The American Diabetes Association’s 74th Scientific Sessions took place in San Francisco from June 13 to 17. Many, interesting and important findings were presented, and here are the five that I believe all people with diabetes should know.
1. ADA New Position Statement Changes The A1C Target Recommendations for the Type 1 Diabetes Pediatric Population
Dr. Ann Peters, MD, FACP helped develop the new position statement for the standards of Type 1 diabetes. She states: “Our goal here is to present a position statement that looks specifically at the needs of people with Type 1 diabetes across the age spectrum.”
Previously, the recommend target A1C for children under the age of 6 was 8.5%, 8.0% for six to twelve year olds, and 7.5% for teenagers. The authors of the new position statement explained that those targets had been chosen due to concerns about the risks of dangerous hypoglycemic episodes. Research has shown, however, the greater risk is prolonged hyperglycemia leading to early developments of serious complications in childhood. Given that new tools to detect hypoglycemia, such as continuous glucose monitors, are now available, lead the authors to issue a target of 7.5% A1C for the entire pediatric population.
It is important to note that despite the new lower recommendation, a recent study showed that only 32% of the Type 1 pediatric population met the previous ADA targets for their age group.
2. “Diabetes Distress” for Type 2 Diabetics and Increased Mortality for Type 1 Diabetcis
It’s no secret that there is a strong correlation between diabetes and depression, but Dr. Lawrence Fisher, PhD, ABPP believes that many individuals with Type 2 diabetes suffer from “diabetes distress” and not clinical depression. Diabetes distress is the feelings associated with the daily burden of a chronic, complex disease.
Fisher states: “Many of the depressive symptoms reported by people with Type 2 diabetes are really related to their diabetes, and don’t have to be considered psychopathology. So they can be addressed as part of the spectrum of the experience of diabetes and dealt with by their diabetes care team.” His study placed individuals who scored high on a patient health questionnaire into three intervention groups: an online diabetes self-management program, an online individualized assistance program, and an education by mail program. All showed significantly reduced distress over a 12-month period.
While Dr. Fischer did not research diabetes distress in the Type 1 diabetes population, a separate study presented an alarming result: those who exhibit the highest level of depressive symptoms are most likely to die prematurely. This group of diabetics, all diagnosed between 1950 and 1980, was studied over a 25-year period using the Beck Depression Scale.
Cassie Fickley, the lead author, said: “For every one point increase on the Beck Depression Inventory Scale, participants showed a four percent increase in risk for mortality – after controlling for other factors that might increase the risk of death.” Results from this study show that the diagnosis of depression in the Type 1 diabetes population and intervention of some type is crucial.
3. The Diabetes Online Community Presented (and Represented)
For the first time at ADA a panel made up entirely of representatives of the Diabetes Online Community (DOC) spoke about the importance of peer social support for the health of those living with diabetes. Jeff Hitchcock, Kerri Sparling, Manny Hernandez, and Scott Johnson, all icons in the DOC shared their thoughts, answered questions from clinicians, and gave important advice on ways to engage with the community.
Kerri Sparling, touting the benefits of the Diabetes Online Community stated: “People with diabetes can find empowerment through shared triumphs,” with Scott Johnson adding his thoughts about the way that diabetes often creates a feeling of isolation and the online community helps to alleviate it. The audience was engaged, excited, and interested in the patient perspective, and it is hoped that this will be the first of many patient presentations at ADA.
4. The Bionic Pancreas Outperforms Insulin Pumps
The latest research regarding the bionic pancreas, a system using insulin and glucagon pumps to regulate blood glucose levels based on data from a continuous glucose monitor, should come as no surprise to those following this exciting next step in diabetes management.
Two studies have shown that: “…this device far exceeded our expectations in terms of its ability to regulate glucose, prevent hypoglycemia and automatically adapt to the different needs of adults – some of whom were very insulin-sensitive – and adolescents, who typically need higher insulin doses, “ said Dr. Edward Damiano. “There’s no current standard-of-care therapy that could match the results we saw.”
Next steps for the bionic pancreas trials will involve longer periods of home use and the addition of larger multicenter trials, eventually leading to what the researchers hope will be FDA approval of this system within the next few years.
5. Does Cow’s Milk Trigger Development of T1 Diabetes?
Speculation ran rampant for years about whether early exposure to cow’s milk acts as a trigger for Type 1 diabetes, with many Type 1 T1 parents choosing to breastfeed or use soy-based formula to lessen the chances of their offspring developing Type 1 diabetes. A randomized controlled study separated infants into two groups: a cow’s milk-based formula group and a hydrolyzed protein formula group.
The researchers studied the children for 7 years and found no difference in the development of Type 1 antibody markers between the groups, leading to the conclusion that cow’s milk is not a trigger. However, the children participating in the study will be followed until age ten to determine if they develop Type 1 antibody markers and/or Type 1 diabetes.
*Author’s airfare to San Francisco and hotel accommodations were paid by Diabetes Advocates, a program of the Diabetes Hands Foundation.