IDF (International Diabetes Federation) Congress

December 4-8, 2017; Abu Dhabi, UAE; Preview – Draft

Executive Highlights

December 4-8 – Abu Dhabi National Exhibition Center – Abu Dhabi, UAE

Agenda

Registration

Conference Website

The International Diabetes Federation (IDF) 2017 Congress will take place December 4-8, 2017 in Abu Dhabi, UAE. The program is split into nine streams, hitting diabetes therapy, technology, policy, and integrated care. Be sure to check out the IDF 2017 mobile app available for Android and iOS, which includes full session details, speaker information, maps, and more.

We’re particularly excited to hear a debate on whether SGLT-2 inhibitors should be considered first-line therapy. This drug class was certainly a hot topic at EASD, and it will be interesting to see how recent clinical trial results have shaped international perspectives. Also on the agenda is a new analysis of the EXCSEL trial of AZ’s GLP-1 agonist Bydureon (which missed superiority for cardioprotection by a razor-thin margin at EASD) revealing an imbalance in the use of open-label drop-in diabetes medications during the trial. We’re also thrilled that our very own Ms. Kelly Close and Mr. Adam Brown will be speaking at the gathering. Ms. Close will chair a panel on hypoglycemia, providing her unique patient perspective on the importance of considering outcomes beyond A1c, and Mr. Brown will be highlighted in a “Meet the Expert” session, where he will discuss the latest in diabetes technology, digital health, and what matters to patients. Other notable speakers include OpenAPS’s Ms. Dana Lewis, Montpellier’s Prof. Eric Renard, Prof. Simon Heller from the International Hypoglycemia Study Group, and International Consortium for Health Outcomes Measurement (ICHOM) President Dr. Christina Akerman.

Scroll down for a list of some of the most notable sessions coming up at IDF 2017, listed day-by-day. You can also take a look at the conference website, agenda, and register for the meeting here. While you’re waiting for December to roll around, peruse our IDF 2015 Full Report, or even our 2013 Highlights from Days 1, 2, 3, 4, and 5! We’re so excited to be going back to this bi-annual conference – let us know if you’ll be attending too!

P.S. The IDF Atlas was just released, and will be featured in a session at the Congress!

Tuesday, December 5

  • (10:00 – 11:30 AM) Symposium: Synergism through Combination: Which Drugs Should Be Used? In this symposium, we look forward to hearing discussion of combination therapy, namely GLP-1 agonists with DPP-4 inhibitors, SGLT-2 inhibitors, and medications to address insulin resistance. On the GLP-1/DPP-4 front, the combination of two incretin based therapies in intriguing, though not well studied, and it’s unclear whether DPP-4 inhibitors can give already-efficacious GLP-1 agonists a boost. On the GLP-1/ SGLT-2 front, AZ’s DURATION 8 trial has demonstrated compelling benefits with the combination of Bydureon (exenatide once-weekly) and Farxiga (dapagliflozin), and this data is now included on both products’ labels as the first combination therapy indication of its kind. That said, thought leaders such as Dr. John Buse have emphasized the need for caution and a better understanding of this combination – particularly due to these agents’ differential effects on glucagon and the sub-additive effects on glycemia seen in DURATION 8. This is sure to be an informative session, and we’ll certainly be grabbing seats early!
  • (1:15 – 2:45 PM) Symposium: Global Increase in Type 1 Diabetes: New Estimates. The incidence of type 1 diabetes is growing at 3-5% per year. The reason for this is thought to be environmental exposure, since this increase in prevalence is occurring in those with lower-risk genotypes. Dr. Jill Norris (University of Colorado, Aurora, CO) will shed light on this issue, while the Kuwait Diabetes Society’s Dr. Hessa Alkandari will present data showing that the incidence of type 1 diabetes in Kuwait has doubled in the last two decades. We’ll also hear from Dr. Lars Stene (Norwegian Institute of Public Health, Oslo, Norway) on the worldwide incidence of type 1 diabetes in youth, how rates have changed globally, and what they can tell us. We’re so looking forward to getting this macro-level perspective on just who type 1 diabetes is affecting.
  •  (1:15 – 2:45 PM) Symposium: Digital Health and Modern Technologies. Director of the University of Michigan Center for Managing Chronic Disease Dr. John Piette will delve into novel strategies to integrate digital health with peer and family support in disadvantaged groups. He’ll be discussing fascinating results from several randomized controlled trials conducted in Central and South America (where diabetes is expected to shoot up by 62% by 2045), as well as the US, and will be touching on ways to leverage AI and machine learning. Also in this session, Dr. Ambady Ramachandran (India Diabetes Research Foundation) will detail a large-scale feasibility study using SMS to screen, categorize, and motivate people with or at-risk for type 2 diabetes. Of the 130 million people reached, nearly 1.1 million were screened and categorized – 21.4% had diabetes and 5.3% were at high risk. However, by the end of the 6th month, only 578 people had responded to the researchers’’ self-evaluation questions, reflecting a very high rate of attrition. The program successfully screened a large number of people (though not even 1% of the targeted population), but a large number of people dropped off in a short amount of time – how can text interventions be made more (i) scalable and (ii) personal/engaging? We’re glad groups are working to answer these questions, because India needs a scalable answer to diabetes now – IDF projects that India will accrue 61 million more people with diabetes in under 30 years at this rate. We’ll also hear perspective from Oman and Senegal.
  • (1:15 – 2:00 PM) Debate: Should SGLT-2 Inhibitors Be the First-Line Therapy for Type 2 Diabetes? We recently heard the argument that SGLT-2 inhibitors should be first-line therapy in patients with heart failure at EASD, and we certainly agree that the CV benefits associated with both Jardiance in EMPA-REG OUTCOME and Invokana in CANVAS are compelling. Moreover, SGLT-2 inhibitors are an appealing new-generation drug due to their patient-friendly oral formulation – but should they be first-line for all patients? Dr. Guntram Schernthaner (Rudolfstiftung Hospital Vienna, Austria) will argue that metformin provides superior A1c lowering and similar weight loss to SGLT-2 inhibitors, while also being safer and cheaper. On the contrary, Dr. Andre Scheen (French Society of Diabetes, France) will argue that the CV benefits associated with SGLT-2 inhibitors, not to mention their effects on glycemia, insulin sensitivity, weight, and beta cell function, make them viable first-line candidates, though cost is certainly a limiting factor. We’ve seen the discussion over drug treatment algorithms burn hotter this year, and we’re so looking forward to a focused debate on the issue.
  • (2:00 – 2:45 PM) Meet-the-Expert: Incretins and Their Pleiotropic Effects. The esteemed Dr. Tina Visbøll (Steno Diabetes Center, Copenhagen, Denmark) will review the cardiovascular actions of incretins, while Dr. Yuichiro Yamada (Akita University, Japan) will do the same for the renal effects of incretins. Dr. Visbøll will consider the multi-faceted effects of GLP-1 agonists (touted as targeting at least six of eight organs in the ominous octet), but also the differences between members of the GLP-1 agonist class, noting that reduction of CV risk factors does not always lead to improvements in CV outcomes. We’ll be looking for any light she might shed on a mechanistic link between GLP-1 agonists and CV outcomes, or commentary on whether or not cardioprotection could be a class effect.
  •  (3:15 – 4:00 PM) Debate: Diabetes Technology – We’re Not Waiting vs. Why Are We Waiting. In what is sure to be a passionate debate, Ms. Annabel Astle, founder of The Understudy Pancreas blog, and Ms. Dana Lewis, co-founder of OpenAPS, will go head to head on the #WeAreNotWaiting movement (Ms. Lewis naturally arguing for the pro side). Any counterpoint will likely have to do with safety of un-regulated DIY systems, but we always point out that dosing insulin the traditional way isn’t so safe itself, and the more DIYers can push industry to meet patient needs at scale, the better. Plus, these systems have been game changing for countless people, including Kelly and Adam! JDRF recently launched an initiative to accelerate “open protocol” automated insulin delivery, a major win for the DIY movement – momentum for this movement is only going in one direction, forward. We last heard her Ms. Lewis speak at AADE regarding the ongoing efforts of the DIY diabetes tech community.
  • (3:15 – 4:45 PM) Symposium: Peer Support: Applications and Approaches. Dr. Zilin Sun, Vice Dean of China’s Southeast University Medical School, will discuss the results of training over 500 physicians and nurses to develop peer support, while Dr. Michele Heisler, Professor of Medicine at the University of Michigan, will detail current research evidence on various peer support models in diabetes prevention and management in the US. Dr. Albert DeTerville will speak to traditional medicine in the Caribbean, and Dr. Felix Assah will discuss peer support practices in Africa. We’re constantly reminded of the value of peer support in diabetes management – having others “in it” with you reduces isolation, and therefore depression/learned helplessness, and offers a motivational network that many digital health companies are working hard to capture. At AADE, we attended an inspiring panel detailing the ways social support networks can help improve diabetes outcomes.
  • (3:15 – 5:15 PM) Symposium: Latest Diabetes Clinical Trials. This symposium will feature two new, big-picture trials; we’re particularly looking forward the presentation of 12-month outcomes data from the Diabetes Remission Clinical Trial (DiRECT, n=280), which was designed to show what proportion of people with type 2 diabetes can re-achieve a non-diabetes A1c level. The active group stopped all diabetes and blood pressure medications and were put on an intensive, three-phase weight management program. We expect that this program could be successful in a very specific, highly-motivated patient population, but we’re excited about the potential impact of these results and the light it will shed on resetting metabolism. We’ll also hear results from the DISCOVER program, examining worldwide treatment patterns and outcomes in patients with type 2 diabetes initiating second-line therapy. 
  • (4:00 – 4:45 PM) Meet-the-Expert: Diabetes Tools and Apps – What’s New, What Works, and What Do Patients Really Want? Our very own Mr. Adam Brown will take to the stage to discuss his take on all things technology in a Meet-the-Expert session. Mr. Brown frequently espouses that technologies/apps must reduce steps and add value in order to be adopted widely. This isn’t limited to the product, as he is also a proponent of business model innovation, shifting to subscription service model that reduces patient/provider prescription load, as well as the burden of seeking out the right management tools at the right time. There is more than enough innovation on both the product and business model fronts to occupy 45 minutes, so expect this one to be jam-packed with insights. Mr. Brown most recently spoke at AADE, sharing actionable tips and advice for how best to navigate the rapidly accelerating diabetes technology world.  
  • (4:00 – 4:45 PM) Meet-the-Expert: Diabetic Retinopathy: From Screening to Treatment. Following the near single-minded focus on retinopathy risk at the FDA’s recent Advisory Committee for Novo Nordisk’s GLP-1 agonist candidate semaglutide – ultimately resulting in a 16-0 vote in favor of approval – we’re eager to hear Dr. Mingguang He (University of Melbourne, Australia) discuss the gap in screening for diabetic retinopathy, which was widely emphasized at the semaglutide AdComm. He’ll argue that while treatments have advanced, screening must be more widely implemented. We couldn’t agree more, and hope that Dr. He will shed light on how to better scale this essential aspect of diabetes care.

Wednesday, December 6

  • (8:00 – 8:45 AM) Launch Session: IDF Diabetes Atlas – The Global Burden of Diabetes. In this highly anticipated session, Dr. Nam Cho from the Ajou Univerity School of Medicine in South Korea will present the latest edition of the IDF Diabetes Atlas. At IDF 2015, we were struck at how much the US disproportionately contributes to global spending on diabetes – 48% of all global dollars spent on diabetes comes from the US, despite having 7% of global cases. This has not changed in the 2017 Atlas – the US now accounts for $348 billion of the $727 billion global spend. It’s important to remember that diabetes is truly a global epidemic with staggering geographic inequity; at IDF 2015, we learned that one in four people with diabetes lives in North America and Europe, although the combined region spends an astonishing two of every three healthcare dollars on diabetes. Designing effective solutions for these disparities requires a multidisciplinary approach, and we hope to learn more at this year’s IDF on how best to tackle these issues.
  • (8:00 – 8:45 AM) Meet-the-Expert: Low Carbohydrate Diets and Other Dietary Approaches – Is There a Best Diet for Diabetes? Dr. Tatjana Milenkovic from the Clinic of Endocrinology, Diabetes and Metabolic Disorders in Macedonia will discuss the merits of low-carbohydrate diets for type 1 and 2 diabetes. It seems like every major diabetes organization has its own nutrition recommendations, so we’ll be interested to see if Dr. Milenkovic will provide any actual clinical data investigating an optimal diet for diabetes. We’d guess that there’s no clear-cut answer here – there remains so much to be learned about nutrition in diabetes, and as of now it seems that a tailored approach to the individual is probably most effective. Also in this session, Dr. Inass Shaltout, Professor Internal Medicine & Diabetes in Egypt, will detail cultural adaptations of the popular Mediterranean diet.
  • (8:00 – 9:30 AM) Symposium: Value Health Care in Diabetes and Real-Life Evidence. At AADE 2017, Joslin’s Dr. Robert Gabbay gave a remarkably well-received talk on what value based care will look like in diabetes as the nation shifts away from a fee-for-service reimbursement paradigm. Now, International Consortium for Health Outcomes Measurement (ICHOM) President Dr. Christina Akerman will discuss the diabetes Standard Set of core outcomes developed with the Imperial College London Diabetes Center and JDRF. We’ll also hear presentations on population health and real-world evidence on value based care, as well as on the value and methods of real life evidence in diabetes.
  • (1:15 – 2:45 PM) Symposium: Diabetes and Technology. Montpellier University’s respectd Prof. Eric Renard will detail both the successes and limitations of closed-loop systems. As a reminder, the MiniMed 670G/Guardian Sensor 3 is the only hybrid closed loop system currently on the market, but there are several ongoing trials, and Prof. Renard is a staunch advocate for IP insulin delivery. See our automated insulin delivery competitive landscape for an overview. Radboud University Medical Center’s Dr. Cornelis Tack will discuss the complex field of digital health, attempting to reconcile the commercial success of mobile health tools with their relative lack of evidence-based research. While a dearth of trials is commonly cited as reason to be wary of digital Health benefits, we’d note that apps like One Drop, Livongo, Virta, and MySugr have all pushed out compelling data (though Virta is the only one to have run a prospective RCT, something many healthcare startups can’t do due to expense and time). We wonder if Dr. Tack will take a perspective similar to that expressed in a panel of physicians at EASD: fearful of the potential for digital Health utilization to go awry, yet still cautiously optimistic.
  • (3:15 – 5:15 PM) Symposium: Latest Cardiovascular Clinical Trials. This symposium will take a deep dive into DEVOTE results, which excitingly demonstrated an impressive 40% relative risk reduction in severe hypoglycemia with Novo Nordisk’s Tresiba (insulin degludec) vs. Lantus. We’re particularly excited for Dr. Thomas Pieber’s (University of Graz, Austria) explorative subgroup analyses and discussion of how hypoglycemia, glycemic variability, and outcomes are related. In addition, past AACE president Dr. Helena Rodbard will provide a clinical perspective on the groundbreaking results. Continuing the CVOT theme, Dr. Angelyn Bethel (University of Oxford, UK) will present new insights from the EXCSEL CVOT of AZ’s Bydureon (exenatide once-weekly) – which missed superiority for three-point MACE by a razor-thin margin (HR=0.91, 95% CI: 0.83-1.00, p<0.001 for non-inferiority, p=0.06 for superiority). We look forward to her presentation of a new analysis revealing an imbalance in the use of open-label drop-in diabetes medications during the trial, showing that more patients in the placebo group received additional antihyperglycemic medications. Finally, the highly-regarded Dr. Rury Holman (University of Oxford, UK) will give new insight on the ACE CVOT, which showed no evidence of cardioprotection with alpha-glucosidase inhibitor acarbose (Bayer’s Glucobay), but did excitingly demonstrate an 18% relative risk reduction for the development of new-onset diabetes in a population of people with prediabetes.

Thursday, December 7

  • (8:00 – 9:30 AM) Symposium: Prevention Trials: Update. If you’re seeking for an international perspective on diabetes prevention, look no further than this session. Dr. Guangwei Li (China-Japan Friendship Hospital, Beijing, China) will review the Da Qing trial, begun with 577 participants in 1986 and eventually demonstrating the legacy effect of a six-year lifestyle intervention period on diabetes prevention, CVD, and mortality several decades later. Dr. Markku Peltonen (Department of Chronic Disease Prevention, Finland) will do the same for the similarly-conducted Finnish Diabetes Prevention Study, and Dr. Trevor Orchard (University of Pittsburgh, PA) fill close the session with findings from the US DPP Outcomes Study.
  • (1:15 – 2:45 PM) Symposium: New Insulins and Innovative Insulin Delivery. Dr. Hannele Yki-Jarvinen (University of Helsinki, Finland) will kick things off with a discussion of new short- and long-acting insulins, which we expect to heavily feature next-gen basal insulins Novo Nordisk’s Tresiba (insulin degludec) and Sanofi’s Toujeo (insulin glargine U300), as well as Novo Nordisk’s recently FDA-approved ultra rapid-acting Fiasp (faster-acting insulin aspart). These new basal insulins have longer and flatter time-action profiles, greatly reducing hypoglycemia risk, while Fiasp allows for more flexible mealtime insulin dosing. Next up, Dr. Jothydev Kesavadev (Jothydev’s Diabetes & Research Center, Insulin Pumps & CGM, India) will review insulin delivery methods, where they’ve been, and where they’re going, including closed loops and dual hormone systems, and new formulations like oral and inhalable insulin. We’ll also hear about how subcutaneous insulin delivery can be improved, as well as factors that lead to variation in insulin absorption.
  • (2:00 – 2:45 PM) Debate: Precision Medicine – Does Genomics Optimize Diabetes Prevention and Treatment? Precision medicine has recently become quite the hot topic in diabetes. At EASD alone, there was an AstraZeneca-sponsored symposium dedicated to precision medicine for type 2 diabetes, an award lecture on precision medicine and diabetes pathogenesis, and a fascinating lecture by Dr. Angus Jones on the UK MASTERMIND consortium and its efforts to leverage precision medicine for the diagnosis and treatment of diabetes. In this debate, Dr. Markus Paulmichl, Director of the Institute of Pharmacology and Toxicology at Paracelsus Medical University, will argue in favor of genomic techniques to optimize diabetes care, while Dr. Valeriya Lyssenko, Professor of Medicine at the University of Bergen in Norway, will take the opposite position. We’ll be very interested to hear these two brilliant leaders dive into the subject.
  • (3:15 – 4:45 PM) Symposium: Hypoglycemia and Time-in-Zone – Wim Wientjens Memorial Symposium. Our very own Ms. Kelly Close will kick off this session, providing a patient perspective on the importance of managing hypoglycemia. We’re so pleased to be seeing outcomes beyond A1c like hypoglycemia and time-in-range getting the attention they deserve – and on a global stage no less! The diaTribe Foundation hosted a Consensus Conference at the FDA on this subject in July, and we were struck by the passion and commitment in the room to better understanding how various therapies work on outcomes beyond A1c, and how to make this a greater focus on the regulatory front.  Dr. Simon Heller of the International Hypoglycemia Study Group will continue the discussion in this vein, detailing the threat of hypoglycemia unawareness and offering a look at the the ways in which this dangerous condition can be reversed. Dr. Heller recently brought his expertise to a panel at ADA dedicated to reaching an international consensus on standardizing CGM outcomes. If his presentation then is any sign of what’s to come, this session is sure to be a treat! 

Friday, December 8

  • (10:00 – 10:45 AM) Meet-the-Expert: Euglycemic Ketoacidosis. Euglycemic DKA – in which ketoacidosis occurs in the absence of severe hyperglycemia – has emerged as the primary safety concern around the use of SGLT-2 inhibitors in people with type 1 diabetes. While thought leaders including Dr. John Buse (University of North Carolina, Chapel Hill, NC), Dr. Julio Rosenstock (UT Southwestern Medical Center, Dallas, TX), and Dr. Ele Ferrannini (University of Pisa, Italy) have consistently characterized this risk as manageable, this remains a topic of debate. At EASD 2017, significant increases in DKA with SGLT-1/2 inhibitor sotagliflozin in Lexicon’s phase 3 inTandem program raised eyebrows, however there was no such signal in AZ’s DEPICT-1 trial of the SGLT-2 inhibitor dapagliflozin in type 1 diabetes (here insulin dose reduction was limited to 20% – seemingly preventing a similar spike in DKA). We’re eager for Dr. Anne Dornhorst’s (Imperial College London, UK) characterization of euglycemic DKA and any insight she might offer on the cause, diagnosis, and treatment of this complication. We are particularly interested in her suggestions for how to educate HCPs and patients about DKA in order to make the risk more manageable, and continue to believe that this is a solvable problem. To this end we are reminded of commentary from Dr. Thomas Danne at EASD: “No one wanted to discontinue insulin because of the risk of hypoglycemia, so I certainly hope SGLT-2 and SGLT-1/2 inhibitor development isn’t hindered by the issue of DKA.”
  • (10:00 – 11:30 AM) Symposium: Language Matters When Speaking To and About People with Diabetes. Professor Jane Speight, Foundation Director of the Australian Centre for Behavioral Research in Diabetes, will explore the language surrounding diabetes today. In October, a Diabetes Care paper from the ADA and AADE detailed the importance of language in diabetes, explaining the rationale for changing certain vocabulary. We’re thrilled to see this topic receiving greater attention, and raising critical awareness of the ways words can shape people’s experiences with diabetes. We’ll also hear from Ms. Betsy Rodríguez, Deputy Director of the CDC’s National Diabetes Education Program, who will speak to the importance of using culturally appropriate resources and tools in diabetes education settings. We’ve noticed that diabetes programs are more likely to be successful when they invest in tailoring to specific populations’ needs: For instance, at Health 2.0 in October, Omada Health emphasized adjusting for differences in health literacy and cultural views on nutrition as critical to the success of its DPP in the Medicaid population.   
  • (1:15 – 2:00 PM) Teaching Lecture: Novel Advancements in Treatments for Diabetic Nephropathy. Dr. Janaka Karalliedde’s (King’s College London, UK) research focuses on new treatment targets and therapies for cardio-renal disease in patients with diabetes. Diabetes is notoriously difficult to treat in patients with advanced nephropathy since so many oral diabetes medications are filtered through the kidney, and diabetic nephropathy itself is an area of severe unmet need in diabetes care. In this teaching lecture, we expect Dr. Karalliedde to focus on evidence suggesting some renal benefit with GLP-1 agonists and SGLT-2 inhibitors, but we’re also curious to see if he mentions any of the many phase 3 candidates in development for diabetic nephropathy.
  • (1:15 – 2:00 PM) Debate: Does a Sugar Tax Affect Obesity Rates? In this debate session, Ms. Charlotte Klausen, Director of Global Public Affairs at the Danish Diabetes Association will argue in favor of a sugar tax, while Dr. Juan José Irazabal Lujambio, President of the Mexican Federation of Diabetes, will take the opposite position. Given recent NHANES data from the CDC reporting a US obesity prevalence of 40% among adults and 19% among youth, it’s now more important than ever to think critically about implementing effective policies to combat the global obesity epidemic. We tend to agree that sugar taxes are an effective measure. As we learned at Obesity Week 2017, preliminary data on the impact of the Philadelphia Beverage Tax found sugar-sweetened beverage (SSB) sales to fall by 57%-66% – wow! Of course it remains to be seen whether the decrease in soda sales translates to a decrease in body weight in a population.

 

-- by Ann Carracher, Maeve Serino, Abigail Dove, Brian Levine, and Kelly Close