https://www.ajmc.com/conferences/ada-2019/ada-sessions-offer-news-on-diabetes-technology
ADA Sessions Offer News on Diabetes Technology

Mary Caffrey

The 79th Scientific Sessions of the American Diabetes Association (ADA) offered plenty of news from the technology front—both studies about emerging products and updates on those already on the market. ADA included advances in diabetes technology in a special briefing, and there was plenty happening both on and off the exhibit floor. Here is a sample of the news:

Tidepool Announces Key Partnerships With Dexcom, Medtronic
The first day of ADA Sessions on Friday featured a pair of big announcements from Tidepool: first, that it would create a partnership with Dexcom to integrate Dexcom’s G6 interoperable continuous glucose monitoring (CGM) system into the Tidepool Loop, its effort to support the do-it-yourself open source automated insulin delivery app. Second, Tidepool will collaborate with Medtronic to develop a Bluetooth-enabled MiniMed insulin pump. Tidepool has an exciting relationship with Insulet, maker of the Omnipod. The news came at the annual DiabetesMine D-Data session. In a blog post, Tidepool president and chief executive officer Howard Look updated the diabetes community on efforts to develop an FDA-regulated iOS app for automated insulin delivery.

Medtronic Announces Real-World Data From Guardian Connect and Sugar.IQ
On Sunday, Medtronic presented data for its Guardian Connect CGM system and the Sugar.IQ app, which integrates data with the data from the Guardian system with artificial intelligence from IBM Watson Health to help people with diabetes stay in their target range. Data from 3100 people who used the app-driven system at least 5 days showed that they had 4.1% more time in range (63.4%) compared with Guardian alone (59.3%), for a difference of about 1 more hour per day. Each 4% change in time in range translates to a 0.3% change in glycated hemoglobin (A1C).1

First Human Tests of Gen3 iLet Bionic Pancreas Presented
The special diabetes technology press briefing featured results for the Gen3 iLet, which is described as a “purpose-built, fully integrated bionic pancreas platform.” Developers say it can use either the Dexcom G5 or the Senseonics Eversense implanted CGM. They performed a random, cross-over outpatient study that compared the iLet insulin-only mode with usual care for 7 days each, with 17 patients each from Stanford (Dexcom G5) and Massachusetts General Hospital (Eversense). Researchers monitored the patients remotely and measured mean glucose, time with glucose concentration less than 54 mg/dL, and secondary measures including time in range. There were no differences in time below 54 mg/dL or mean CGM glucose, but iLet increased time in range (70.1% vs 61.5%). No serious events were reported in either arm. Researchers said reports from patients led to improvements in bionic pancreas.2

CITY Reports CGM Helps Teens, Young Adults Reduce A1C
Lori Laffel, MD, MPH, chief of the Pediatric, Adolescent and Young Adult Section at Joslin Diabetes Center, presented results from CITY (CGM Intervention in Teens and Young Adults with Type 1 Diabetes).3 The study evaluated how the use of CGM affected disease management of 153 teens and young adults who were aged 14 to 24 years, an age group that Laffel has researched for decades. Historically, this group often sees a drop in glycemic control as parents hand over the reins of disease management. This group did not necessarily embrace earlier generations of CGM, but newer systems require less patient involvement. The study participants were randomized to wear either a Dexcom CGM or use standard blood glucose management. Results showed that 70% of the CGM group wore the device an average of 5 days or more per week. After 6 months, less than 10% of the users were no longer wearing the device.3

SENCE Finds Fewer Glycemic Extremes With CGM in Youth
A study that looked at how CGM use affected glucose management in young children had mixed results, but offered direction for future training for youth and families with type 1 diabetes (T1D). Strategies to Enhance New Continuous Glucose Monitoring Use in Early Childhood (SENCE) enrolled 143 children aged 2 to 7 years who had not previously used a CGM. They were randomly assigned to 3 groups: 1 did self-monitoring of blood glucose with a meter and test strips, 1 used CGM, and 1 used CGM with 5 half-hour education family intervention sessions. Initial results did not show differences in time in range among the groups, but a second look showed the group that received the education sessions had better time in range in the later weeks of the study. Quality of life among CGM users was improved, with families worrying less about diabetes care, and CGM compliance was 90%. Groups using CGM also had less hypoglycemia and hyperglycemia.4

Diasome Presents Phase 2B Data on Nanotechnology That Targets Insulin to Liver
A game-changing insulin delivery approach may be on the way. Diasome presented results from a phase 2B clinical trial for its hepatocyte directed vesicle (HDV) technology, which targets insulin directly to the liver and allows users to manage T1D with far less insulin. The additive, which directs insulin with a nanoparticle disc, is designed to work with all commercial insulins and is mixed directly with insulin before administration. In the 26-week ISLE-1 (InSulin Liver Effect) study, patients either had conventional mealtime treatment with insulin lispro alone or insulin lispro with the HDV additive. Results showed that patients with an A1C of 8.5% or greater taking insulin with HDV had the same A1C reduction as those taking insulin without the additive, but took about 25% less insulin and spent 73% less time in hypoglycemia.5

References
  1. Arunachalam S, Zhong Y, Abraham SB. Real-world performance of the Guardian Connect system with Sugar.IQ  Presented at: 79th Scientific Sessions of the American Diabetes Association; San Francisco, California; June 7-12, 2019. Abstract number 939-P.
  2. Jafri RZ, Balliro CA, Sherwood J, et al. First human study testing the iLet, a purpose-built bionic pancreas platform. Presented at: 79th Scientific Sessions of the American Diabetes Association; San Francisco, California; June 7-12, 2019. Abstract number 77-OR.
  3. Laffel LM. Continuous glucose monitoring intervention in teens and young adults (CITY)—primary study results. Presented at: 79th Scientific Sessions of the American Diabetes Association; San Francisco, California; June 7-12, 2019.
  4. DiMeglio L. Strategies to enhance new continuous glucose monitoring in early childhood (SENCE)—primary study results. Presented at: 79th Scientific Sessions of the American Diabetes Association; San Francisco, California; June 7-12, 2019.
  5. Klonoff DC, Bode BW, Cohen NJ, Geho W, Muchmore DB. Divergent hypoglycemic effects of hepatic directed prandial insulin: a 6-month study in type 1 diabetes. Presented at: 79th Scientific Sessions of the American Diabetes Association; San Francisco, California; June 7-12, 2019. Abstract number 1084-P.
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