The American Diabetes Association 80th Scientific Sessions was held this year in a virtual format and instead of seeing all my diabetes colleagues in Chicago this year, I pre-recorded my sessions and watched webinar versions sheltered at home.
I missed the comradery of seeing old friends and making new ones, but there were also benefits in having on-demand access to the sessions that allowed me to view more of the sessions without running from room to room in a big convention center and worrying about which session to watch when some of my favorites were scheduled at the same time. I could also fast forward through the boring parts.
After years of headline announcements on the protective benefits of the GLP-1 and SGLT2 drug classes we have reached the end of the series of big cardiovascular safety trials on these medications with the results of the VERTIS-CV trial on the Steglatro, the most recent SGLT2 drug approved. As all other medications in this class it reduced the risk for heart failure but was less impressive on other cardiovascular markers and showed less benefit on kidney than others in the class.
A surprise finding from one clinical trial designed to study heart failure was that the SGLT2-inhibitor Farxiga prevented the development of diabetes in people with prediabetes by 32%. This effect was different from the impact of metformin on the development of diabetes, which is interesting. Now we need to do the research to figure out why and if it does this in a larger group of individuals.
The other big trend is diabetes care has been the evolution of hybrid closed loop insulin pumps (also called the “artificial pancreas".) Tandem's Control-IQ system is now approved for children ages of 6-13 years. There was impressive real-world data presented that showed a time in range number of 78% percent (translating to an A1C of <7%). There is a learning curve to starting this system, but we are seeing similar numbers in our patients as well.
Two systems not yet on the market also presented data at the meeting. Data was presented on Insulet’s Omnipod 5 Automated Glucose Control System powered by Horizon and Medtronic MiniMed 780G Advanced Hybrid Closed Loop System. The OmniPod will be an update to their current tubeless DASH system. The 780G was approved in Europe and will still use a sensor that requires calibration two time a day. However, the algorithms are better than for the 670G and will help lower after eating blood glucose levels more effectively. Both systems still need FDA approval and are expected to be available next year.
In other diabetes technology news, the FreeStyle Libre 2 was approved by the FDA has the additional clearance for use in children. The system has improved accuracy and adds Bluetooth connectivity to their current system of scanning the sensor for a reading. The addition of Bluetooth allowed the Libre 2 sensor to join the Dexcom G6 in earning the iCGM designation that will allow it to be integrated with automated insulin delivery systems. The sensor has been available in Europe and the US distribution is rolling out. It has an optional alarm for a low glucose level but still requires that the sensor is “swiped” to give a glucose reading.
Lilly presented data for their tongue-twisting new faster acting insulin sold as Lyumjev that was recently FDA approved for adults with diabetes. It is similar to Fiasp, the other faster acting insulin on the market. Lyumjev will be available in both U-100 and U-200 strength and initially will be sold in pens and is not approved for use in pumps. It will be at least 6 months until insurance will cover it in most cases.
Novo Nordisk also surprised many with the release of phase 2 trial data from a once-weekly basal insulin known as icodec. The insulin had a similar safety and action profile to current long-acting insulins, but not many clinicians were even aware that the once a week insulin was under development and there are interesting questions on who the right patient is to use such a long-acting insulin.
There is some additional good news on the type 1 diabetes prevention capability of teplizumab on the relatives of T1Ds. New data show that a single 14-day infusion of teplizumab, an anti-CD3 monoclonal antibody, leads to a median 3-year delay in type 1 diabetes onset among high-risk individuals compared with placebo. Half of the treatment group remains diabetes free compared to 22% of the placebo group.