The CWD Team traveled to Florence, Italy, to attend the annual Advances in Treatments and Therapeutics in Diabetes conference and learn about the latest updates on diabetes care. Here are some updates that may be pertinent for PWD, their loved ones, and any healthcare professionals who work in diabetes.
Artificial Intelligence for AID Algorithms
Throughout the last couple of years, more research has been focused on using artificial intelligence to enhance the algorithms for AID systems. Multiple groups are pursuing this path, including Dr. Boris Kovatchev and Marc Breton at UVA and Dr. Roman Hovorka at Cambridge. Both groups presented fully automated AID system data where people with diabetes did not have to manually bolus for meals. Dr. Peter Jacobs from Oregon Health & Science University discussed a neural network system. This system takes data from the wearer and uses a multilayered network to determine dosing.
Devices and Technology
Many speakers focused on improving access to diabetes technologies for everyone with insulin-requiring diabetes. Dr. David Maahs discussed the resounding success of Stanford’s 4T study, in which they started children with T1D on CGM early after diagnosis with support from diabetes educators and the diabetes team. He stressed the importance of having adequate support from diabetes educators for early technology adaptation to be successful. Dr. Maahs also teed up their next steps of adding Automated Insulin Delivery (AID) within the first 1-3 months after diagnosis and provided resources to ensure access to AID for all people with diabetes.
Diabetes Community
There were excellent presentations by various members of the #dedocº community, including Tinotenda Dzikiti, who discussed disparities for underserved regions of the world, and Nur Akca about the accessibility of diabetes technologies. Tinotenda addressed the importance of coming together as a community to create an international consensus statement for access to insulin. There is a website with a petition where you can sign your name for this international consensus (LINK). The goal is to help raise awareness of the need for insulin for people with insulin-dependent diabetes and help people understand that without insulin, many people die.
Nur discussed her experience with limited vision from a congenital condition and how difficult it is for her healthcare providers to understand that she needs to look at the device in real life, not just the demo apps, to ensure she can see the screen well enough. She also pleaded with the attendees to ensure we are considering more aspects of accessibility with diabetes devices. Dr. Asra Ahmed from Saudi Arabia presented the D-CODED website, which takes research articles and simplifies them so that people with diabetes and people with less English literacy can understand them. The theme of diabetes was felt throughout the conference through diabetes advocates and #dedocº participants: Nothing about us, without us.
Exercise Guidelines
Diabetes exercise research experts presented on Saturday at the conference and provided valuable insights into recommendations for managing T1D when exercising. Dr. Klemen Dovc showed his data on adolescents exercising and using AID systems versus conventional therapies. Dr. Mike Riddell discussed additional data on exercise and preventing hypoglycemia both during and after exercise. He discussed that hypoglycemia and/or fear of hypoglycemia remains a significant barrier for many PWD to exercise.
Dr. Dessi Zaharieva finished the session with a wonderful resource for PWD and healthcare professionals working in diabetes that simplifies the recommendations for exercise in T1D. She discussed the challenges of creating these guidelines because of how individualized exercise can be for T1D patients. Dr. Zaharieva is continuing to develop an online resource for diabetes and exercise on Diabetes Wise.
Here are some top data that were presented in this session:
- Reducing insulin or activating activity/exercise mode 90-120 minutes before exercise is optimal for preventing hypoglycemia.
- The best way to determine what works best for you is to try different things and see what works.
- Do your best to reduce the amount of insulin on board before exercise.
- Consider a 25-75% reduction in mealtime bolus if eating a meal before exercising – more of a reduction if the exercise will be longer and more intense.
Nutrition
Dr. Daria Igudsman presented some very interesting data on dieting and the microbiome with T1D. Here’s a summary of what she presented:
- The Mediterranean Diet is more effective than low-calorie and low carbohydrate for adults with T1D, and you get to eat more
- The gut microbiome in people with T1D is different than people without T1D
- Some not helpful bacteria are more prevalent in T1D
- Some helpful bacteria are less prevalent in T1D
- We need more data
Dr. Igudsman hypothesizes that these microbiome abnormalities may contribute to inconsistent post-meal glucose levels. She acknowledges that this hypothesis still needs to be studied and hopes to continue pursuing research in the gut microbiome of people with T1D.
Pregnancy with AID
Multiple sessions were held regarding the use of AID systems in pregnant women with diabetes. Dr. Jennifer Yamamoto presented in the ATTD Yearbook a summary of the research throughout 2023 about pregnancy and diabetes. Multiple studies have shown that using the Medtronic 780G system in pregnancy with T1D has been successful. The system allows for a lower target of 100 mg/dl and has helped many women achieve pregnancy glycemic targets. She also discussed the use of different insulins in pregnancy. She noted that one study showed that Tresiba was correlated with a slight increase in fetal abnormalities but stated that more research needs to be done to determine causality.
There were many more sessions about various topics, including biosimilar insulins, obesity, and GLP1s improving equity in diabetes, and diabetes prevention. Overall, the conference was very inspiring and showed a lot of hope for the near future in diabetes management.
Written and clinically reviewed by Marissa Town, RN, BSN, CDCES
