The Official Journal of ATTD Advanced Technologies & Treatments for Diabetes Conference Austria, Vienna—February 14–17, 2018
2018; Mary Ann Liebert, Inc.; Volume: 20; Issue: S1 Linguagem: Inglês
10.1089/dia.2018.2525.abstracts
ISSN1557-8593
Tópico(s)Diabetes and associated disorders
ResumoDiabetes Technology & TherapeuticsVol. 20, No. S1 AbstractsFree AccessThe Official Journal of ATTD Advanced Technologies & Treatments for Diabetes Conference Austria, Vienna—February 14–17, 2018Published Online:1 Feb 2018https://doi.org/10.1089/dia.2018.2525.abstractsAboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail ATTD 2018 Invited Speaker Abstracts001 OPENING CEREMONYATTD8-0442BEYOND A1C: CONSENSUS ON CGM OUTCOMESDanne T.11Kinder- und Jugendkrankenhaus AUF DER BULT, Dep. of General Pediatrics-Diabetes-Endocrinology & Clinical Reserach, Hannover, GermanyRecently several panels of physicians, researchers, regulators and individuals with diabetes who are experts in continuous glucose monitoring (CGM) technologies addressed the issue how to move beyond the HbA1c measurement as the sole marker of glycemic control. Although HbA1c has proved extremely valuable in for patient management, is a valuable measure of population health and remains a validated indicator of glycation as a risk factor for complications, it is not as helpful for personalized diabetes management. The recently published ATTD consensus recommendations represent the current understanding of how CGM results can affect outcomes. CGM, either from real-time use (rtCGM) or intermittently-viewed continuous glucose monitoring (iCGM), address many of the limitations inherent in HbA1c testing and SMBG. The reliable identification of hypoglycemia is just as important as the measurement of time in range (70–180 mg/dl [3.9–10.0 mmol/L]) in clinical trials. Quantifying the duration and extent of glycemic excursions and glycemic variability (by Coefficient of Variation, which defines stable glucose levels as CV 50,000 meals, lifestyle, medical and food frequency questionnaires, blood tests, genetics, and gut microbiome. We showed that blood glucose responses to meals greatly vary between people even when consuming identical foods; devised the first algorithm for accurately predicting personalized glucose responses to food based on clinical and microbiome data; and showed that personalized diets based on our algorithm successfully balanced blood glucose levels in prediabetic individuals. These results suggest that personalized diets may successfully modify elevated postprandial blood glucose and its metabolic consequences.I will also present our studies of the mechanisms driving recurrent post-dieting obesity in which we identified an intestinal microbiome signature that persists after successful dieting of obese mice. This microbiome signature contributes to faster weight regain and metabolic aberrations upon re-exposure to obesity-promoting conditions and transmits the accelerated weight regain phenotype upon inter-animal transfer. These results thus highlight a possible microbiome contribution to accelerated post-dieting weight regain, and suggest that microbiome-targeting approaches may help to diagnose and treat this common disorder.Finally, we studied the relative contribution of host genetics and environmental factors in shaping human gut microbiome composition. To this end, we examined genotype and microbiome data in over 1,000 healthy individuals from several distinct ancestral origins who share a relatively common environment, and demonstrated that the gut microbiome is not significantly associated with genetic ancestry. In contrast, we find significant similarities in the microbiome composition of genetically unrelated individuals who share a household, and show that over 20% of the gut microbiome variance can be explained via environmental factors related to diet, drugs and anthropometric measurements. We define the term biome-explainability as the variance of a host phenotype explained by the microbiome after accounting for the contribution of human genetics. Consistent with our finding that microbiome and host genetics are largely independent, we find significant biome-explainability levels of 24%–36% for several human traits and disease risk factors. We also successfully replicated our results in an independent Dutch cohort. Overall, our results suggest that human microbiome composition is dominated by environmental factors rather than by host genetics.009 MAJOR OUTCOME STUDIES: THE HypoDE STUDYATTD8-0437INDEPENDENT COMMENTARYDe Vries H.11Academic Medical Center at the University of Amsterdam, Endocrinology, Amsterdam, The NetherlandsDr DeVries will give an independent commentary on the HypoDE study design, execution, results and their implication for clinical practice.010 CLINICAL DECISION SUPPORT SYSTEMS (ADVISORS)ATTD8-0453DECISION SUPPORT SYSTEMSKovatchev B.11University of Virginia, Center for Diabetes Technology, Charlottesville, USAIn this presentation we discuss decision support systems (DSS) based on self-monitoring of blood glucose (SMBG), or on continuous glucose monitoring (CGM). These expert systems are designed to provide actionable information to physicians and/or patients with diabetes.A general rule is that the density of the data determines the treatment options recommended by the DSS. For example, SMBG data could provide information that enables insulin dosing advice, risk stratification, long-term glycemic pattern recognition, or estimated HbA1c (eA1c). Because CGM data are time series reflecting a person's metabolic system's dynamics, CGM expands these treatment options further, with prediction of events (e.g. hypo- or hyperglycemia), real-time trends, alerts, and warnings, real-time monitoring, or automated closed-loop control. The common framework of SMBG- and CGM-based DSS is a set of algorithms that are deployed to estimate the metabolic state of a person from available data, taking into account the data density.We illustrate this concept by reviewing a DSS originally developed at the University of Virginia and further refined by TypeZero Technologies, Inc. This DSS uses CGM data to track actionable risk over time and to deliver feedback through modules implemented on mobile devices, including: (1) Exercise Advice; (2) Sleep Advice; (3) Smart Bolus Calculator; (4) Hypoglycemia Prediction; (5) Estimated HbA1c (eA1c), and (6) In Silico Therapy Optimization. Data from ongoing NIH-supported trial are presented to illustrate the ability of the DSS to improve the glycemic control of insulin pen users with type 1 diabetes.011 ISPAD SESSION: CHALLENGES WITH DIABETES TECHNOLOGY IN PEDIATRICSATTD8-0448DIABETES TECHNOLOGY IN ADOLESCENTS AND YOUNG ADULTSCengiz E.11Yale school of Medicine, Pediatric Endocrinology, New Haven-CT, USATeenage years and the transition to adulthood are difficult phases of human life due to rapid physical development and deep emotional change that occur during that period. Managing a demanding chronic disease such as diabetes adds additional burdens and complexity to lives of adolescents and young adults with diabetes. It is not surprising that HbA1c levels are notably worse among 13 to 25-year olds with only 14% meeting the recommended target HbA1c level as compared to other age groups. Consequently, adolescents and young adults are identified as one of the most challenging patients within the diabetes population.The path to improve diabetes management for this challenging, high-risk group of patients has never been simple, however the brainchild of technology revolution, the diabetes technology, has become a strong contender to confront the obstacles by becoming an ally for people with diabetes and their clinicians. From continuous glucose monitors and automated insulin delivery systems to smart phone applications, the integration of diabetes technology to daily management of diabetes has been tangible and continuously evolving. There is a growing body of evidence supporting the favorable impact of diabetes technology on diabetes management and indicating that there is still room for improvement.The presentation will be centered on the successes and limitations of diabetes technology in managing adolescents and young adults with diabetes. New and advanced diabetes technology systems on the horizon to transform diabetes management and unlock opportunities will be summarized with an emphasis on innovative methods to break the vicious cycle of poor treatment compliance and poor glycemic control in adolescents and young adults with diabetes.012 ISPAD SESSION: CHALLENGES WITH DIABETES TECHNOLOGY IN PEDIATRICSATTD8-0457DIABETES TECHNOLOGY IN DEVELOPING COUNTRIESCalliari L.E.11Santa Casa de São Paulo, Pediatrics, Sao Paulo, BrazilThe concept of developing countries varies depending on the source and sometimes is translated as “less developed country” or “underdeveloped country”. Criticism for using this term is that it assumes the desire to develop following the traditional western model. The most used index to define it is the Human Development Index (HDI) (1). Independently of the political debate, this term is accepted as referring to sovereign states that are categorized into Medium or High HDI, meaning that they are not in the extremes of Low or Very High HDI. Brazil, China, and India, among others, are some examples of this idea of “developing countries”.Characteristics that can be similar between these major “developing countries” are related to their extensive territories, their vast population, and high GDP. Also, there are internal cultural and economic discrepancies and social and health inequities. Due to all these characteristics, and to those depending on political and governmental decisions, it is not possible to delineate a pattern of general technologic evolution of a developing country. Even the evaluation focused only on diabetes technology also brings forward many inequalities, due to geographic, economic and politic disparities. In this context, the growth of technology is erratic and dependent on particularities of societies and governments.Technology in all these countries still has room to increase. In Brazil, a recent nationwide survey with 2961 patients showed that only 1.2% of type 1-diabetes patients using insulin infusion systems in tertiary hospitals. This number is probably smaller for the whole population of patients with type 1 diabetes, since those hospitals have diabetes specialists and would probably be the places for public patients to get access to the newest technologies (2).Limitations to the increase in the use of new technologies in diabetes are related to many aspects, mainly health care system, social and educational issues and medical knowledge and experience.Each country has its characteristics regarding the organization of health care system. In Brazil, there is a clear division of attendance of patients with diabetes in three major areas – public, insured and private patients. The majority of patients is on public services, without resources to obtain medication and other required diabetes material (strips, meters, needles, syringes, pens, etc.) and receives NPH and Regular insulin from the government for free. Insulin analogs and pumps may be obtained only via administrative or judicial processes. Insured and private patients are usually from a better economic background and have more resources to acquire better treatment.Social and educational challenges include unstructured families, unprepared schools, and difficulties in understanding basic concepts and putting into practice multiple daily injections, frequent monitoring and calculations. Families coming from better educational and economic levels have a better level of education and these aspects reflect on HbA1c outcomes (3), which is also true when considering only children and adolescents (4).The unfamiliarity of healthcare professionals with new technologies is also a barrier to its use. In a survey during the Brazilian Congress of Pediatric Endocrinology in 2013, where the majority of the doctors were specialists and shared professional time between public and private attendance, 63.6% of the 316 respondents had no patients on pumps, 21.7% had one patient and only 14.8% had 2 or more patients on pumps (5). One of the reasons detected was the lack of previous experience and knowledge to initiate and manage technical aspects of the systems.The conclusion is that developing countries have to overcome many barriers to increase the use of health technology in general, diabetes-related technology specifically.Diabetologists and pediatric diabetologists are fundamental in this process, to get and spread knowledge and information about new treatments, products and services, and their impact on diabetes management. In accordance with these ideas, it is key that they get deeper into diabetes technology, looking after information, participating in clinical protocols, advisory boards, and international congresses, paving the way to bring technology closer to the regular clinician that attends the patients. In this matter, Brazil is a good example, the last decade being full of novelties. There was an increase in information exchange, culminating in the first ATTD out of Europe, the ATTD Latin America in Rio in 2012 and the creation of a Department of Technology by the Brazilian Diabetes Society in 2014, for the first time. Following these steps, in 2015 the first International Symposium of Diabetes Technology in Brazil was organized, followed by the second one in 2017, consolidating the necessity and the interest on new technologies to improve diabetes treatment in the country. These kinds of initiatives are happening all over the world, and assistance of non-profit diabetes societies, like IDF and ISPAD is essential.Technology is also important for these developing countries because it can be used to fight obstacles and to mitigate costs. Even with difficulties, the creativity and tenacity of a few diabetologists are leading to the creation of facilitators, like telemedicine, bolus calculators, in-patient insulin dose calculator and diabetic ketoacidosis apps, which are accessible and helps spread good practices more easily (6,7).Parallel efforts have taken parent associations and medical societies to press the government and insurance companies to accelerate the access to technology for a greater number of patients, grounded on evidence-based data.The balance between the socio-economic limitations and the increase in technology remains a big challenge for the majority of the countries, but probably more prevailing for “developing countries.” From their point of view, it is imperative that diabetes technology evolution considers lowering costs and being clinically meaningful, so the equation of information plus access can reach to better long-time control and quality of life.References1. Human Development Index, United Nations Development Program. In Wikipedia, the free encyclopedia. Wikimedia Foundation, Inc, 6 December 2017. Web. 15 Dec 2017.2. Gomes MB, Negrato CA, Cobas R et al. Determinants of intensive insulin therapeutic regimens in patients with type 1 diabetes: data from a nationwide multicenter survey in Brazil. Diabetol Metab Syndr. 2014 May 31;6:67.3. Gomes MB, Cobas RA, Matheus AS, et al. Regional differences in clinical care among patients with type 1 diabetes in Brazil: Brazilian Type 1 Diabetes Study Group. Diabetol Metab Syndr. 2012 Oct 29;4(1):44.4. Gomes MB, de Mattos Matheus AS, Calliari LE, et al. Economic status and clinical care in young type 1 diabetes patients: a nationwide multicenter study in Brazil. Acta Diabetol. 2013 Oct;50(5):743-52.5. Calliari LE. How to insert insulin pump in your clinical practice. Retrieved 28 Jun 2013. youtube.com/watch?v = onWicz5SaFA. Web 15 Dec 2017.6. Glic (2017). Quasar Telemedicina (Mobile application software). Retrieved from http://itunes.apple.com.7. Insulinapp (2016). MEDC Serviços Medicos LTDA, Version 1.1.3, Mobile application software. Retrieved from http://itunes.apple.com.013 DIABETES INDIA SYMPOSIUMATTD8-0456USE OF INSULIN PUMP THERAPY IN INDIA - THE CHANGING PERSPECTIVEChawla M.1, Chawla P.1, Kothari M.1, Shaikh F.11Lina Diabetes Care Centre, Diabetology, Mumbai, IndiaInsulin pump therapy in the management of hyperglycaemia has been used for more than three decades globally and more than a decade in India.Available since 2013, insulin pumps have benefitted more than 10,000 diabetic individuals and the acceptance rate is fast growing. A number of studies and guidelines have been published and pump therapy is also starting to gain reimbursement from many government bodies and government undertakings.The current availability and pricing of insulin pumps and consumables are as follows:-i) Non-sensor augmented pumps eg. Paradigm 715 (∼2,640$)ii) Sensor augmented pumps eg. Minimed 640G (∼8,750$), Paradigm Veo (∼6,250$) and Paradigm 722 (∼3,580$) with the predictive alerts/low glucose suspend algorithm.iii) Infusion Set (∼60$/month)iv) Reservoir (∼23$/month)v) Glucose sensor (∼55$/sensor)There are ongoing efforts to raise Insulin Pump therapy awareness at the level of the medical practitioners and general population by means of providing - structured learning programs, clinical insights and indications for insulin pump therapy in practice.The usage is divided as follows, most with T1DM (60% vs 40% T2DM), males (60% vs. 40% females), in the age group of 13–30 years of age (35% vs 25% 60 years). The average insulin infusion set use is for 4.5 days. The adoption rate is maximum in West India 37%, next in the South with 33%, North 25% and the rest in the East.014 DIABETES INDIA SYMPOSIUMATTD8-0455SMBG AND VIRTUAL CONSULTATION DTMS (R): 20 YEARS' EXPERIENCEKesavadev J.11Jothydev's Diabetes Research Centre, Diabetes, Thiruvanathapuram, IndiaSMBG AND VIRTUAL CONSULTATION VIA DTMS®: 20 YEARS' EXPERIENCEBenefits of a structured Self-Monitoring of Blood Glucose (SMBG) Program on improving glycemic control has been well-documented by many studies in individuals with diabetes. Data obtained from SMBG can help clinicians to take appropriate treatment decisions. It also allows the patients to more clearly understand the impact of their daily routine on their glycaemic status, thus making them more informed as well as motivated towards a judicious diabetes management. However, such benefits of SMBG can only be gained with a collaborative effort from both the patients and the clinicians alike in terms of obtaining SMBG data, analysing and interpreting them to make appropriate decisions on medications, diet and lifestyle choices.In 1990's, in India, glucose meters were not popular. Procuring a glucose meter was considered too expensive, the results were inaccurate and of no benefit not only among patients but also among physicians. It was in the second half of the 1990s, the benefits of intensive glucose management in type 2 diabetes from the landmark clinical trial UKPDS began throwing new light into the science of diabetes. It was quite evident that patients despite the practice of blood glucose monitoring are not able to achieve the targets when the possibilities of a complementing technology were thought of.The major gaps in diabetes management have always been lack of awareness on prevention of complications, suboptimal dosages prescribed to avoid fatal hypoglycemia, non-adherence to drugs, wrong t
Referência(s)