AACE for Dummies

Chicago_wideSo the American Association of Clinical Endocrinologists (AACE) held their annual meeting this week(end) in Chicago — while I was off galavanting around Palm Springs for my 15th wedding anniversary, empirically testing the insulin-carb ratio for Pina Coladas (results indicate ca. 60 carbs, N=1).

Anyway, whenever these big meaningful diabetes conferences roll around, I do try to cut through the hype to put my finger on what all the news really means to us average PWD laymen-types. Based on my readings, and the insights of the highly intelligent and fun D-consultant Kelly Close, I’ve gathered the following so far:

* DexCom was the belle of the ball. Makers of the newly-approved DexCom STS tubeless continuous monitor released new accuracy data that blew their old figures away. In a three-week study of 86 patients (69 with type 1 diabetes and 17 with type 2), these subjects experienced upwards of 10% improvement in their overall BG control. Also, the subjects spent 24% more time in the target range and as well as significantly less time above 240 mg/dL or below 55 mg/dL. Sounds like a winner to me! (DexCom’s apparently been inundated with orders, and medical providers are delighted about the minimal patient training necessary to get patients started on the product.)

The company also wowed the crowd at AACE with its flashy booth featuring knockout colorful images of “People. Gorgeous, together, caught up in the midst of life – walking, biking, cooking, kissing, sleeping, lazing around …” Kelly writes. “If you ever want to know what the average intensively managed patient wants their life to be like, go look at this. It’s all about living uninterrupted, tangle-free, from diabetes.” The experience, she says, was “like being on acid.” So glad I’ll be at the ADA Conference myself next month to experience THAT live!

* Gylcemic Variability in the spotlight. That’s the fancy clinical term for bouncy-bouncy blood sugar. A number of talks focused on the importance of reducing the yo-yo effect in reducing long-term diabetes complications. Unfortunately, this means an on-target A1c is not enough — if it’s simply the midpoint between three months of the Roller Coaster Effect.

The biggest proponent of this approach is Dr. Irl Hirsch of the University of Washington Diabetes Care Center, who started all the buzz about paying attention to standard deviation in blood glucose levels. That’s the fancy mathematical term for how spread out the values in a data set are (actually, the average difference between the individual data values). Hirsch also reportedly gave a memorable talk at the Mannkind (inhalable insulin) investor day in April, where he emphasized that glycemic variability is the real culprit fueling complications, as opposed to A1C and fasting glucose, as emphasized by the FDA now. As a PWD already struggling to lower my A1C, may I just say, Oy Vey?!

* Byetta (exenatide) smells like roses. A new clinical study presented at the conference confirmed that exenatide does just what it was intended to, and does it well; this new injectable drug reduces glucose highs after meals and brings down patients’ fasting glucose levels.

* Making headway on Gene Expression. That’s the fancy scientific term for the process by which a gene’s DNA sequence is converted into the structures and functions of a cell. Dr. Ronald Kahn of Joslin Diabetes Center in Boston gave a knockout talk on beta-cell deficiency, insulin, and diabetes influence levels of gene expression. In studies of mice with completely uncontrolled type 1 diabetes, 513 genes of 10,000 tested changed. What this means is researchers are learning more about the important process by which certain genes are directly insulin-regulated.

Great minds report that the newly discovered ARNT gene may be a “master switch” regulating pancreatic cells. Apparently, mouse gene expression correlates to levels of gene expression in humans with type 2 diabetes. So the mice studies are not as nerdy and irrelevant as they might seem!

* Abbott’s good news for continuous monitoring. Abbott’s sales are up a healthy 11% to $273 million — not that we care how rich they are. But healthy earnings are always a good sign for product development, and the company is hoping to get its new FreeStyle Navigator continuous monitor on the market by the end of this year. More CGM product choices for us D-consumers is good news! Now if the insurance companies would just get on board…

* Blood pressure meds now for diabetic kidney disease. New research presented here showed that Type 2 diabetes patients taking ACE inhibitors also enjoy decreased risk for kidney disease. ACE inhibitors are pills used in millions of patients with high blood pressure. Studies show they help against heart disease, too. And now this. New miracle drug?

* Newt Gingrich on stage. The former Speaker of the House gave the AACE keynote speech. An indication of just how Big Business diabetes is? Anyhoo, this is another one I sure wish I’d caught!

* * *

Next up in the conference line-up is the biggest event in diabetes: the American Diabetes Association annual conference, June 9-13, Washington DC. Tune in for my version of “The ADA Conference for Dummies.” That one’ll be live.

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6 Responses

  1. Nick
    Nick May 3, 2006 at 8:44 am | | Reply

    Hey! I got some low-carb margarita mix last week. Now all I need is some tequila and ice cubes!
    Low-carb frozen margaritas….here we come!
    Mmmm………………….

  2. Nick
    Nick May 3, 2006 at 8:50 am | | Reply

    Dr. Hirsch’s criterion for well-controlled blood sugar is that the standard deviation not exceed one third of the mean blood sugar value.

    It has been an elusive goal for me. For the first fifteen months of following Bernstein’s regimen, I failed to attain it. Finally, for the first time in April 2006, I attained it!

    This means my blood sugars averaged over a month have been fairly stable as well as low (average 83 mg/dl).

    I am so proud of myself! The fact is, the more you lower your average blood sugar, the harder it becomes to attain the Hirsch criterion.

  3. AnnaQ
    AnnaQ May 3, 2006 at 12:07 pm | | Reply

    The SD theory absolutely makes sense to me; however, are there any scientific studies correlating BG SD with complications?

  4. Johnboy
    Johnboy May 3, 2006 at 12:17 pm | | Reply

    I missed all those SD posting you did earlier. Makes sense to me too and i’m a statistics nut anyway. Yeah, weird…I know.

    Anyway, the software I use with my meter spits that out so I don’t have to calculate it manually.

  5. Paul
    Paul May 4, 2006 at 10:35 am | | Reply

    findings correlating Mean Amplitude of Glucose Excursions with superoxide radical (the molecule released during hyperglycemia that destroys blood vessels and causes long term complications) were published in the JAMA (journal of the american medical association) in April. Go to the jama website and search for MAGE, superoxide, and diabetes

  6. Aetiology
    Aetiology May 9, 2006 at 3:37 am | | Reply

    Grand Rounds n.2 v.33

    Welcome to Grand Rounds at Aetiology! Grab a cup of joe, take a seat, and enjoy the best of this week’s medical blogging. Just make sure to wash your hands when you’re done…you never know what’s lying around here, between…

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