Meeting Highlights from American Diabetes Association 78th Scientific Sessions

June 22-26, 2018
Orange County Convention Center Orlando, FL

More than 14,000 diabetes practitioners from around the world convened in Orlando for five days of sessions, posters, abstracts, and exhibits during the 2018 annual meeting seeking to gain insights into the significant advances in diabetes management and technology, and how the research might inform researchers and clinicians in the year ahead.

The main undercurrent building from views expressed and data introduced in many presentions, poster sessions, and product theaters was a shift in clinical practice toward precision medication.

Certainly, the fast pace of new devices met with four FDA approvals on the eve of the meeting, such as the interactive Dexcom iG6, the Omnipod Dash system, and the Eversense wearable, implanted continuous glucose monitor (good for 90 days), inhaled and oral insulin, developments in artificial intelligence and advances in diabetes-driven technology such as the IBM Watson designed, Sugar.IQ  diabetes assistant which was unveiled in the (investigational) Guardian Connect continuous glucose monitor. 

The topics that were trending and reflected some of the most well-attended sessions included:

Cardiovascular outcomes trials (CVOTs) in diabetes—Exploring the path forward. Steven P. Marso, MD, of MHCA Midwest Health,  argued that CVOTs are worth the high cost of medications given the knowledge gained, and outcomes achieved. However, Darren K. McGuire, MD, MHSc, at the University of Texas-Southwestern Medical Center, countered with the need to change course. Dr. McGuire challenged that it is time to refocus our current clinical approach to better manage the long-term outcomes and reduce the co-morbidities and mortality that commonly arise with diabetes complications. 

Metformin debated: Should it stay or should it go? A robust, yet entertaining discussion about the role of metformin and how it fits into the current best practices given the variety of newer medications available. Given the acknowledged need to get beyond the limitations of old thinking: start metformin, then wait and see, as this approach clearly fails to prevent not just complications of cardiovascular disease but a host of macro- and microvascular diseases.

Arguing in favor of preserving the role of metformin, Vinita R. Aroda, MD, associate director of diabetes clinical research at Brigham and Women’s Hospital and on the faculty at Harvard Medical School in Boston, confirmed that given the need to address long-term morbidity and mortality challenges facing people with type 2 diabetes, it's really just the start.  

Alice YY Cheng, MD, associate professor of medicine at the University of Toronto School of Medicine in Canada, argued against reliance on metformin, presenting a strong case that we are due of a change in medication management given the availability of newer,  more efficacious therapeutic options.

Time to rethink hemoglobin A1c (HbA1c) as the primary outcome goal. In an oral poster, Jordan E. Perlman, MD, a resident at the University of Washington (UW) Medical Center in Seattle, examined at the differences in hemoglobin A1c (HbA1c) and average glucose in patients with diabetes who also had one of three comorbid conditions: chronic kidney disease (CKD), anemia,” and nonalcoholic fatty liver disease (NAFLD), which introduced convincing evidence that its time to shift our clinical focus to average glucose and away from HbA1c. Senior author, Irl B. Hirsch repeated the proposition that HbA1c is only useful for population-based comparisons he has been 

And much, much more. 




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First Article From This Meeting:
Data Supports Efficacy of Omnipod DASH Over Standard Care
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