The diaTribe Foundation and TCOYD Bring Together the Brightest Minds in Diabetes to Wrap Up ADA 2015

by Alexander Wolf

Twitter Summary: @kellyclose + @TCOYD’s Dr. Steve Edelman host panel discussion at end of #2015ADA – highlights from this compelling discussion on future of #diabetes

To cap off the ADA Scientific Sessions in Boston, The diaTribe Foundation and TCOYD hosted our 9^th annual Diabetes Forum, welcoming almost 400 attendees to a panel discussion featuring some of the leading experts in diabetes. This year’s panel featured:

• Dr. John Buse (University of North Carolina)

• Dr. James R. Gavin III (Emory University, Healing Our Village)

• Dr. Aaron Kowalski (JDRF)

• Dr. Andrew Boulton (European Association for the Study of Diabetes)

Dr. Steve Edelman of TCOYD and our very own Kelly Close co-moderated the panel, which discussed a wide range of topics from the most stimulating presentations at ADA, the most exciting future technologies, and the challenges that face technologies such as CGM and the artificial pancreas. Our top takeaways from these expert panelists are described below:

1) Most Anticipated Technological Advances in Diabetes

Kelly asked the expert panel to declare which future diabetes advances they are most excited about. The responses varied from closed-loop to new drugs, including:

Dr. Buse: Bionic Pancreas…I’m also excited about combining insulins with GLP-1 agonists – it’s the most powerful and well-tolerated therapy in the type 2 diabetes space.

Dr. Gavin: I am really interested in [Intarcia’s] ITCA-650, the mini-osmotic pump. I think it will do a lot for overall quality of life in diabetes management and it will really be a type 2 diabetes game changer.

Dr. Kowalski: Although this won’t happen in the next three years, I am really excited about glucose-responsive insulin moving into the clinic. I have seen that project at MIT and also at Merck moving now into clinical trials.

2) Insulin-Only versus Insulin and Glucagon Closed Loop Systems

The panelists had a hearty debate on the future of artificial pancreas systems, specifically discussing the benefits of insulin-only versus dual hormone (insulin + glucagon systems) systems. Dr. Buse stated that he is most excited about the Bionic Pancreas (a dual hormone system), expecting it to reach patients by 2018.

Dr. Kowalski provided a counter-argument, saying, “I think insulin alone systems will come to the market first. I think glucagon in the closed loop has potential, but that may be farther down the path. I do think that insulin alone systems will be the first systems that significantly improve glycemic control and reduce burden. That will be transformative.”

At diaTribe, we certainly hope that patients will have some choice – there is a lot of work still being assessed on pricing, as many believe the dual hormone system will be far more expensive.

3) SGLT-2 Inhibitors in Type 1 Diabetes

Dr. Buse said that he is “particularly excited about the use of SGLT-2 inhibitors in type 1 diabetes,” calling it a “promising space.” While there have been some concerns about the risk of euglycemic DKA (a rare but potentially serious side effect) with these drugs, Dr. Buse stated that he “honestly believes that that could be easily mitigated.”

Dr. Gavin, on the other hand, was less quick to dismiss the chorus of concerns about euglycemic DKA, warning that “if we don’t manage this rising tide of concern really carefully, this is the kind of thing that can get really out of hand.”

4) Heart Safety of Diabetes Drugs

As Kelly described in her reflections on this year’s ADA, a critical finding at this year’s conference was that two major heart safety trials – TECOS and ELIXA – found that the drugs Januvia (a DPP-4 inhibitor) and Lyxumia (a GLP-1 agonist) were safe to use. As Dr. Boulton expressed, “TECOS is really reassuring that there is no [negative] effect of DPP-4 inhibitors on heart failure…Showing that these drugs are safe is good message from this meeting.”

5) Driving Better Patient Outcomes

Dr. Kowalski shared an illuminating perspective on the term “adherence,” challenging researchers and industry players to continue to work on therapies that motivate patients to drive better outcomes. As he explained, “There is a fundamental problem in diabetes about the term ‘adherence.’ We need to think about the return on investment. What is the return on investment for doing something? I have never met a person without diabetes using a pump just for kicks. We’re asking people to wear pumps and sensors, and we need a return that justifies it. Access is a component. But the ultimate metric for success is that [clinical outcomes] data looks a lot different…We need to develop therapies that drive positive outcomes. In the next decade, we need to change the curve of A1c where the majority of patients with diabetes are meeting target – right now, 80% are not meeting the target according to the T1D Exchange data."

6) Ultra-rapid Acting Inhaled Insulin Afrezza

This new inhaled insulin was front and center in the ADA exhibit hall, and we have been deeply interested in learning more about real-world experiences using this drug. According to Dr. Edelman, who has type 1 diabetes himself, “I have used Afrezza many times myself, and the rapid off is really impressive.” Dr. Edelman also pointed out that in clinical trials, Afrezza led to reductions in hypoglycemia, though those results are not on label. Dr. Kowalski added that Afrezza is a drug that has generated a lot of interest in the type 1 community, saying it “holds a lot of potential” as a stand-alone insulin an as in insulin in combination.

7) Raising Urgency Amongst Payers

The panel discussed the rising costs of managing diabetes, noting that this very complex issue is a grave need in the diabetes community. Dr. Edelman pointed out that health insurance companies play a major role in determining prices of therapies. Indeed, Dr. Gavin expressed his personal interest in this area, saying, “I work at trying to close the gap in quality of care and outcomes in underserved populations. We’re working hard towards getting payers to recognize the value proposition, medical urgency, and moral imperative in the newer forms of therapies that are effective in stopping the damaging effects of poorly-controlled blood glucose."

8) Dr. Edelman’s Humorous Video on the “Good” and “Bad” Patient and Doctor

As is tradition, Dr. Edelman showed a short video to emphasize that both patients and doctors can be “good” and “bad,” and both can affect patient outcomes – this is a hilarious six minutes!

9) More Attention to Behavior Change

In response to hearing more about behavior change at this ADA, Kelly said in her opening remarks that, “I love at this meeting not just seeing ‘this product or that therapy,’ but also a call for more than that – there’s a lot more that everyone is talking about around what people need to do to change behavior and be much more successful. About 50% of people are at their glycemic target. We could all go home if we were happy about where things are – thank you for not doing that and for working harder on integration among prevention of complications, therapy, and behavior.”