Technology Themes Will Be Center Stage at ADA in Orlando

Miriam E. Tucker

June 14, 2018

New trial results in type 1 and type 2 diabetes, women's health and careers, and glucose-sensing technology are just a few of the wide range of topics to be explored at the American Diabetes Association (ADA) 2018 Scientific Sessions.

The meeting, taking place June 22 to 26 in Orlando, Florida, offers a massive array of diabetes-related information.

"This is one of the biggest diabetes meetings of the year with the most excitement," ADA president, medicine & science, Jane E.B. Reusch, MD, of the University of Colorado, Denver, told Medscape Medical News.

"I think this meeting is cutting-edge based on all the new data in new areas," added William T. Cefalu, MD, ADA chief scientific, medical & mission officer.

The ADA is also instituting a new policy on taking and posting photos on social media this year dubbed #RespectTheScientist, in light of a major dustup at last year's meeting. The official hashtag for the meeting is #2018ADA.

Soccer will also be given some space at the congress, with organizers recognizing that many attendees will be keen to follow their national football teams during the FIFA World Cup, taking place in Russia. Delegates can catch up with matches in-between sessions in the World Cup lounge in the Level 1 Lobby.

And the annual 5K fun-run/walk will take place on Sunday, June 24, at 6.30 AM on the west concourse of the Orange County Convention Center. Delegates can register at the 5K@ADA booth located in the Level 1 Lobby on Thursday and Friday.

Also on June 24, attendees will be encouraged to "Wear Red to Stop Diabetes."

Major Trials in Type 1 and Type 2 Diabetes

Major trial results to be presented include 13-year data from The Environmental Determinants of Diabetes in the Young (TEDDY) study of more than 8500 children at high risk of type 1 diabetes.

They will also cover 15-year data from the Veterans Affairs Diabetes Trial (VADT), tracking macrovascular complications in over 1300 men with type 2 diabetes, and early findings from Restoring Insulin Secretion (RISE), looking at metformin and insulin use in youth with type 2 diabetes and exploring differences in pathophysiology between youth and adults.

Those presentations will take place Saturday, Sunday, and Monday, respectively.   

According to Cefalu, TEDDY is "one of the largest studies to date that looks at infants at high risk for development of type 1 diabetes, examining the role of environmental factors over many years…We are eagerly awaiting those results."

The RISE study, expected to demonstrate whether an intervention can preserve beta-cell function, "is going to be an interesting symposium," Cefalu said.

And in the field of diabetes prevention there will be presentations on the 30-year follow-up of the Da Qing Diabetes Prevention Study and new data from the Diabetes Prevention Program Outcomes Study (DPPOS).

Another special symposium taking place unopposed on Tuesday is entitled "SLGT Inhibition for Type 1 Diabetes Mellitus Management — How Far Have We Gone?" It will feature pivotal trial data for the SGLT-2 inhibitors dapagliflozin (Farxiga/Forxiga, AstraZeneca) and empagliflozin (Jardiance, Boehringer Ingelheim) and the SGLT-1/SGLT-2 inhibitor sotagliflozin (Lexicon/Sanofi) as adjunctive treatments with insulin in type 1 diabetes.

Another talk at that session will address whether companies should be required to conduct cardiovascular outcomes trials for their drugs in patients with type 1 diabetes when they seek US Food and Drug Administration (FDA) approval.

"These are not indicated as yet [for type 1 diabetes], but there's a lot of evidence that they improve hemoglobin A1c and have a good effect on hypoglycemia, and weight…We didn't want to oppose this session because we thought it was exciting," Cefalu said, adding that there will also be oral abstracts presented during the meeting on adjunctive treatments for type 1 diabetes.

New ADA Initiative on Women's Health and Careers in Diabetes

Reusch, who serves as associate director of the Center for Women's Health Research at her institution, has spearheaded the creation of the Women's Interpersonal Network of the American Diabetes Association (WIN ADA), a members-only network for women who are clinicians, scientists, and other health professionals in the field of diabetes.

The group will hold its inaugural session on Monday afternoon with a mini-symposium entitled "Overcoming Gender Gaps in Science."   

"I'm very interested in both sex and gender gaps in career paths in the field of diabetes, as well as sex and gender gaps in research on diabetes," she told Medscape Medical News, adding that the objectives of WIN ADA are "to foster the careers of all women in the field of diabetes."

"That goes from academic researchers through to the people providing the health care and education for people with diabetes, who are primarily women."

Women currently outnumber men in endocrinology, she noted, observing "that is often the case in a subspecialty with fewer procedures and less money."

The WIN ADA network will also strive to further the National Institutes of Health drive towards sex and gender evaluation in research, particularly clinical.

Reusch noted, "In cardiovascular outcomes and diabetes complications trials, there has been little attention to detail regarding sex differences or even the inclusion of women."

In an attempt to change that, WIN ADA has established a new series of awards for young investigators to examine sex as a biological variable in diabetes.   

At the meeting, sessions related to women's health will include several pertaining to gestational diabetes, as well as examinations of sex differences in health outcomes for people with diabetes.

"I am thrilled that we're making a specific effort towards addressing the careers of women in the field of diabetes and sex as a biological variable for women's health in people with diabetes," she commented.

Lots of Technology, With a Focus on CGM

There will also be a plethora of new information on diabetes-related technologies, particularly continuous glucose monitoring (CGM), at the meeting.

Sessions will cover the investigational implanted Eversense (Senseonics), now under FDA review, the latest in closed-loop insulin delivery (artificial pancreas), and even a first-ever symposium on the "Diabetes Do-It-Yourself Revolution," which will explore how patients have devised ways to hack their devices into functioning as an "artificial pancrease" ahead of the traditional device development pathways.

This year's Saturday morning Diabetes Care symposium will also focus on diabetes-related technology. 

Both Cefalu and Reusch pointed out that the increasing use of CGM is now allowing for more fine-tuning of glycemic control for people with both types of diabetes by providing adjunctive information to hemoglobin A1c.

"A1c is the gold standard for measuring glucose control, but the advent of the new CGMs let us know that because of the characteristics of 24-hour glucose control and variability, an A1c may mean different things to different folks," Cefalu said.

For example, two patients can have the same A1c, but one has steady-state blood glucose levels while the other may be frequently swinging from high to low and back again, he explained.

"We're not moving away from the A1c, but I think what we'll be doing will be value-added parameters....It's going to tell us what to do precisely in terms of adding or taking away therapy."

Indeed, Reusch observed, "We have so many options of therapy that target different aspects of diabetes, particularly in type 2. Now we're able to look at glucose profiles, we can understand better whether an A1c is representative of good or poor control and whether there are ways we can fine-tune it to achieve optimal care with less variability."

New in 2018: Draft Diabetes Guidelines, #RespectTheScientist

Deliberately kept back for Tuesday morning, the ADA will hold a joint session with the European Association for the Study of Diabetes (EASD) entitled "Management of Hyperglycemia in Type 2 Diabetes — Draft ADA/EASD Consensus Report 2018."

Audience members will have a chance to comment on the draft document, which is updated every 3 years. A similar session will be held at the EASD 2018 Annual Meeting in early October. The session will be a first for both organizations, Cefalu said.

"This is the first time people can see publicly where this is headed. The release of new medications and the new data greatly changed our algorithm last year, so you can assume it's going to be a markedly different document, just based on the data."

Meanwhile as part of the revamp of the association's policy on the use of photographs, #RespectTheScientist will mean that each presenter/study author will announce at the beginning of their presentation during the scientific sessions whether or not they approve of photographs being taken of their slides.

If allowed, attendees may take photographs as long as they're for personal, noncommercial use and not for publication or rebroadcast without the express written permission of the author. Flash photography is not permitted, and photography is not allowed in the exhibit or poster halls.

But within the parameters of the photography policy and embargoes, the ADA encourages social media use "to update followers on the latest news coming from the Scientific Sessions."

Cefalu is an employee of the ADA. Reusch is an advisor to Sanofi-Aventis and has received research support from AstraZeneca and Merck.

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