Discover and read the best of Twitter Threads about #ADA2019
Most recents (9)
1/ Diabetes mellitus is one of the most active areas of drug development. Fascinating advances have occurred in the past decade, leading to easier-to-administer medications and reductions in cardiovascular mortality.
2/ I saw a young patient with T2DM & obesity (BMI 62 kg/m2). She was being treated with high-dose insulin glargine at night, lispro sliding scale & metformin. Her morning BS were ~140 and her pre-meal levels ~150 mg/dL. Despite these numbers, her A1c was 8.6%. Next step?
3/ A reasonable A1c goal for a young patient is ~7%. A ⬆️ A1c with reasonable morning and pre-prandial BS levels suggests post-prandial excursions poorly covered by lispro.
The ideal drug to add is one that is potent (⬇️ A1c >1%), is easy to administer and does not further ⬆️Wt.
The ideal drug to add is one that is potent (⬇️ A1c >1%), is easy to administer and does not further ⬆️Wt.
Summary of results from iDCL trial of Tandem/Dexcom hybrid-closed loop system at #ADA2019
Included: 14 yrs and older, T1D > 1 yr
Minimal entry restrictions
170 subjects enrolled: Closed loop (112 ppl), sensor-augmented pump (56 ppl) #diabetes #t1d #closedloop
Included: 14 yrs and older, T1D > 1 yr
Minimal entry restrictions
170 subjects enrolled: Closed loop (112 ppl), sensor-augmented pump (56 ppl) #diabetes #t1d #closedloop
Subject characteristics: 33 years old; A1c 7.4% baseline; 20-25% MDI; 70% current CGM user;
Median diabetes duration 15 yrs
Median diabetes duration 15 yrs
Outcomes:
100% of people completed study
Time in range increased 11% (to 71% in closed loop group); A1c decreased -0.33%; Mean glucose decreased 13 mg/dL;
Participants used CGM 97% time; 92% time with closed loop active.
100% of people completed study
Time in range increased 11% (to 71% in closed loop group); A1c decreased -0.33%; Mean glucose decreased 13 mg/dL;
Participants used CGM 97% time; 92% time with closed loop active.
The 1st drug (a monoclonal antibody) to delay onset of autoimmune #diabetes in high risk individuals (by ~ 2 years)
nejm.org/doi/full/10.10… #ADA2019 @NEJM #T1D @T1D_Trialnet
nejm.org/doi/full/10.10… #ADA2019 @NEJM #T1D @T1D_Trialnet
"The results of this trial are striking, with several caveats."
A long road that has taken 40 years. And still just a start to prevention.
Exciting, nonetheless.
nejm.org/doi/full/10.10… @NEJM editorial #ADA2019
by @clifford_rosen and @ingelfinger
A long road that has taken 40 years. And still just a start to prevention.
Exciting, nonetheless.
nejm.org/doi/full/10.10… @NEJM editorial #ADA2019
by @clifford_rosen and @ingelfinger
'Herold procrastinated when it came time to analyze the data. “I kept pushing it off,” he says, because he worried about failure.'
Some interesting backstory to this major milestone trial
@sciencemagazine sciencemag.org/news/2019/06/m… by @jcouzin
Some interesting backstory to this major milestone trial
@sciencemagazine sciencemag.org/news/2019/06/m… by @jcouzin
Thread from “Glycemic Control and Glycemic Variability in People with Type 1 Diabetes Using Open Source Artificial Pancreas Systems”, presented by Andreas Melmer, incl. @dcberne1 colleagues @ChriStettler, @thomaszueger, @markuslaimer, & @scottleibrand & @danamlewis. #ADA2019
Artificial Pancreas Systems (APS) now exist, leveraging a CGM sensor, pump, and control algorithm. Faster insulin can help, too. #ADA2019
Traditionally, APS is developed by commercial industry, tested by clinicians, regulated, and then patients can access it. However, DIYAPS is designed by patients for individual use. #ADA2019
GLP1-RA trials #T2Diabetes showing attenuation of nephropathy:
(Nb: Dulaglutude reports tomorrow)
Points of note?
1. In “good” renal function
2. As secondary outcome
3. Overarching outcome driven by reduction of persistent macroalbuminiuria
#ADA2019
(Nb: Dulaglutude reports tomorrow)
Points of note?
1. In “good” renal function
2. As secondary outcome
3. Overarching outcome driven by reduction of persistent macroalbuminiuria
#ADA2019
Summary of action and possible mechanism of GLP-1RA on kidneys #ADA2019
ICYMI: all of my #ADA2019 poster content is now up and summarized at bit.ly/DanaMLewisADA2…
Below are threads for each individual poster, too.
Below are threads for each individual poster, too.
Summarizing 1056-P in category 12-D at #ADA2019, "Preliminary Characterization of Rhythmic Glucose Variability In Individuals With Type 1 Diabetes", by @danamlewis & @azure_dominique,
Summarizing 117-LB at #ADA2019, "DIWHY: Factors Influencing Motivation, Barriers and Duration of DIY Artificial Pancreas System Use Among Real-World Users." (from team OPEN)
Here is a Twitter thread from poster 78-LB at #ADA2019, Detailing the Lived Experiences of People with Diabetes Using Do-it-Yourself Artificial Pancreas Systems - Qualitative Analysis of Responses to Open-Ended Items in an International Survey.
Introduction:
There is currently a wave of interest in Do-it-Yourself Artificial Pancreas Systems (DIYAPS), but knowledge about how the use of these systems impacts on the lives of those that build and use them remains limited. #ADA2019
There is currently a wave of interest in Do-it-Yourself Artificial Pancreas Systems (DIYAPS), but knowledge about how the use of these systems impacts on the lives of those that build and use them remains limited. #ADA2019
Until now, only a select few have been able to give voice to their experiences in a research context. In this study we present data that addresses this shortcoming, detailing the lived experiences of people using DIYAPS in an extensive and diverse way. #ADA2019
Here is a Twitter thread from poster 117-LB at #ADA2019, DIWHY: Factors Influencing Motivation, Barriers and Duration of DIY Artificial Pancreas System Use Among Real-World Users.
Background
Until recently, digital innovations in healthcare have typically followed a ‘top-down’ pathway, with manufacturers leading the design and production of technology-enabled solutions and patients involved only as users of the end-product. #ADA2019
Until recently, digital innovations in healthcare have typically followed a ‘top-down’ pathway, with manufacturers leading the design and production of technology-enabled solutions and patients involved only as users of the end-product. #ADA2019
This is being disrupted by increasing influence and popularity of more ‘bottom-up’ and patient-led open source initiatives. A primary example is growing movement of people with diabetes (PwD) who create their own “Do-it-Yourself” Artificial Pancreas Systems (DIY APS). #ADA2019
Here is a Twitter thread summarizing poster 1056-P at #ADA2019 in category 12-D Clinical Therapeutics/New Technology–Insulin Delivery Systems, Preliminary Characterization of Rhythmic Glucose Variability In Individuals With Type 1 Diabetes, by @azure_dominique & @danamlewis
Background:
Human physiology, including blood glucose, exhibits rhythms at multiple timescales, including hours (ultradian, UR), the day (circadian, CR), and the ~28-day female ovulatory cycle (OR). #ADA2019
Human physiology, including blood glucose, exhibits rhythms at multiple timescales, including hours (ultradian, UR), the day (circadian, CR), and the ~28-day female ovulatory cycle (OR). #ADA2019
Individuals with T1D may suffer rhythmic disruption due not only to the loss of insulin, but to injection of insulin that does not mimic natural insulin rhythms, the presence of endocrine-timing disruptive medications, and sleep disruption. #ADA2019
