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American Diabetes Association, June 12-16

The American Diabetes Association 80th Scientific Sessions

The annual meeting of the American Diabetes Association was held virtually this year from June 12 to 16 and attracted participants from around the world, including clinicians, academicians, allied health professionals, and others interested in diabetes. The conference highlighted the latest advances in diabetes research and improving patient care, with presentations focusing on treatment recommendations and advances in management technology.

In the RELIEF study, Ronan Roussel, M.D., Ph.D., of the Hôpital Bichat, Fédération de Diabétologie, AP-HP in Paris, and colleagues found that use of the FreeStyle Libre flash glucose monitoring system was associated with a decrease in the rate of diabetic ketoacidosis hospitalizations for patients with type 1 (52 percent decrease) and type 2 (47 percent decrease) diabetes.

"This decrease was even more striking in patients using very few test strips reimbursed during the year before their first use of the FreeStyle Libre (presumably, the patients did not check their blood glucose levels often) and in patients using more strips reimbursed during the year before their first use of FreeStyle Libre (presumably, they had unstable diabetes, so they needed to check their blood glucose levels more frequently)," Roussel said. "New use of flash glucose monitoring with the FreeStyle Libre had major and rapid relevant clinical benefits for patients, which could lead to better use of health care resources. The results support wider use of the device."

Several authors disclosed financial ties to Abbott, the manufacturer of the FreeStyle Libre.

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In the FLAIR study, Richard Bergenstal, M.D., of the International Diabetes Center at Park Nicollet in Saint Louis Park, Minnesota, and colleagues evaluated the effectiveness of a next-generation automatic insulin delivery system in a patient population with difficult-to-control type 1 diabetes.

"The population we studied is unlike other study populations used in previous studies," Bergenstal said. "We took a broad group of type 1 diabetes patients, including young adults and adolescents, who have not been using insulin pumps, continuous glucose monitors, or hybrid closed-loop systems. We broadened the study entry criteria to really understand the use of this next-generation automatic insulin delivery system as it compared to a previous generation of approved hybrid closed-loop technology."

The investigators evaluated the effectiveness of a next-generation automated insulin delivery system across seven study sites around the world among 14- to 29-year-old type 1 diabetes patients and compared it to a previous-generation hybrid closed-loop system, the Medtronic MiniMed 670G.

"We evaluated 113 participants who utilized either the next-generation automated insulin delivery system or the approved 670G system for three months and then crossed over and used the opposite automated insulin delivery system," Bergenstal said. "We found that the new advanced system was better in every regard than the previous system. Participants were able to maintain more time in target range (70 to 180 mg/dL) without getting more hypoglycemia with the new system as compared to the previous system. In addition, we showed that the new system was more effective than the previous system during the day and at night. Patients found the new system easier to use, ranked it better than the previous system, and had improved glucose control."

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Soren E. Skovlund, of the Steno Diabetes Center North Denmark in Aalborg, and colleagues found that even in a well-resourced modern public health diabetes care system such as the Danish health care system, failure to explicitly integrate psychosocial evaluation and care as a standard part of diabetes care can have negative implications for those affected by diabetes.

"In the largest nationwide survey of people with diabetes in Denmark of this kind, involving approximately 9,000 people with type 1 and 2 diabetes, we found that one in five people with diabetes experienced negative psychological impact of their diabetes most of the time or all the time. In addition, one in five said they had not been offered a psychological referral, but would like to be offered one in relation to their diabetes," Skovlund said. "More than one in three said they did not get the support they needed from the health system overall for thriving mentally with their diabetes."

Advanced regression analyses of the survey study data highlighted the following key risk factors for having a very negative psychological impact from diabetes: using insulin (if having type 2 diabetes), having type 1 diabetes compared with type 2 diabetes, having more complications, being unemployed or forced to be retired, and being female.

"Furthermore, we found that people with diabetes who experienced their health professional to be person-centered and those who reported getting the mental coping support had significantly less risk of being negatively psychologically impacted and needing a psychologist referral," Skovlund said. "Our study also included a major qualitative research component highlighting that psychological impacts of diabetes cannot be put into one bucket -- it transcends all aspects of diabetes care, ranging from the impact of daily demands such as doing painful blood sugar measurements multiple times a day to having to plan every dining and social activity more carefully than other people."

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Elizabeth Kobe, M.D. candidate at Duke University Medical School in Durham, North Carolina, and colleagues found that patients with type 2 diabetes in rural populations were more likely to lack access to specialty care and intensive self-management programs compared with their urban counterparts.

"Telehealth represents a potential strategy for extending specialized diabetes care to rural areas and may be helpful in combating diabetes disparities. The Veteran's Administration (VA) has a nationwide network of home telehealth nurses who are routinely used for telemonitoring of diabetes," Kobe said. "Our goal was to improve diabetes care in clinical practice for rural veterans with uncontrolled type 2 diabetes by developing an intensive diabetes telehealth intervention specifically for delivery by clinical home telehealth nurses, using standard equipment and electronic health record infrastructure."

The investigators partnered with the VA Office of Rural Health to implement Advanced Comprehensive Diabetes Care (ACDC), a six-month telehealth intervention that bundles telemonitoring with module-based self-management support and medication management.

"ACDC is an effective telehealth-based strategy for managing hard-to-control diabetes, including for rural populations, where diabetes management can be particularly challenging," Kobe said. "ACDC has already made a substantial difference for rural patients with diabetes in clinical practice. In fact, some of our sites have now been delivering ACDC successfully for up to four years, which supports the sustainability of ACDC. Because ACDC requires only existing clinical staffing and infrastructure that is ubiquitous across VA, it is well-positioned for further dissemination in clinical practice across the VA system with minimal adaptation to original intervention design."

One author disclosed financial ties to pharmaceutical and medical device companies.

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