of My Sentry , Minimed’s device that projects blood glucose readings from the sensor to a separate display that can be placed anywhere around the house — so a parent can tell what their kid’s blood glucose is from a device on the side of their bed. Pretty cool, right? Well, imagine what would happen if you took that idea and made your glucose sensor even more like my FrontPoint security system. What if a parent could log onto their phone and see what their kid’s bg was at any time of day, or could tell whether or not they’d had insulin at lunch with their meal or checked their blood glucose when they were supposed to. Or, for the childless among us, what if you could program a loved one’s phone number into your device or phone and, if you failed to respond to a low glucose warning for a set person of time, that loved one would automatically receive a call alerting them to the fact that you were unresponsive? It’s all what I’d call “smart sensors,” but which Minimed refers to as “connected care” — and which is a real priority for them. 

They also are working on an integrated pump/CGM system that, as the jargon goes, would “treat to range.” It wouldn’t give you perfect control, in other words, but in keeping you within a relatively narrow range (say, 70 to 180 mg/dl), it’d get you one-step closer to having automated control. (Also a promising area/potential step: open loop by day, closed by night, since overnight you’re less likely to do things like eat or exercise.)

I find all this incredibly exciting. Here you’ve got Minimed, which — as John pointed out — already has a great pump and algorithms and is about to launch a much more sophisticated sensor, and (in addition to the amazing closed loop stuff) they’re emphasizing the idea that your diabetes devices should actually *interact* with you and your loved ones to help you with your care, rather than sitting passively in the background. If my home security system can do it, it makes sense that my diabetes gear could as well — and I am truly thrilled to know that Medtronic is so committed to advancing that goal. 

 

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Steve

Awesome summary! Lots of great things to look forward to. Thank you!

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