July 10, 2013

Top 10 Take Aways from ADA 2013 – Part Two

I recently attended the 73rd American Diabetes Association (ADA) Scientific Sessions in Chicago, June 21-25 where brilliant and dedicated researchers and health care professionals from around the globe gather to learn, share and connect. As a diabetes educator involved in the diabetes field nearly 35 years and counting, I was once again wowed by this meeting...and learned a ton!

Though tough to choose, here are my top 10 take aways from the 2013 ADA meeting - divded into Part One and Part Two:

6. Delivering Improved Diabetes Care and SUPPORT Using Technology: It’s been said before and was said again and again this year, people with diabetes (and prediabetes) need ongoing and consistent support. As Marti Funnell, MS, RN, CDE said, “If we don’t address the emotional side of diabetes we won’t ever improve outcomes. It is an imperative!” And as Ed Fisher, PhD, of Peers for Progress (link) said, “Humans have fundamental need for support and social connections.” People not only need emotional support to manage this disease, but research clearly shows that to make the necessary health behavior changes and implement the management strategies for good control, people also need support. See #10 – The DOC.

The good news is today we have technologies, from Skype, to online systems, to tracking devices, telehealth tools, and more to come in the future, to incorporate important support systems. And numerous studies presented at ADA again showed that people do better with support…and that we can deliver this conveniently to people and more cost effectively. Though this seems like a dah…at this point, it still feels that we are hamstrung by 20th century reimbursement regulations which call for face-to-face care.

In light of healthcare delivery reform and implementation of Obamacare, I was heartened to hear a speaker from the Office of National Coordinator for Health Info Technology (ONC) who mentioned the website www.healthIT.gov. She spoke about the National Action Plan to Advance Consumer Engagement in eHealth. She also spoke, surprisingly, about how HIPAA has been misunderstood over the years and her office, along with other government agencies, is engaged in an extensive effort called the Blue Button. This started with the Veteran’s Administration (VA) and is spreading to Medicare. It’s based on the notion that all Americans have the legal right to see and get a copy of our health information and medical claims. The speaker noted that having your health information at your fingertips is powerful medicine. Here, here…can I just dream for a second about never having to fill out a paper and pen form in a HCP office again?

7. Reflecting on the Look AHEAD Lifestyle Intervention Study in Type 2: The efficacy of intensive lifestyle intervention doesn’t typically receive the attention it deserves (yes, it’s the Rodney Dangerfield of diabetes therapies!). So I was pleased to see positive results from two studies – the NIH-funded tightly controlled Look AHEAD (Action for Health in Diabetes) trial in type 2 diabetes and the MOVE (Managing Obesity and Overweight in Veterans Everywhere) study from the VA – another attempt to translate the Diabetes Prevention Program/Trial (DPP) in a real life setting with a challenging population of veterans. Both studies showed that with sufficient and ongoing support (see #6) people can maintain that crucial minimal weight loss over time. This relatively small amount of weight loss translates into a number of clinical benefits and healthcare cost savings. We just need to continue to develop systems in which we can deliver this care cost efficiently and use technology to our advantage. Read more details about Look AHEAD in my recent Diabetes Mine blog 7/2/13 about the final results presented at ADA, but not generally reported in the media.

8. Weight Loss, Slowing Progression of Prediabetes and Type 2 Needs All Tools on Deck: There was plenty of hype about the two new weight loss medications which have recently become available in the U.S. – Qysmia (phentermine/topiramate) and Belviq (lorcaserin). While neither appears to lead to dramatic weight loss and both need to be partnered with healthy lifestyle changes in food intake and exercise (we haven’t figured out how to implement and reimburse this effectively for the masses), they do represent another tool in our armamentarium to offer some people a bit more help. And there are more on the way not yet approved, naltrexone/bupropionSR, which will have the trade name Contrave. A higher dose of liraglutide/Victoza has also been studied for obesity. 

The goal is of these medications is simply to further help people chip away at a few pounds to decrease risk factors for type 2 diabetes and cardiovascular disease or in people with type 2 to assist them with glycemic control…a bit. One speaker referred to this as a reduction of co-morbidities approach…not to help people get “skinny.” And in the words of Virginia Valentine, RN, CNS, CDE, “let’s use what we’ve got to help people in ways that result in success for them.”

There were a number of presentations on various forms of metabolic surgery with more effort to press presenters on the long term clinical effectiveness of these surgeries when viewed within the spectrum of effective therapies for weight management (see my article Life After Weight Loss Surgery, Diabetic Living). One talk covered both metabolic surgery and several unique endoscopic procedures to cause a decrease in food intake…to in essence bypass the bypass and still achieve significant weight loss. Certainly more to come on the weight control front! 

9. What’s the Gut Got to do with Obesity, Type 2 Diabetes: The answer looks like plenty! Several sessions at ADA touched on or delved into the relationships between the health status of the gut and the impact of the quality of food consumed on gut health. The point was made that when it comes to our gut we are born largely sterile. One speaker noted something or, more likely things, have changed in our environments, which has led to changes in our overall gut microbiota. Changes in gut microbiota have been associated with diseases in which chronic inflammation plays a role, type 2 diabetes being one, which is often kicked off with excess weight. Another speaker discussed an important role of a healthy gut in maintaining normoglycemia.

It was noted that as humans we respond to microbes with a set of receptors in the gut that allow us to recognize microbial products. These receptors can be activated by various nutritional factors – with less healthy foods eliciting less positive responses. An unhealthy gut can elicit an immune response that can activate the inflammatory response. Yes, what you eat and excess weight affects the gut microbiota negatively was the conclusion of one speaker but this can be improved with weight loss and healthier food choices. Another related session discussed the impact of metabolic surgery on gut health noting that animal research shows metabolic surgery has a dramatic effect on components of the microbiota and on metabolites. 

10. The Diabetes Online Community Front and Center: The Diabetes Online Community (or DOC) has evolved relatively quickly over the last decade. Over the last few years there has been a sprinkling of DOC members at ADA. This year the rise of social media, both the players and the platforms, were front and center. This includes the Twitter board at the front of the exhibit hall which ran tweets one a time throughout the entire meeting. There were tweets from ADA (@amdiabassn), from corporate Twitter feeds promoting their events or wares, and, of course, from a number of the highly visible DOC members and their communities. There were tweetups and receptions sponsored by DOC initiated organizations. Yes, as a group the DOC has become movers and shakers in this community…and rightly so. My hat is off to the DOC! 

As you can read, lots of learning!

Check out my Top Ten Take Aways, Part One.