ISPAD 2019 (International Society for Pediatric and Adolescent Diabetes)

October 30 - November 2, 2019; Boston, MA; Preview – Draft

Executive Highlights

  • The 45th annual meeting of the International Society for Pediatric and Adolescent Diabetes (ISPAD) takes place October 30 – November 2 in Boston, Massachusetts. Register for the conference here, and see the full scientific program here and the industry program here.

  • The conference begins Wednesday with a great mix of both diabetes technology and therapy content. In technology, we will hear about implementing automated insulin delivery technology and overcoming barriers to uptake and continued use. In therapy, Drs. Bruce Perkins, Chantal Mathieu, and Simeon Taylor will dive into the pros and cons of SGLTs in pediatric diabetes care – a can’t miss session!

  • Thursday will feature a plenary session focused on beyond-A1c, with speakers Drs. Roy Beck and Barbara Anderson. Later in the day, we’ll also attend a clinical science symposium on CVD risk in pediatric populations, a Lilly sponsored session on Baqsimi (nasal glucagon), and a Medtronic sponsored symposium on real-world experiences with the MiniMed 670G system.

  • On Friday, Dexcom will hold a symposium with updates on the SENCE and CITY studies of Dexcom G5 in 2-8 year olds and 14-<25 year olds, respectively. The two six-month, randomized studies comparing BGM and CGM both read out at ADA 2019 and added to the body of evidence supporting CGM’s effectiveness in type 1s of all ages. Notably, in the CITY study, both the BGM and CGM groups were put on Dexcom G6 for six-months after the study. We are interested to see how the move from G5 to G6 improves clinical outcomes, and how much the BGM improves with the jump straight to G6.

We’re packing our bags and shipping off to Boston, where the 45th annual International Society for Pediatric and Adolescent Diabetes (ISPAD) Conference will be taking place. The meeting will run from October 30th – November 2nd and is packed with sessions covering diabetes therapy and technology alike. We were fortunate to be able to speak conference co-president, Joslin Diabetes Center’s Dr. Lori Laffel, about the conference program. The main topic of the conference is that the future of diabetes starts now, and all plenary and symposia sessions were planned with an interdisciplinary focus tying together basic science, clinical science, and translation to clinical care. See session titles denoted with an asterisk for the ones she is most looking forward to, as well as our own personal picks from the agenda. Check out the full scientific program here, industry program here, and be sure to register here!

Wednesday, October 30

  • (11:00 AM – 12:30 PM, Grand Ballroom) Education Symposium: Implementing Technologies and Overcoming Barriers to Use. ISPAD will kick off on Wednesday with BDC’s Laurel Messer discussing implementing automated insulin delivery. We’re excited to potentially hear more on Ms. Messer’s CARES (Calculate, Adjustment, Revert, Education, Sensor) paradigm for understanding AID systems. Dr. Bärbel Aschemeier (Diabetes-Zentrum für Kinder und Jugendliche) will touch on the role of family education about technology, and lastly, renowned diabetes psychologist Dr. Korey Hood (Stanford University) will speak on barriers to technology uptake and durable use.

  • (3:45 PM – 5:15 PM, Grand Ballroom) Clinical Science Symposium: SGLT Inhibitors – Do They Have a Role in Pediatric Diabetes Care? Dr. Bruce Perkins (Mount Sinai Hospital, Canada) will start off the session with an overview of the mechanism of action of the SGLT drug class and its potential for use in both type 1 and type 2 pediatric diabetes. Next, we will hear Dr. Chantal Mathieu (Katholieke Universiteit Leuven, Belgium; who was also an esteemed panelist at The diaTribe Foundation’s Solvable Problems event at EASD 2019!) discuss findings from clinical studies on the use of SGLT inhibitors in type 1 diabetes. Dr. Simeon Taylor (University of Maryland School of Medicine, United States) will close out the session with a cost-benefit analysis of SGLT-use in pediatric populations. The SGLT class was a topic of focus at EASD 2019, with sessions advocating for broader use, potential as a combination therapy, and more prescriptions for people with type 1 given the class’s CV and renal benefits. As these conversations have centered on adults with type 1 and 2, we are curious to see what KOLs think about the class for younger patients  -- for example, at EASD 2019, we heard Dr. Thomas Danne advocate for the class’ use in pediatric patients. Presumably this would be on a case-by-case basis, where patients could be well-trained in risk management.

  • (3:45 PM – 5:15 PM, Constitution Ballroom) Clinical Symposium: Going Beyond Routine Care. In this session, we will hear from distinguished speakers on managing diabetes with diet, remote care visits, and apps. The session will begin with a presentation from Dr. Olga Kordonouri (Hannover Medical School, Germany) on proteins and fats’ effects on insulin management. In an era of carb-centric diet changes, it will be necessary to discuss how other dietary staples can help or hinder glycemic control. We will then hear from Dr. Jennifer Raymond (Children’s Hospital of Los Angeles, United States) on implementing remote care visits as an added support to making any lifestyle changes suggested by clinicians. The session will conclude with a talk from our own Kelly Close on opportunities in taking charge of personal diabetes management using apps, virtual visits, and more.

Thursday, October 31

  • (9:00 AM – 10:30 AM, Grand Ballroom) Plenary Session II: It’s Not Just About A1c. In this session, we will learn about glycemic outcomes beyond A1c, as well as beyond glycemic control in general, from Drs. Roy Beck (Jaeb Center for Health Research, United States) and Barbara Anderson (Baylor College of Medicine, United States), respectively. Though we have no further information on what these outcomes may be from the conference program, we can assume time-in-range will be heavily discussed. Dr. Beck has discussed time in range based on DCCT trial data in the past, but this analysis (published in Diabetes Care) does not answer whether outcomes differ greatly once time-in-range levels supersede 70%, 80%, and 90%. With this, Dr. Richard Bergenstal recently urged for time-in-range to become standard in glucose monitoring at EASD 2o19. As CGM use becomes mainstream and partnerships between technology and pharmaceutical companies become more common (see Novo Nordisk’s recent partnership with Medtronic), time-in-range may become standard in clinical practice earlier than we expect.

  • (11:00 AM – 12:30 PM, Constitution Ballroom) Clinical Science Symposium: CVD Risk, an Often-Overlooked Pediatric Concern (Presented by the European Society for Pediatric Endocrinology). Dr. Kristen Nadeau (Children’s Hospital Colorado, United States) will begin the session with a talk on insulin resistance in type 1. What we know about insulin resistance is constantly changing with new data, and its links to CVD are becoming more clear. Next, Dr. Loredana Marcovecchio (University of Cambridge, United Kingdom) will discuss updates from the AdDIT trial, which sought to explore risk for kidney, eye and cardiovascular disease during puberty, and if ACE inhibitor and statin could reduce development of vascular complications in young people with type 1 diabetes. Topline results have been published in NEJM and show that ACE inhibitor and statin use did not change albumin-to-creatinine ratio overtime. As these findings are over two years old, we’re curious to hear new updates. Lastly, we will hear from Dr. Michelle Katz (Joslin Diabetes Center, United States) on pediatric CVD risk and clinical inertia.

  • (11:00 AM – 12:30 AM, Constitution Ballroom) Clinical Science Symposium: Current Thinking about Microvascular Complications. Given the great focus on diabetes complications in adult populations, we are happy to see that this same topic is also being emphasized in younger populations. If potential complications are addressed early, prevention and delay of complications is much more possible in later years. Dr. Petter Bjornstad (University of Colorado, United States) will focus on predicting, preventing, and treating renal complications, while Dr. Jenny Sun (Joslin Diabetes Center, United States) will focus on the same for eye complications. The session will wrap up with Dr. Yoon Hi Cho’s (University of Sydney, Australia) thoughts on the diagnosis and management of autonomic neuropathy.

  • (11:00 AM – 12:30 PM, Grand Ballroom) Exercise Symposium: How and Why Exercise Matters. In one of the most interesting top-down sessions of the conference, different researchers and physicians will present the science behind exercise. Dr. Laurie Goodyear (Joslin Diabetes Center, United States) will begin the session with a talk on exercise science covering cells, organ systems, and human physiology. Next, Dr. Michael Riddell (York University Toronto, Canada) will take it one step further with a presentation on exercise physiology and how it differs between trained and untrained athletes. Dr. Elizabeth Davis (University of Western Australia, Australia) will tie the session up with the clinical applications of exercise in pediatric type 1.

  • (12:45 PM – 2:15 PM, Republic Ballroom) Baqsimi (Glucagon) Nasal Powder 3mg is now Approved! (Sponsored by Eli Lilly). Excitement is high for Baqsimi since it received FDA approval earlier this summer as the first-ever non-injectable rescue glucagon. We will hear from Drs. Thomas Danne (Hannover Medical School, Germany), Jeff Hitchcock (Children with Diabetes, United States), and Teresa Pearson (AADE, United States) in this symposium. They will discuss common experiences of caregivers in severe hypoglycemic events and Baqsimi’s use and application in these scenarios. This year at AADE, we loved learning about compelling data on the ease of use and overall satisfaction of nasal glucagon versus its injectable counterpart. In a study that mimicked real life situations with a high-fidelity manakin in a severe hypoglycemic event, 90.3% of trained nasal glucagon users were able to administer medication successfully, while only 15.6% of injectable glucagon users were able to do so. In a follow-up study, 90% of untrained users were even able to successfully administer nasal glucagon, while none were able to successfully administer the injectable. With Baqsimi having been on the market for about a month now, we’re curious if Lilly will include any testimonials from early users in their presentation.

  • (3:45 PM – 5:15 PM, Grand Ballroom) Clinical Science Symposium: Obesity and Type 2 Diabetes. Given the unfortunate trends on childhood obesity presented recently in the Robert Wood Johnson Foundation’s 2018 State of Childhood Obesity report, a session devoted to childhood obesity is warranted. The first presentation will be given by Dr. Thomas Inge (Cincinnati Children’s Hospital, United States) and center on the potential reversal of type 2 diabetes with results from the TEENLabs study. TEENLabs compared surgical and medical therapies for adolescents with type 2, finding that bariatric surgery provided effective weight loss that persisted for at least three years in participants with severe obesity. We will next hear from Dr. Silva Arslanian (Children’s Hospital of Pittsburgh, United States) with updates from the RISE and TODAY studies. As a reminder, RISE sought to determine if pharmacologic therapy can preserve or improve beta cell function in adults recently diagnosed with type 2, but found no improvement in beta cell function or sustained weight loss among the groups studied. TODAY sought to create population-level statistics for type 2 diabetes in youth, and found that the cohort showed increased cardiovascular, renal, microvascular, and pregnancy risks/complications. The session will wrap with Dr. Jill Hamilton’s (SickKids, Canada) talk on practical management of childhood obesity and type 2 diabetes, which will contextualize highlighted study in clinical practice.

  • (5:30 PM – 7:00 PM, Constitution Ballroom) Global Real-World Experience with MiniMed 670G System (Sponsored by Medtronic). Medtronic will host a corporate symposium on Thursday evening on real-world experiences with the MiniMed 670G system. Medtronic last shared real-world data on MiniMed 670G in May from ~120,000 users. When users were in Auto Mode, they were able to achieve a time-in-range of 71%, almost identical to the 72% time-in-range achieved in 670G’s adult pivotal. In Medtronic’s pipeline, MiniMed 780G’s pivotal trial has likely finished recruiting and the system is expected launch by April 2020, with a lower blood glucose target of 100 mg/dl, no juggling between Auto and Manual Modes, automated correction boluses, and no meal announcements.

Friday, November 1

  • (12:45 PM – 2:15 PM, Constitution Ballroom) Real Time CGM as the Standard of Care for Glycemic Improvements in Pediatrics: Updates with the SENCE and CITY Studies (Sponsored by Dexcom). Joslin’s Dr. Lori Laffel will chair the Dexcom symposium, which will feature updates on the SENCE and CITY studies of CGM in pediatrics. The six-month, randomized CITY trial (n=153) using Dexcom G5 in teens and young adults (14-<25 years) and the six-month, randomized SENCE study (n=143) using Dexcom G5 in 2-8 year olds both read out at ADA 2019. Both studies added on to the building body of evidence supporting effectiveness of CGM at improving time-in-range, A1c, and hypoglycemia in all type 1s. After the CITY study ended, both the BGM and CGM groups wore Dexcom G6 for an additional six months. Participants in the CGM group will be assessed for the durability of use and sustainability of glycemic benefits. It will also be interesting to see how the move from G5 to G6 improves clinical outcomes, and how much the BGM improves with the jump straight to G6. Those in the BGM group will be evaluated for glycemic benefits and preferences regarding CGM alerts/alarms.

  • (3:45 PM – 5:15 PM, Grand Ballroom) ATTD Session - Technologies and Diabetes: Where are we Today? Drs. Tadej Battelino (University of Lubljana, Slovenia) and Mark Sperling (University of Pittsburgh, United States) will chair a 1.5-hour overview session on the current state of diabetes technology. The renowned Dr. Lori Laffel (Joslin Diabetes Center, United States) will present on diabetes decision support systems. Data integrations between CGM and connected insulin pens were all the rage at EASD, with partnerships between Abbott/Sanofi and Medtronic/Novo Nordisk announced on the first day of the conference. On the provider decision support side, Dreamed’s Dr. Revital Nimri and University of Colorado’s Dr. Greg Forlenza will present results from the Advice4U study. Advisor Pro received CE Mark and FDA clearance for Advisor Pro using BGM-only data just last month. Lastly, Dr. Natasa Bratina (University of Lubljana, Slovenia) will close the session out with a discussion on the impact of diabetes technology on children when they are in school.

Saturday, November 2

  • (8:00 AM – 9:30 AM, Grand Ballroom) Plenary Session IV: Prediction, Prevention, and Interdiction of T1D. In this session, we will hear updates from two large type 1 delay and prevention studies: EXTEND and TEDDY. Dr. Carla Greenbaum (Benaroya Research Institute, United States) will start with a presentation of the primary results of the EXTEND study, which tested whether tocilizumab can preserve functioning beta cells in those recently diagnosed with type 1 diabetes. To date, teplizumab is the only compound to delay type 1 diagnosis (by ~two years!) in those without diabetes. We can imagine we are close to developing a compound that can slow progression of type 1 post-diagnosis and hope to hear good news from EXTEND. Next, we will hear from Dr. Marian Rewers (University of Colorado, United States) with an update from TEDDY data on the triggers and promoters of beta cell autoimmunity. We recently heard a new analysis of TEDDY data at EASD 2019, which showed genetic trends in onset of type 1 and a potential viral link to insulin autoimmunity.

  • (9:45 AM – 11:15 AM, Grand Ballroom) Nutrition Symposium: Controversies and Considerations. Given the uncertainty among the best dietary patterns for managing diabetes, we are always on the lookout for talks that will challenge our thinking. This symposium does just that, with multiple views on carb intake and its effect on diabetes. The session begins with a talk from Dr. Belinda Lennerz (Boston Children’s Hospital, United States) on the assumed benefit of very low carb diets in type 1 diabetes. Next, we will hear from Dr. Carmel Smart (Hunter Medical Research Institute, Australia) on the challenges of low carb diets in type 1 diabetes. Lastly, we will hear from Dr. Laurie Higgins (Joslin Diabetes Center, United States) on how CGM and trend arrows can help with bolusing for carb intake via automated insulin delivery.

  • (11:45 AM – 1:15 PM, Grand Ballroom) Plenary Session V: Closing the Loop (Presented by JDRF). ISPAD will close out with a 1.5-hour session sponsored by JDRF on automated insulin delivery. Harvard engineering professor Dr. Eyal Dassau were present on human factors design advances in closed loop devices. Dr. Roman Hovorka (University of Cambridge) will give an overview of closed loop studies in children and adolescents, while Tidepool’s Brandon Arbiter will close out with a presentation on DIY approaches. With Insulet’s Omnipod DASH getting ACE pump approval, an interoperable ecosystem of closed loop devices is developing faster than most of us had anticipated! An “iController” pathway for AID algorithms will be the last step needed for the complete plug-and-play, mix-and-match vision to be a reality. Tidepool (and potentially Tandem/Dexcom with Control-IQ) are working on this de novo pathway with the FDA.

                                                                                                                                                      

--by Ursula Biba, Albert Cai, Martin Kurian, and Kelly Close