Welcome to the ATTD 2023 Interactive Program

Displaying One Session

PARALLEL SESSION
Session Type
PARALLEL SESSION
Date
Fri, 24.02.2023
Room
Plenary Hall A6
Session Time
16:40 - 18:10
Session Icon
Live Q&A

IS049 - Why do CGM performance assessments need more standardization? (ID 942)

Lecture Time
16:40 - 17:00
Session Type
PARALLEL SESSION
Date
Fri, 24.02.2023
Session Time
16:40 - 18:10
Room
Plenary Hall A6
Session Icon
Live Q&A

Abstract

Abstract Body

Systems for continuous glucose monitoring (CGM) have become an essential tool in the therapy of people with diabetes that provides information to the patent and allows to calculate CGM derived parameters like TiR etc. Accuracy of CGM systems has since become a topic of discussion, promoting the mean absolute relative difference (MARD) as one of the key characteristics of a CGM system. Experiences from practice as well as from structured head-to-head studies, however, have shown that different CGM systems may exhibit considerable variations in clinically relevant accuracy parameters even if they claim similar MARD values. On the one hand, this shows that the MARD alone is inadequate to fully characterize the accuracy of CGM system, which has led to the proposal of several alternatives. On the other hand, it shows that the apparent accuracy of a CGM system can be highly dependent on various factors related to the design and evaluation of the respective performance study. Among these factors are the selection of study participants as well as the characteristics of the comparator measurements (e.g. range and rate of change) and their traceability. This leads to a broad range of reported accuracy and makes comparison of different systems indeed difficult because all aspects of the respective study design have to be taken into consideration which requires extensive background knowledge that cannot be expected from practitioners or users.
Given the importance of CGM in current diabetes therapy, reliable and transparent performance declaration is essential which can be reached by standardized and scientifically reasonable study procedures. In his talk, Dr. Freckmann will provide an overview on past and current efforts, including the work of the IFCC working group on CGM, to achieve this goal of standardization.

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IS050 - Can Hybrid Closed Loop and/or Verapamil Prolong Islet Survival in new onset type 1 diabetes? Results from the JDRF CLVer Trial (ID 943)

Lecture Time
17:00 - 17:20
Session Type
PARALLEL SESSION
Date
Fri, 24.02.2023
Session Time
16:40 - 18:10
Room
Plenary Hall A6
Session Icon
Live Q&A

Abstract

Abstract Body

Background: Thioredoxin-interacting protein overexpression induces pancreatic beta cell apoptosis and is involved in glucotoxicity-induced beta cell death. Calcium channel blockers, like verapamil, reduce these effects and in a small pilot study in adults with newly diagnosed type 1 diabetes (T1D) was found to preserve pancreatic beta cell function. Near-normalization of glucose levels instituted immediately after T1D diagnosis has been postulated to also preserve beta cell function by reducing glucotoxicity. Previous studies have been hampered by an inability to achieve tight glycemic goals.

Methods: We conducted a double-blind factorial-design trial at six pediatric endocrinology centers across the United States. Using a balanced factorial design, each participant was randomly assigned to the verapamil group or placebo group and also to receive either intensive diabetes management with an automated insulin delivery (AID) system or standard care diabetes management. Eligible participants were 7 to <18 years old with type 1 diabetes diagnosed within 31 days of randomization who had at least one positive islet autoantibody, and for verapamil only weighed ≥30 kilograms and had no contraindication to use of verapamil. The primary outcome for both arms was mixed-meal-tolerance test-stimulated C-peptide area under the curve (AUC) 52 weeks from diagnosis.

Results: For the drug-therapy arm, 88 participants were randomly assigned to the verapamil group (N=47) or placebo group (N=41). Participant age ranged from 8.5 to 17.9 years (mean 12.7±2.4); 74% of the participants identified as non-Hispanic White, 3% as non-Hispanic Black, 17% as Hispanic White, and 5% as another or more than one race or ethnic group. The trial was completed by 44 of the 47 (94%) participants in the verapamil group and 39 of the 41 (95%) in the placebo group.

For the intensive management arm, 113 participants were randomly assigned to the intensive-management (N=61) or standard-care groups (N=52). Participant age ranged from 7.0 to 17.9 years (mean 12±3); 76% of participants identified as being non-Hispanic White, 4% as non-Hispanic Black, 14% as Hispanic White, and 4% as another or more than one race or ethnic group. The trial was completed by 60 of the 61 (98%) participants in the intensive-management group and by 48 of the 52 (92%) in the standard-care group.

Conclusions: We will present the results of change in islet function as assessed by C-peptide AUC at 52 weeks in both arms of this multicenter randomized controlled trial.

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Surgical treatment of obesity and type 2 diabetes: Outcomes, mechanisms and future perspectives (ID 944)

Lecture Time
17:20 - 17:40
Session Type
PARALLEL SESSION
Date
Fri, 24.02.2023
Session Time
16:40 - 18:10
Room
Plenary Hall A6
Session Icon
Live Q&A

IS051 - The use of SAP In pregnancy: Comparison of the initiation of the treatment before and after conception (ID 945)

Lecture Time
17:40 - 18:00
Session Type
PARALLEL SESSION
Date
Fri, 24.02.2023
Session Time
16:40 - 18:10
Room
Plenary Hall A6
Session Icon
Live Q&A

Abstract

Abstract Body

Previous studies showed that achieving and maintaining optimal metabolic control remain a challenge during pregnancy complicated with type 1 diabetes (T1D). The International Consensus on Time in Range recommends increasing time in range (TIR) in pregnancy with T1D promptly and safely with a target glycaemia range of 3.5-7.8 mmol/L and TIR >70%.
However, CONCEPTT, a large multicenter randomized controlled trial of real-time continuous glucose monitoring (CGM) before and during pregnancy with T1D, indicate that women only achieved these targets towards the end of the third trimester.. However, it is suggested that even a 5% increase in TIR is associated with clinically relevant improvements in neonatal health.
Previous trials demonstrated the safety of sensor-augmented insulin pump therapy (SAP), and its potential to improve glucose control in pregnancy, without increasing maternal hypoglycemia. Also, recent trials conducted in women with T1D who started SAP before pregnancy, including our study, showed an earlier significant reduction of HbA1c and improvement in TIR all over from prepregnancy to third trimesters.
Hybrid closed-loop insulin pumps with automated insulin delivery based on CGM readings have not been approved for use in pregnancy. However, many women use it in preconception and during pregnancy, after discussion of risks and benefits. Recently, use of artificial pancreas (AP) with a model-predictive control algorithm, in pregnancy with T1D, was associated with comparable glucose control and significantly less hypoglycemia than SAP therapy. Further trials are needed to identify suitable candidates for CGM, SAP and AP technology in pregnancy.
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Q&A (ID 946)

Lecture Time
18:00 - 18:10
Session Type
PARALLEL SESSION
Date
Fri, 24.02.2023
Session Time
16:40 - 18:10
Room
Plenary Hall A6
Session Icon
Live Q&A