Dr. Evan's take aways from the American Diabetes Association Conference

I have just returned back from the 78thAmerican Diabetes Association Conference. This was my first time attending and I have to admit the whole event was a bit overwhelming. Over seven different conference streams with over 11,000 attendees and over half were ‘international’.  The audience ranged from researchers, clinicians, dietician, students, industry, patients and more. 
 
Overall, I was very impressed with the sense of community. Everyone in attendance had a clear mission to improve the lives of people with diabetes while developing a cure [type 1] or prevention strategies [type 2/pre-diabetes]. 
 
Here is my take away summary of the conference, and this is in no way an endorsement or recommendation for any products, therapies or services.
 
Neuropathy– there have been no new therapeutic advances in the field since my trial that resulted in the development of Nutarniq Essentials. There have been some mechanistic developments and animal models studies that have improved the understanding of disease progression. I attended a lecture discussing how human genetics can increase painful symptoms. My presentation at the conference was on the development of clinical reference standards for nerve loss. You can check a video on that here.  
 
Continuous Glucose Monitoring (CGM)– This allows people with diabetes to monitor blood glucose using a sensor with a very very very small flexible needle that goes through the skin and transmits data to a handheld reader or smartphone. Google Abbott FreeStyle Libre or Dexcom G6 as examples. This has been one of the most significant technical advances over the past year in my opinion. The ability to regularly monitor blood glucose without the need to take finger prick samples not only increases the frequency of monitoring but also helps to increase awareness of the effects of different foods on blood sugar and ultimately lowering HbA1c.
 
Dr.Evan and Dr.Bruce at the ADA grand stairway.

Artificial Pancreas – Another major area of advancement has been the development of an artificial pancreas for people with type 1. This is not the creation of a new organ, but instead the infusion of both insulin and other medications through a pump that can mimic the activity of healthy pancreas. This technology relies on algorithms to properly infuse the correct amount of hormones given the time of day, meals, exercise etc. The current research is focused on fine-tuning these algorithms and safety testing for more widespread use. 
 
I did learn about an online community – OpenAPS– which is a collective of people with type 1 diabetes that has created an open source artificial pancreas with predictive technology to improve blood glucose levels overnight. Health Canada and the FDA have no way to regulate or test this for safety, so it is an interesting situation from a regulatory point of view. Could this be a new trend in health technology? I don’t know, but they have gained a critical mass of users (~700) and have a well-documented safety profile of their system. 
 
SGLT1/2i– More data was presented on the use of this relatively new class of drug that helps to lower blood glucose by inhibiting (i) Sodium GLucose Transporter 1 and 2 (SGLT2i). By inhibiting this transporter, less glucose is absorbed into the bloodstream from the intestines and there is increased excretion of glucose through the kidneys. This class of drug has been shown to decrease HbA1c and can lead to weight loss. This is not recommended for people with poor kidney function.
 
Nutrition for Diabetes – I attended some very interesting talks in this area and some disappointing talks that all came back to ‘everything in moderation’. I think ‘everything in moderation’ is contributing to the diabetes epidemic because it is generally being abused. What I found interesting was the increase in research of moderate- to high-fat diets as a technique to improve blood glucose control. I was happy to see an increased emphasis on the Mediterranean Diet that promotes a balanced intake of carbs/protein/fat, with an emphasis on healthy fats and lots (~70%) of the plate as plant-based foods. In fact, the ADA is promoting this as a general nutrition strategy for people with diabetes. 
 
I also attended three talks about low carb (<50 g/d), high fat / ketogenic diets. In smaller research studies (<150 people), this strategy lowered body weight, fat mass, improved HbA1c and insulin sensitivity. While many more studies will no doubt be required before this nutrition strategy becomes mainstream, it does reinforce that improving or changing lifestyle through diet and exercise can have a dramatic impact on health and in some cases, reverse type 2 diabetes / pre-diabetes. 
 
**On a personal note, the keto diet has received a lot of publicity, especially through social media. When followed properly, this can be very effective for improving health, but when followed incorrectly it can be quite dangerous. If you are considering this nutrition strategy, please consult a qualified healthcare provider.

Stay healthy,
Dr. Evan

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