Experts Focus on Access and Outcomes Beyond A1c at 2017 ADA Forum

By Lily Wushanley

The diaTribe Foundation and TCOYD host discussion at ADA focusing on access, outcomes beyond A1c, and future expectations

This year, The diaTribe Foundation, in conjunction with TCOYD, hosted their 11^th annual Diabetes Forum at the American Diabetes Association’s 77^th Scientific Sessions in San Diego. Key opinion leaders and experts in the diabetes community convened to discuss topics ranging from access, outcomes beyond A1c, and expectations for the following year.

Over 250 doctors, researchers, and advocates took part in an invigorating discussion with the expert panel made up of:

• Dr. Vanita Aroda – The Medstar Health Research Institute

• Dr. Bruce Buckingham – Stanford University

• Dr. John Buse – University of North Carolina Chapel Hill

• Dr. Ralph DeFronzo – University of Texas Health Science Center

To start, panelists agreed that the issue of healthcare access cannot be ignored. On the technology side, Dr. Buckingham gave credit to the Medtronic’s MiniMed 670G system, explaining that it does very well overnight, though more can be done to reduce the burden on people with diabetes during the day. In almost the same breath, however, he drew attention to the global populations with type 1 diabetes that can barely afford one glucose test per day, let alone advanced sensors and pumps. Dr. Buse expressed outrage that GLP-1 agonists (Victoza, Trulicity, Bydureon, Tanzeum) and SGLT-2 inhibitors (Invokana, Jardiance, Farxiga) are “drugs that save lives,” but are currently used by less than 10% of people with type 2 diabetes in the US.

On a more positive note, panelists were enthusiastic that often, the effects of combination therapy go beyond solely lowering A1c. Dr. Aroda expressed optimism about the changes she is starting to see, noting new considerations such as fasting and post-meal blood glucose levels, hypoglycemia, blood pressure, and weight, that are increasingly used in measuring day-to-day “success.” Such holistic outlooks are a part of the “outcomes beyond A1c” movement in the diabetes community, and Dr. Edelman was particularly excited about The diaTribe Foundation’s upcoming gathering on outcomes beyond A1c!  

Dr. Edelman shared positive feedback from people using inhaled insulin (MannKind’s Afrezza), while Dr. Buse shared praise for an in-development pill to better manage type 1 diabetes (Sanofi/Lexicon’s sotagliflozin). As Dr. Edelman put it, insulin that works faster is a sizeable need in type 1 diabetes, and Afrezza rises to the occasion. Ms. Close positioned Novo Nordisk’s Fiasp (faster-acting insulin aspart) similarly, as a better option to what’s currently on the market for mealtime insulin (approved for use in Europe but still awaits FDA approval).

After a slew of insightful questions from attendees with personal experience with diabetes, each panel member contributed his or her hope for changes in the next year. Dr. Buse wants to see leadership in Washington that will guarantee reasonable options for healthcare for everyone, while Dr. DeFronzo wished for a serious program focused on beta cell regeneration. Dr. Aroda emphasized the need for an increased effort to train a generation of passionate, focused primary care providers and endocrinologists. We are looking forward to what the future will bring in diabetes care and access!

Below are some great quotes from the evening:

Quotable Quotes

• With regards to artificial pancreas systems, “a year ago, we didn’t have a commercial product, and now we have over 20,000 people signed up to go on the Medtronic MiniMed 670G system. It’s a landmark. It’s a story change.” – Dr. Bruce Buckingham (Stanford University)

• “This is an outrageous story – that there are drugs that save lives, and 5% of people in the US are on SGLT-2 inhibitor at best? 10% are on GLP-1 agonists at best?” – Dr. John Buse (UNC Chapel Hill)

• “You cannot start with a single drug, and then wait until you fail to start another drug…I advocate for combination therapy [in type 2 diabetes].” – Dr. Ralph DeFronzo (University of Texas Health Science Center)

• “We’ve done a lot of trials on combination therapy of a GLP-1 agonist with a long-acting basal insulin analog, which I think are without a doubt the most powerful glucose-lowering agents on the planet.” – Dr. John Buse (UNC Chapel Hill)

• “In this new era, you have to choose drugs that not only have glucose benefits, but also cardiovascular benefits.” – Dr. Ralph DeFronzo (University of Texas Health Science Center)

• “I can feel the change happening year by year. We’re getting away from the singular view of diabetes, and we’re instead viewing diabetes more holistically. I’m excited about it. In a few years, I don’t know if it will be all about A1c.” – Dr. Vanita Aroda (The Medstar Health Research Institute)

• “The most waste in type 2 diabetes is to continuously put people on metformin and sulfonylureas (glyburide, glimepiride, etc.). These drugs have no protective effect on the beta cell, and by the time you figure out what you’re doing, there are no beta cells left to save.” – Dr. Ralph DeFronzo (University of Texas Health Science Center)

• “It’s also about the global picture of type 1 diabetes. I’d love to be able to see kids everywhere get anything they want: sensors, pumps, etc.” – Dr. Bruce Buckingham (Stanford University)

• “I truly feel that we have all the tools, all the resources, and yet we all kind of putz around with diabetes. We, meaning the healthcare system. The true waste is time. As we know from the concept of clinical inertia, health care providers all-too-often go three-four years before making any changes to treatment that could actually make a long-term difference.” – Dr. Vanita Aroda (The Medstar Health Research Institute)

[Photo Credit: Jim Babwe]