Friday, July 3, 2020

News from ADA 2020

June 12th to 16th was ADA 2020, the scientific sessions of the American Diabetes Association, which is the largest diabetes focused medical conference in the world.  This year, the scientific sessions were all on line.   As in previous years, I did not attend, but I did read publicly available information and watched the tweets and Facebook posts which discussed the talks.  Finally, I exchanged information with the JDCA as they covered the sessions as well.

There are scores of talks and 100s of posters; far too much for me to cover all of it.  Also, about 90% of the content was focused on type-2 diabetes.  After all, about 90% of the people who have diabetes, have T2D.  So what I've done is included a paragraph describing some of the bigger, more interesting news ideas, and after each paragraph some links which can tell you more about it.

I've divided the blog up into these sections:
  1. Summaries
  2. Cure Focused Research
  3. Better Devices
  4. Treatment News
  5. Diversity and Diabetes Research


Overall, I think that BeyondType1 has great summaries of the news from ADA 2020:

The JDRF did a video summary of each day:
diaTribe's Sunday summary:

Cure Focused Research

I hope to write blog postings on each of these results in the future.

Teplizumab Gets Better
Teplizumab already had some of the strongest results seen in terms of being able to delay the onset of type-1 diabetes, and there was an update this year which showed longer, stronger results.  My previous blogging is here:
Anti-IL-21 and Liraglutide
Combining Treg and anti-CD20
These two treatments have both been tried before, but this is the first time they have been tried together.

Better Devices

There was a lot of news about new and improved devices.  Here are three summaries:
The big news was results of pivotal trials of the 780G (also called "AHCL") which just got approved in Europe and should be approved in the US soon.
There was some belief that the next generation of Artificial Pancreas / Automated Insulin Delivery devices might be so good that the main barrier to use would be the sets, rather than them pumps:
DIY ("We are not waiting.")
There was a lot of buzz about various "do-it-yourself" devices.  I'm sorry I only saved this one reference, because there was a lot more going on:

Treatment and General News

T2 Movie On PBS
There was a lot of excitement about this movie, although it focuses on T2 rather than T1:
New, Faster Insulin
Patients like faster insulins because they lower BGs; companies like newer insulins because they are covered by patents for longer.  This Insulin is faster and newer.
Weekly Insulin
There were phase-II results from a clinical trial on a weekly insulin.  This is a basal insulin (like Lantus) except that it only needs to be injected once a week, not once a day.  It was compared to Lantus and was just as effective.

TIR vs. A1c
Another debate which I expect to remain "hot" for the next few years is the Time In Range (TIR) vs. A1C debate.  Which is better for measuring the success of a new drug or device, and therefore which is better for patients?  Because better measurements in research lead to better treatments and hopefully cures in the future.
I have two opinions on this debate:  First, I don't see how it is that important.  I have never seen a study where TIR led to a different conclusion than A1c.  Quite the opposite, in studies that measure both, if the TIR data shows one device is better than another, then the A1c data will show the same thing.  So arguing about which is "better" is pointless splitting of hairs.  Second, there are clear differences in how easy they are to use, and that is likely more important than one being "better" (ie. more predictive) than the other.  For example, TIRs can be measured at home, by the person with T1D.  But A1c is a single number with no ambiguity so easier to use in data analysis.   (A1c of 5.5 is better than 5.6, but if someone has BG way too high for 1 hour is that better or worse than being a little too high for 2 hours?)  But, it is a lively debate, and I don't think it will end soon.

TP-399 (treatment, not cure)
This drug is being tested as therapy that you take for T1D in addition to insulin.  The study found that it could lower A1c by .32 or raise your time in range by 2 hours.
One Hormone vs. Two
I suspect that the next big debate in devices will be between Artificial Pancreas devices which use insulin vs. those that use insulin and Glucagon.  The current trade off seems to be an average of 10 points lower BG numbers vs. the added hassle of two drugs as opposed to one. 

Microbiome based prevention:
The idea that bacteria in the gut might cause T1D or impact it's severity is comes up most years at ADA.  This is a summary of some JDRF funded research looking into it:


Two T1Ds or One?
This is another topic which might turn into a larger debate.  It is generally understood that people who get T1D when they are younger have faster onsets (shorter honeymoon phases) and generally stronger disease symptoms.  But is this because younger people are struck by a different (and stronger) form of the disease, or does everyone get the same form of the disease, it is just that people diagnosed younger have the disease for longer?  Are there two forms of type-1 diabetes (younger onset and older onset), or just one form (which varies in strength from person to person)?

Hiding Cells from the Immune System
Something about beta cells is targeted by the immune system.  This research is attempting to change beta cells, so that the immune system can not target them:

Diversity In Diabetes Research

This ADA conference was held against the backdrop of Black Lives Matter.  I've included some of the more eye-opening research on race and diabetes below.  (Personal note: I tried to write a short introduction to racism and diabetes research for this section.  However, the subject is too complex and too impactful to be summarized so briefly, at least with my writing skills.  I hope to blog on it in the future, giving it the space it deserves.)

Black vs. White Gestational Diabetes

AP with Different Starting Points
When companies test new devices they often end up testing them on "good diabetics" by which I mean people who already have good management, already see their doctors regularly, and have the money to buy good medicine in the US.  So the tests end up showing that someone who is already in good shape will be even better with the new device.  But that excludes people who are not doing well to start (who arguably need new devices more), and does not give a realistic whole-population view of the new device.

Joshua Levy
publicjoshualevy at gmail dot com
All the views expressed here are those of Joshua Levy, and nothing here is official JDRF or JDCA news, views, policies or opinions. My daughter has type-1 diabetes and participates in clinical trials, which might be discussed here. My blog contains a more complete non-conflict of interest statement. Thanks to everyone who helps with the blog.