This year’s clinical DTS meeting was held at the Omni Hotel in downtown
Los Angeles on April 20th-21st. Unlike the large annual
meeting of the Society in the Autumn, this one focuses on clinical aspects of the role of technology for
diabetes care. As well as the formal meeting, the other benefit of attending is
to network with fellow scientist-clinicians, educators and high-level industry
attendees. Unsurprisingly, the audience was overwhelmingly US.
As well as discussing the current state of the art in relation to
diabetes technologies, there were many glimpses into the future. So what were
the take-home messages?
Self-monitoring of blood glucose
The debate about acceptable levels of accuracy for test strips continues
but the general impression was that the level of accuracy depends on the
patient group – for example better accuracy is needed for those at greatest risk
of hypoglycemia.
The hot topic, as far as the audience was concerned related to
preventing serious infections in care homes and hospitals (now known as
assisted blood glucose monitoring) in relation to the lancets but also the
meters per se. The US regulatory authorities are increasingly turning their
attention to this topic and industry will have to deal with this.
Fantastic presentation and discussions around structured blood glucose
monitoring for people with diabetes not using insulin highlighting the
importance of thinking about the timing and frequency of testing and most
importantly making sure that clinicians as well as people with diabetes know
what to do with the results! This is especially relevant when working out the
cost-effectiveness of self-monitoring.
Continuous Glucose Monitoring
There were detailed descriptions of the role of CGM in certain
situations including pregnancy and for children with diabetes and discussion
around interpretation of sensor data.
Perhaps there is a need for the creation of a platform for sensor
downloads to be more widely available and in a more understandable form for
education purposes? The recent findings showing value of CGM in type 2 diabetes
were also highlighted. There was
also an update into the potential appearance of implantable glucose sensors.
The bottom line – CGM can add value to diabetes care and needs to be more
widely available in health-care systems but the costs need to come down!
Insulin Delivery Systems
In a nutshell, everyone is waiting to access smaller patch pumps and the
race is on from at least two new companies entering the commercial arena as
well as the usual suspects. Key requirements seem to be (a) better connectivity
and (b) an absolute requirement for a bolus button on the patch pump. For pens
can we have new technologies that date and time stamp the insulin injections
and ones that can be downloaded? Experience and data are increasing on the use
of CSII in type 2 diabetes – this could have important economic consequences
for any healthcare system though! An excellent talk on software guided systems
for insulin delivery made the important point that this approach should be more
widely sued in Critical Care Units but the real difficult nut to crack remains
glucose control elsewhere in the hospital.
Other important take home messages from the meeting were:
2.
Telehealth
for diabetes care continues to develop and there is increasing interest in
using this approach for discrete diabetes monitoring.
3.
Dealing
with exercise and insulin remains a difficult challenge but a great deal can be
gained by learning from the approach used by elites athletes and their diabetes
teams
4.
Work on
the artificial pancreas continues to bear fruit – it is likely that a system
for overnight closed-loop control will be the first to be widely available
although the exact timing is still not clear.
Given that I gave the presentation it is probably no surprise that one
take-home message from the Clinical DTS meeting is that social media has the
potential to add enormous value to diabetes care although it is still in its
infancy. Traditional research funding bodies will need to re-evaluate their
approach and methods to allow imaginative trials in this space to happen.
So what next?
From both formal and informal discussions there is a clear need to offer
more practical training for whole diabetes teams for common (and often evidence free) clinical
scenarios. With this in mind we are exploring developing this for next year so
please keep following developments on http://www.VoyageMD.com
Back to a rain and wind swept UK now!!!
