ADA 2020 Preview – A Deep Dive on Time in Range and CGM

By Monica Oxenreiter and Frida Velcani

The ADA Scientific Sessions starts later this week – we've highlighted some of the most important presentations and poster for you to look forward to

[Please note that sessions will be recorded and can be accessed for up to 90 days after the meeting]

This year, due to the COVID-19 pandemic, the American Diabetes Association (ADA) 80th Scientific Sessions will be held virtually from Friday, June 12 to Tuesday, June 16 – see video background here. This is an exciting chance for more learnings on basic and clinical science, technology, and progress in all other facets of diabetes. People all over the world will come to together to learn more about diabetes – register here – and diaTribe will be sending updates close to daily! If you’d like to receive our daily updates, click here.

At diaTribe, we have looked through the schedule and want to highlight some of the most important presentations – for now we’ve focused on time-in-range and continuous glucose monitoring, and we’ll be adding more areas of focus before the conference begins. diaTribe’s community manager, Cherise Shockley, will be all over social media – connect with @diaTribe on Instagram and @diaTribeNews on Twitter and Facebook. Look for #ADA2020 and also follow @amdiabetesassn to keep up with the action!

Please note our time in range category is very broad! Included are multiple talks on strategies and learnings on technology and therapy that influence time in range in particular – there are many others, of course, that could influence time in range in other ways.

Thank you to so many researchers, healthcare professionals, and diabetes advocates for the work they are bringing to the ADA. Please note – all conference times are CDT.

Click to jump down to a section:

• Time in Range – check it out! 

• Continuous Glucose Monitoring (CGM) and Closed Loop/AID – so much happening!

• Exercise – we’re excited to hear new perspective on guidelines

• Diabetes and Pregnancy – lots of learning awaits on metformin

• Diabetes Remission – low-carb, low-calorie studies

• Crushing Chronic Kidney Disease, what has to happen? 

• The Microbiome – a deep dive

• And More – Nine Other Key Talks diaTribe Is Spotlighting

Time in Range

• The Next Generation of Automated Insulin Delivery System for Persons with Type 1 Diabetes – Four New Clinical Trials – This Friday at 2 pm will be a popular session. An international team of experts (from New Zealand to the US) will discuss automated insulin delivery (AID). The experts will review the different closed loop offerings from Medtronic’s MiniMed pumps (670G and 780G) and Insulet’s Omnipod Horizon. These clinical trials can give us a glimpse into this important technology, offering an exciting preview into what may be available over the next few years.

• Reduction of Hypoglycemia by New Therapies in Clinical Trials – Overestimated, Underestimated, or Both? – On Saturday at 8 am, this “star-studded cast of speakers” will talk about severe hypoglycemia (under 54 mg/dL) and the amount of time spent with a low blood sugar. Using hypoglycemia as an endpoint for clinical trials could limit the design of a trial; this debate will shed more light on the topic and explore what other options researchers have to study hypoglycemia.

• The “Legacy Effect” in Diabetes – Are There Long-Term Benefits of Short-Term Tight Glycemic Management? – Saturday at 8 am is an early timeslot, but this presentation promises to be an interesting discussion about the long-term benefits of early glycemic control. If aggressive control is maintained early after diagnosis, could it mean that better outcomes are achieved over time? This team of doctors will discuss this issue from both type 1 and type 2 perspectives, so it should be interesting for everyone in the diabetes world.

• Is There a Current Place for Sulfonylureas in the Treatment of Type 2 Diabetes? – This Saturday at 5 pm, Dr. Sophia Zoungas and Dr. Carol Wysham will delve into the role of sulfonylureas to treat type 2 diabetes – there will be lots of learning about time in range, we believe, even if that is not the exact focus. As a commonly prescribed drug for type 2, it is important to know the pros and cons of its use. Currently, CMS covers CGM for those that use insulin, particularly to help reduce hypoglycemia, and we hope to learn more about CGM use in people taking sulfonylureas. Tune in for a lively debate that could have important implications for the treatment of type 2 diabetes.

• Adjunctive Glucose-Lowering Therapies for Adults with Type 1 Diabetes – Evidence – This session, which will be Sunday at 8 am, will discuss oral agents like metformin, GLP-1, and SGLT-2 inhibitors, and their role in type 1 diabetes. As more therapies have been approved for use in Europe than in the US, it is always interesting to see how their outcomes compare. This topic will be of interest to those watching time in range.

• Lifestyle Interventions for Type 2 Diabetes Remission – On Sunday at 8 am, researchers will share the impact that the DiRECT trial and low-calorie diets had on people with type 2 diabetes in remission. As more evidence is showing that food, nutrition, and exercise have various influence on diabetes, it is good to learn more about what that will mean for interventions and treatment therapies in the future.

• Primary Cardiovascular Prevention with SGLT-2 inhibitors or GLP-1 Receptor Agonists – Are We Ready for Prime Time? – On Monday at 2:15 pm, we are looking forward to a debate with Dr. Mikhail Kosiborod and Dr. Darren McGuire. This discussion will look at whether or not SGLT-2s and GLP-1s are ready to be rolled out to the general type 2 population, or if we need to wait for more evidence to ensure it is safe to use these therapies in wider portions of the population. This will be a nice debate on the pros and cons of these drug classes. 

• Weekly Basal Insulin – The Wave of the Future? – This “can’t miss” session on Monday at 3:15 pm will explore all of the new long-acting basal insulins. There are many new types of insulins being tested in clinical trials and pilot studies, so we are keen to see the clinical evidence from these efforts. It might be the beginning of the “wave of the future” for new types of weekly basal insulin.

• Poster Sessions: On Saturday, there will be multiple poster sessions related to time in range. Of these, “Effect of Time-in-Range over 14 Days on Glycemic Controls and Hypoglycemia Unawareness in Patients Using FreeStyle Libre” will begin at 8:45 am. The rest should be viewed at 10:00 am. These include:

  • “Differences in Time-In-Range, Glycemic Variability, and the Glucose Management Indicator in Pregnant Women with Type 1 (T1D), Type 2 (T2D), and Gestational Diabetes (GDM)”

  • “Is Time-in-Range Independent of A1c?  A Study in Asian Indian Population”

  • “Newly Diagnosed Pediatric Patients with Type 1 Diabetes Show Steady Decline in Glucose Time-in-Range (TIR) over 1 Year: Pilot Study”

  • “Estimated HbA1c Discordance: Should Estimated HbA1c Be Derived from Time-in-Range or Mean Glucose Levels?”

These poster sessions offer a valuable opportunity to hear from the speakers and to see an actual representation of the data.

• Professional Interest Group Discussion on Diabetes in Youth "Do-It-Yourself"/"Do-It-Together" (DIY/DIT) Closed-Loop Systems in Youth – On Sunday at 12:00 pm, this discussion will help explore “DIY” closed-loop systems, including its benefits and risks. This talk will focus in large part on the psychosocial impact of closed-loop systems on young people, and we look forward to hearing more about what might be controversial yet unstoppable.

• Joint ADA/ISPAD Symposium – Hemoglobin A1C vs. Time-in-Range as the Primary Metric in Pediatric Diabetes. This program will begin on Saturday at 1:45 pm. As healthcare professionals shift from the traditionally important A1C to the new metric of time in range, we look forward to hearing how experts characterize the pros and cons to each method of measuring success. Of all of the programs listed on this guide, we suspect this will be among the most illuminating .

Continuous Glucose Monitor (CGM) and Closed Loop/AID 

• Technology Alone Can Solve the Problem of Hypoglycemia in Diabetes – This Friday at 11:30 am, this program will focus on CGM and closed-loop systems. Particular examples will be discussed, including pros and cons, such as when using automated insulin delivery results in less than 1% of time spent with low blood sugar (below 70 mg/dL).

• Expanding the Use of Continuous Glucose Monitoring (CGM) in Pediatric Settings – This Friday at 4:15 pm, there will be a series of four talks that will discuss the use of CGM in four groups of people with diabetes: (1) “stage 2” type 1 diabetes; (2) “early stage 3” type 1 diabetes; (3) pediatric type 2 diabetes; and (4) diabetes in hospital settings. Access to technology is ultimately important in all diabetes populations, and we look forward to learning more about these lesser-known groups.

• The Use of Continuous Glucose Monitoring in Type 2 Diabetes Mellitus: Is There a Value? – This Friday at 4:15 pm, there will be a debate on CGM use in type 2 diabetes. As the technology becomes more accessible, it raises many questions about how it can be used in different populations, like people with type 2 diabetes.

• Poster Sessions: On Saturday, there will be multiple poster sessions related to the topic of continuous glucose monitoring and its impact on diabetes management. Of these, “Remote Monitoring of CGM Data at Diabetes Camp Mitigates Hypoglycemia Day and Night” will begin at 8:30 am. The rest of the presentations can be viewed beginning at 10 am. These include:

  • “Utilization of Continuous Glucose Monitoring (CGM) and Its Impact on the Care of Veterans Differences in Time-In-Range”

  • “Using CGM as a Feedback Tool in Diabetes Mellitus Patients Management: A Retrospective Real-World Evidence Study Conducted in India”

  • “Comparison of Dexcom G6 CGM with Self-Monitoring Blood Glucose in Young Adults with Type 1 Diabetes: The Millennial Study”

  • “Use of Real-Time CGM Is Associated with Fewer Hospitalizations Compared with SMBG in the Insulin-Treated Medicare Population”

  • “Sustainable HbA1c Decrease at 12 Months for Adults with Type 1 and Type 2 Diabetes Using the FreeStyle Libre System: A Study within the National Diabetes Register in Sweden.”

Similar to the time-in-range poster sessions, these presentations offer interesting takes on diabetes technology. This technology can prompt huge value and can revolutionize care in diabetes; these presentations can also give a glimpse into what kind of research is being done in this area.  

Exercise

• Physical Activity Guidelines for Americans – This Friday at 11:30 am, health experts Dr. Katrina Piercy and Dr. Ronald Sigal will discuss the 2018 US Physical Activity Guidelines for Americans. In recent years, annual healthcare costs of $117 billion and 10% of all premature mortality can be attributed to low levels of physical activity. It will be helpful – we hope! –  to hear the discussion about how these guidelines can affect people with diabetes. Then, we’ll be excited to get the diaTribe team views, which we’ll share by social media.

Diabetes and Pregnancy

• Diabetes and Pregnancy and the Use of Oral Agents – This Friday at 12:45 pm, this discussion with Dr. Denice Feng and Dr. Linda Barbour will explore the use of oral drugs like metformin to treat pregnancy with diabetes. Many of us are curious to hear about whether these oral agents can be a promising answer to some of the problems associated with pregnancy and type two diabetes.

Diabetes Remission – low-carb, low-calorie studies

• The Best Strategy for Diabetes Remission Using Obesity Treatment is… This Friday at 2 pm is an exciting talk about diabetes remission and reversal. This discussion will delve into the impact of what treatments are most promising, like low-carb and low-calorie studies. As studies show that it is possible to have diabetes remission, we are hopeful to learn more about this topic for all people with type 2.

Crushing Chronic Kidney Disease, what has to happen?

• Doing Better with Diabetes and Chronic Kidney Disease – On Friday at 2 pm, this session will focus on what options exist for treating chronic kidney disease. There is a lot of excitement about the growing potential for SGLT-2 inhibitors as a way of treating kidney disease in people with diabetes. The experts in this discussion, including Dr. Susanne Nicholas, Dr. Peter Rossing, and Dr. Katherine Tuttle, will all talk about the new ways they have been addressing kidney disease in people with diabetes.

The Microbiome

• The Microbiome in T1D – This discussion on Saturday at 4 pm about the microbiome will give us more information about the potential seen in this research in the last few years. A buzzword at prior conferences, “microbiome” will be explored a bit more in depth here. What the gut looks like in a person with type 1 diabetes, how to manipulate it to treat diabetes, and what treatment options exist are three major areas of focus for this talk.

Ten Additional Can’t-Miss Talks (listed in order, starting Saturday at 10 am, and diaTribe will be closely watching)

• Can Taxes Alter Dietary Behavior and Outcomes – Saturday at 8 am will be an exciting session about whether taxes can influence behavior. The five speakers will be thinking about policies like soda taxes, which increase taxes on sugar-sweetened drinks. There are some ways that this can improve behavior, but there are some situations in which there is no observed difference in behavior. These experts will explain a few examples of where these efforts have worked, and what that means for future efforts to direct consumer behavior through taxes.

• Professional Interest Group Discussion on Diabetes Self-Management Education and Support (DSMES) – An overview of the DSMES will start on Sunday at 10:15 am; from the broader overview, the researchers will move into the more in-depth role of DSMES in healthcare today, and what that means for people and their healthcare providers. Education is one of the most important ways to increase compliance and better outcomes, so we are keen to hear what these experts suggest for how to improve diabetes self-management. This is especially important for those with multiple chronic conditions, so we hope you will tune in if that applies to you. In the meantime see this impressive article that was just published in Diabetes Care – Diabetes Sisters CEO Anna Norton was a co-author and and no doubt an incredibly important contributor.

• Reaching the Hard to Reach – Real-World Stories – The discussion starting Sunday at 2:15 pm will get the ball rolling on the case studies of adults experiencing hardship amid their diabetes diagnosis. As the hardships they experience can increase their risk for worse physical and mental health outcomes, it will be important to learn more. These perspectives are often forgotten or overlooked, so it is great to see the inclusion of a more diverse set of experiences with diabetes in a formal case-study analysis.

• Physiological Mechanisms of Remission of Type 2 Diabetes – We are looking forward to joining the session on Sunday at 2:30 pm, which will define remission of type 2 diabetes and discuss how people with diabetes and their healthcare providers can work toward that goal. More and more positive results are coming out of the various trials about this topic, which gives a lot of hope and promise to those of us living with type 2 diabetes. The broad range of experience of the panelists will make for an exciting and lively discussion, which will hopefully leave us all with a bit more information and optimism about the promise of type 2 diabetes remission.

• Should Metformin Be Considered First-Line Therapy for Individuals with Type 2 Diabetes with Established Arteriosclerotic Cardiovascular Disease (ASCVD) or at High Risk for ASCVD? – This Sunday at 4:30 pm, the guidelines determining the status of SGLT-2s and GLP-1s vs. metformin will be explored. This talk will further elaborate on what role metformin could and should be expected to play in the care of type 2 diabetes – we assume various patient populations will be discussed.

• Population Health Effects in the Prevention and Treatment of Diabetes – This Sunday at 4:30 pm, check out this panel as experts discuss population health and what that means for the prevention and treatment of diabetes. While there are still many existing challenges, this talk will address those barriers and offer up potential solutions based on successes of the past. While it will mainly focus on population effects, the end of the discussion will include the need to balance individual efforts with societal approaches to diabetes prevention.

• What Will Be the Impact of Proposed Health Policy Changes on Diabetes Care? – On Sunday at 4:30 pm, we are excited for the health policy session that will be offered by a team of healthcare professionals and experts. This discussion will range from coverage for pre-existing conditions to the future of Medicaid and commercial insurance with high-deductible health plans. Insurance coverage is a huge issue for everyone with a chronic illness, so this talk will be a highlight, especially given the context of the elections coming up in November. Make sure to tune in early, as the Q&A session at the end could get full.

• Economic Drivers of Obesity Treatment – From Individuals to Systems – On Tuesday at 8 am, four doctors will discuss the economic drivers of obesity treatment. There are economic impacts caused by treating obesity, as well as economic barriers. The end of the discussion will delve into potential models that can be used to care for people with obesity in a more cost-effective manner, as well as a way to assess people for the factors impacting their health outside of obesity.

• Results of the eValuation of ERTugliflozin Efficacy and Safety CardioVascular Outcomes Trial (VERTIS-CV) – This Tuesday at 10:15 am is an exciting look at the efficacy safety outcomes of the recent clinical trial about the SGLT-2 inhibitor Steglatro. This brand new data has not been shared before, so we are curious to see the outcomes. 

Reach out if you have any questions – we’d love to hear from you and will be back to share perspectives and guidance from the experts. We’ll also update this piece with information on additional sessions that will also be valuable – on digital health, therapies, healthcare delivery, and more.

This article is part of a series on time in range. 
 
The diaTribe Foundation, in concert with the Time in Range Coalition, is committed to helping people with diabetes and their caregivers understand time in range to maximize patients' health. Learn more about the Time in Range Coalition here.