Madrid

EASD blog – Day 1 (20th February 2020)

This year’s Advanced Technologies and Treatments for Diabetes (ATTD) conference was held in Madrid in Spain. Over the course of three days, although a much smaller conference than, for example, the congresses of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD), the ATTD programme delivered sessions on an interesting range of topics − from hyperglycaemia and cognitive function to continuous glucose monitoring, insulin pumps and closed-loop technologies

As with previous blogs for this part of the site, I’m going to report on the sessions that I think had most resonance for you, the healthcare professionals accessing the EASD’s new e-learning platform and seeking more knowledge and learning in cutting-edge topics of treatment, management and care of people with diabetes.  

The opening ceremony featured a keynote lecture delivered by Professor Jay Skyler. This was a retrospective look at the treatment and technology for diabetes following the identification and isolation of insulin almost 100 years ago. 

Toronto Daily Star 1922

Professor Skyler started his talk with a newspaper cutting from the Toronto Daily Star dated 22nd March 1922, whose headline stated, “Diabetes Sufferers Given Message of Hope – Discovery made at the University of Toronto will be means to prolonging life considerably”.

The ATTD has a long history of establishing consensus statements. In 2019, it published its most recent consensus statement − on time in range, a topic that was at the centre of many of today’s talks and discussions. (Professor Thomas Danne, one of the lead authors of this consensus statement, has already worked with the EASD’s e-learning team to create a very popular module on time in range, which can be accessed here.)  This year discussions for the next consensus statement, which will be on the digital/virtual diabetes clinic, have been taking place and Professor Moshe Phillips outlined the main findings:

  • Virtual diabetes clinical should be developed for all people with diabetes and not just for those who are already digitally active
  • Digital clinics should aim to empower people with diabetes to self-treat their diabetes
  • Data ownership should be regulated worldwide, with a focus on whom the patient wishes to share it with
  • Digital clinics may replace some of the face-to-face appointments and increase interactions between visits 
  • Smooth transmission is necessary so that data from all different devices can be easily integrated 

Another very well attended session on the first day of the conference was on Emerging Technologies in Type 2 Diabetes, which was chaired by Professor Chantal Mathieu.

Professor Julio Rosenstock cast a critical eye over the plethora of guidelines that national and international bodies are producing, suggesting some pointers for how type 2 diabetes therapy could be advanced via simultaneous combination therapy.

He listed the principles for fixed-dose oral medication and fixed-ratio injectable formulations, as follows:

  • Components should exhibit complementary actions
  • Glycaemic control should be better than with each individual component
  • Combined doses may be lower than each individual component alone
  • Side effects should not be increased and, ideally, should be mitigated
  • Treatment could be simplified and could improve both adherence and persistence
  • Cost could be lower than the sum of the costs of the individual components

And, with the results of the VERIFY trial extolling the use of early combination therapies (https://www.ncbi.nlm.nih.gov/pubmed/31542292), he concluded that it was highly conceivable that initial therapy with a combination of metformin and an SGLT-2 inhibitor and/or an oral GLP-1 receptor agonist may become the preferred treatment for people newly diagnosed with type 2 diabetes, regardless of HbA1c levels. He further argued that, in uncontrolled metformin monotherapy with an HbA1c >8%, it makes little sense just to add a single oral agent. Simultaneous SGLT-2 inhibitor and a DPP-4 therapy could be a more logical and effective option.

This was an interesting and thought-provoking session, with every seat taken and people standing in the aisles, demonstrating the strength of feeling on new ways to think about how best to treat type 2 diabetes.

The opinions expressed in this article are those of Dr Eleanor D. Kennedy.

Want to learn more about these topics?

Insulin

To mark the anniversary of the discovery of insulin, our e-learning team is working to create a new course on insulin and its evolution, which will launch at next year’s EASD conference in Stockholm. When this new course launches, you will then be able to access it and test your knowledge on arguably the most important drug in the diabetes armamentarium. Please click here to register on our site.

Pumps, CGM and closed-loop systems

Our platform already boasts a course on “Technology and type 1 diabetes” led by Dr Pratik Choudhary from the UK on insulin pumps and continuous glucose monitoring (CGM) and Professor Thomas Danne from Germany on advances in closed-loop technology. Click here to access these three modules. More modules will be coming to this course, including working effectively with ambulatory glucose profiles, as we recognise the speed at which these fields are developing and the demand from you, the healthcare professional, to keep abreast of these advances.

Early combination therapies

Until such time as a widespread acceptance of early combination therapies develops, the EASD e-learning platform will continue to bring you modules on the guidelines that matter, including the ADA/EASD consensus report on the management of hyperglycaemia in type 2 diabetes (published in 2018) and the subsequent update to this. Click here to access these two important modules.