Highlights from the 15th Annual Diabetes Forum

July 21, 2021 | By Kelly Kunik

There was so much incredible information in a relatively short amount of time. Below are my highlights from this animated and incredibly informative diabetes discussion.

COVID-19’s Impact on People With Diabetes

Dr Edelman and Kelly Close opened the forum by acknowledging and discussing the COVID-19 pandemic’s impact on people living with diabetes and no matter the type — which was also Dr. Eldman’s first question to the panel.

Dr. Dagogo-Jack, MD, DSc responded by sharing that during the first days of the pandemic, data from China flagged people with Type 2 diabetes for increased risk of COVID-19 infection, which led HCPs to discover that diabetes is indeed a predictor of worst outcomes — including death in patients with Type 2. Data from both Europe and North America backed up China’s early data re: diabetes predicting worse clinical outcomes and higher death rates in COVID-19 patients.

COVID-19 and its impact on people with diabetes (and people who develop diabetes after battling COVID-19), are still being studied.

Dr. Dagogo-Jack mentioned that cellular receptors used by the COVID-19 virus may be upregulated in people with diabetes and also discussed the potential for the virus to cause diabetes in some COVID-19 patients. “It’s sad, but it’s true, COVID-19 can lead to diabetes. But if you’re improving glycemic control, you can improve COVID-19 outcomes.”

Dr. Pettus took the baton, reminding the virtual attendees that as the pandemic went on, healthcare professionals discovered that COVID-19 patients with Type 1 share the same risk as their Type 2 counterparts when it comes to COVID-19.

The bottom line, we found out that Type 1s are equally as high risk as people with Type 2. We were thinking, gosh, we hope type 1s are more like non-diabetics than type 2s, and we did a comparative analysis of type 1, type 2, and healthy controls in a large dataset and found out that type 1s are much more like type 2s than non-diabetics and that’s been the story unfortunately.”

If you have diabetes and no matter the type, you are high risk when it comes to COVID-19 and all it brings.

Silver Linings

Improving blood glucose and Time-In-Range, can improve COVID-19 and decreases adverse outcomes.

COVID-19 has made EVERYONE (healthcare professionals and patients) more cognizant of inequalities in healthcare.

Telemedicine: Combining Telemedicine With Face-To-Face Office Visits, Endo Finding What Works Best for The Person With Diabetes, Endo’s & Primary Care Physicians Working In Tandem

Certified Nurse Practitioner Ms. Davida Kruger informed the “room” that people aren’t making a mad dash back to in-person doctor’s appointments, and highlighted telemedicine's positives: Telemed can access lab data and fits/works around an individual’s lifestyle, office & childcare issues. She believes a combo of virtual and face-to-face appointments is the future. Telemed isn’t going away — and that’s not a bad thing.

Paraphrasing Ms. Davida Krugar: Some patients do better face-to-face, others will do better and prefer more video appointments and fewer in person visits. Patients can and will I.D. themselves re: what works best for them.

 Dr. Drucker acknowledged that while things like labs and glucose numbers are “beautifully discussed online,” the need to examine the patient for issues such as foot-care and nerve damage are difficult to perform online and stated “while we have clear benefits for virtual medicine/telemedicine, we are going to miss many things that require a physical examination. There’s a reason why, when you go to medical school, you need to learn to examine patients — we risk impairing some of our diagnostic acumen, unless we bring them in as you say, once a year, twice a year.”

Dr. Rury Holman POV: Face-to-face physical examinations remain essential, but what we have learned from this enforced pandemic is a different way of working . What I'd like to see more of? Perhaps more frequent, but short virtual sessions with patients to fine tune medications and  support them mentally and in their daily life, better than what we do currently — at least in the UK, with more spaced out consultations. 

Everyone agreed that Endo's need to work together with Primary Care colleagues and patients to deliver the best ongoing diabetes care and pointed to combining face-to-face and telemedicine in order to deliver that goal.

Diabetes Technology

Ms. Kruger kicked off the discussion by stating that CGM is a right for people with diabetes, not a privilege. The panel agreed with her in terms of Type 1, feelings where mixed re: Type 2s having access to insulin pumps and CGMs in on order to optimize their diabetes management.

Dr. Drucker felt users who need CGM most are Type 1s and Type 2s on insulin therapy and shared his concerns re: Payers/insurance companies not authorizing CGM for Type 2s, and feared it would make CGM coverage more difficult for those patients needing it most.

Dr. Holman thought intermittent Type 2 CGM usage would provide patients with insights into their own behaviors and would encourage them to spearhead behavioral changes.

Everyone agreed that the next 5 years will bring an explosion in diabetes technology in terms of hybrid closed-loop systems, including MDI, which was brought up with the mention of Big Foot’s Unity system (smart pen communication with a CGM and with input from the PWD’s healthcare professional), which recently received FDA clearance, and called an “MDI hybrid closed-loop system,” by Dr. Edelman.

As the event came to a close, panelists looked ahead five years and predicted the following hot topics at ADA 2026:

  1. Cell-based therapies for type 1 diabetes
  2. Smart insulins becoming even more intelligent
  3. High dose oral GLP-1s for patients with Type 2, pre-diabetes/early diabetes — not only for glucose management, but also to protect heart and kidneys
  4. US government/payers finally realizing that SGLT-2s are only a fraction of the cost of dialysis for people living with Type 2
  5. Type 2 treatments that provide added layers of defense to hearts and kidneys transferring over to use in people with Type 1, -who run higher risk of both cardio vascular disease and renal issues
  6. Diabetes technology blowing everyone out of the water.

The evening left everyone in attendance with much to absorb and think about and I’m still thinking about what was discussed!

Thanks to diaTribe and TCOYD for hosting such an amazing event and thanks to Ascensia for giving me the opportunity to cover the event!