Diabetes Technology Meeting 2005
The fifth annual Diabetes Technology Meeting was held in San Francisco from November 10 - 12, 2005. In attendance were over 650 scientists, engineers, and doctors from government, industry, academia, and clinical practice. During the two-and-a-half days of sessions, speakers shared information on a variety of topics, including continuous glucose monitoring, non-invasive glucose monitoring, continuous sensor accuracy, insulin delivery alternatives, and various types of computer technologies. Here is a summary of some of the sessions:
- In The Business of Diabetes, the first of three pre-meeting workshops, speakers from investment firms, industry, and academia spoke about the nature of diabetes businesses. Ross Jaffe, MD, of Versant Ventures, stressed the importance of focusing on specific needs, rather than trying to be all things to all people with diabetes. He also warned about pursuing perfection, using the example of Xeno's Paradox to suggest that the pursuit of perfection instead of "good enough" can result in worthwhile products never making it to market.
- Diabetes Technology Society International Workshop for the Establishment of Performance Standards for Continuous Glucose Monitors, the second of three Pre-Meeting Workshops, reviewed issues surrounding how accuracy should be defined for the new continuous glucose sensors. Steven Gutman, MD, from the FDA, briefly explained the approval process but noted that the FDA offers no guidance to industry or academia on what level of accuracy is required for FDA approval. William Clarke, MD, stressed that rate of change information from continuous sensors will prove to be as important as point accuracy and has developed strategies for measuring rate accuracy. One speaker reported on the surprising effectiveness of existing continuous sensors in a real patient population, demonstrating that patients -- even kids -- are able to learn to use the data from continuous sensors to improve their diabetes care, and demonstrating that the level of accuracy currently achieved is more than sufficient for real world benefit.
- Several speakers presented on the general topic of hypoglycemia. From the four presentations we learned about changes that take place in the brain in response to prolonged hypoglycemia as the brain adapts to using other fuels (Brain Interstitial Fluid Glucose: Effect of Hypoglycemia by Dr. Robert Sherwin and Consequences of Recurrent Exposure to Hypoglycemia in Type 1 Diabetes by Dr. Brian Frier). These changes result in the phenomenon known as hypoglycemia unawareness, though Dr. Frier suggested that a better term is Impaired Awareness of Hypoglycemia since it more accurately reflects the changes that are taking place. People who experience this do sense hypoglycemia, but at a much lower level than they would otherwise, resulting in a much shorter period for intervention to prevent loss of consciousness or seizure. Because of this, Dr. Anthony McCall, in Hypoglycemia Unawareness and Hypoglycemia Risk Prediction, stressed that it's not enough to know that you're low now -- prediction is critical to prevent lows. Dr. McCall offered a mathematical approach to predicting risk of severe hypoglycemia based solely on episodic glucose results (finger stick checks).
- Tim Goodnow, Ph.D., from Abbott Diabetes Care, presented Clinical Performance and Accuracy of the Five-Day FreeStyle NavigatorTM Continuous Glucose Monitoring System, bringing the Diabetes Technology Society members up to date on a technology we're heard about for several years. Dr. Goodnow reviewed how the system is to be used (10 hour warm up, calibration, five day wear). He also discussed technical details of the implanted sensor, noting that the sensor had a very short 2 to 2.5 minute sensing delay due to the membrane and a very steady signal over seven days (longer than the recommended five day wear time). Dr. Goodnow even showed slides of CWD's own Monica wearing the Navigator.
- Volker Lodwig, Ph.D., from the Institute for Medical Informatics and Biostatistics in Basel, Switzerland, gave an excellent presentation entitled Self-Monitoring of Blood Glucose in Type 2 Diabetes is Associated with Improved Long-Term Outcomes: The ROSSO Study. Dr. Lodwig noted that patients with type 2 diabetes who regularly check their blood glucose, regardless of their treatment regimen, experience a 32% reduction in non-fatal problems (amputation, blindness, etc.) and a 52% reduction in death compared with people with type 2 diabetes who do not check their blood glucose. These risk reductions were independent of all other factors, including A1c, weight, etc. There was considerable discussion among the attendees on what could explain this.
- Dr. Irl Hirsh presented Present and Future Interactive Diabetes Management, focusing on the benefits he has been able to obtain just by ensuring that patients download their meter data for analysis. In a population of adults with type 2 diabetes, Dr. Hirsh was able to achieve a reduction in A1c of 1.1% simply by using the Internet to help patients who had downloaded meter data.
- In the Annual Diabetes Technology Survey, conference participants are asked to vote on several questions related to diabetes technology. The first question asked which technology under development was most needed by patients with diabetes. Of the options, 33% voted for a real-time continuous sensor, 23% for a highly accurate hypoglycemia detector, 22% for a noninvasive glucose sensor, 11% for an artificial pancreas, 8% for computerized individual management tools, and 3% for inhaled insulin. When asked to predict when type 1 diabetes will be cured, most voted for 25 years (58%), while 50 years received 21%. Just 10% felt that type 1 diabetes would be within 10 years, the same percent that felt it would take 100 years or more to cure. More optimistically, 65% thought that an artificial pancreas would be available within 10 years, though 20% felt it would take 25 years.
Dr. Bruce Buckingham from Stanford explains the DirecNet poster entitled Evaluation of Factors Affecting CGMS Calibration
Dr. Gordon Weir from the Joslin Diabetes Center explained some of the latest thinking about how beta cells develop during his keynote address, Cellular Therapy for Diabetes
Dr. David Klonoff, head of the Diabetes Technology Society, learns about Clinical Utility of the Continuous Glucose Monitoring System in Intensified Insulin Treated Patients
Tim Goodnow, Ph.D., presented new data about Navigator, the continuous glucose sensor under development by Abbott Diabetes Care
The poster sessions, held each evening, offered attendees a chance to speak directly with scientists, engineers, and clinicians working on developing new technology or using cutting edge technology