ate last year when I was offered the opportunity to attend the 76th ADA Scientific Sessions, of course I said yes. I decided my goal would be to seek out the newest information and research and share it with my AADE colleagues. I just completed my first day of sessions on Friday. There was SO much information. This will be difficult to try and be brief and just hit the highlights.
My first session was Preventing Diabetic Foot Ulcers (DFUs). DFUs are now considered an epidemic affecting an estimated 371 million people worldwide. The presenter stated that treating DFUs costs more than all cancer therapies combined and that 85 percent of DFUs are preventable. The seven major areas that must be observed, measured and managed are foot temperature, exercising the foot, utilization of appropriate insoles, wearing properly fitted shoes, reducing foot shear, patient adherence to proper foot care and reduction of pressure points. There are many new technologies available to assist with improving foot care, such as smart insoles which measure pressure points or shear pressure sites and then send a message to the patient’s smart phone so they can take corrective action.
I think the most interesting point made was the importance of properly tying their shoes. The presenter noted that due to neuropathy, many people with diabetes often tie their shoes too tight creating pressure, or they tie their shoes too loose allowing their shoes to rub. Researchers are looking at a pressure gauge of sorts, similar to what snowboarders use to assure proper fit of their boots. Also, just using a simple mirror to best observe the bottom of their feet is an important tool that all patients can use.
The number one point made was that Metformin is not metabolized in any organ of the body. It is excreted by the kidneys unchanged.
My next session was on the repurposing of Metformin. The number one point made was that Metformin is not metabolized in any organ of the body. It is excreted by the kidneys unchanged. Many physicians commented that patients continue to tell them their Metformin was discontinued because it was “harming” their kidneys. This is incorrect information. There was conversation around the more liberal restrictions recently released by the FDA. If you are not familiar with the new guidelines, you need to do some research. Also, research continues on the correlation between cancer and Metformin.
I was able to attend a press conference on beta cell replacement. One researcher presented on his work using pig islet xenotransplantation. It is his opinion that there are not enough cadaver islet cell donors to meet the huge number required to treat people with diabetes. He is working on genetically engineered pigs which will be raised in bio-secure housing to protect the islet cells from any immunogenecities. He believes adequate numbers of pigs can be raised to provide plenty of beta cells to transplant. He also stated that the typical procedure of injecting the islet cells into the portal vein is incorrect. His research has shown it is better to inject islet cells into the sub-mucosa of the stomach.
The other researcher is working on developing universal donor stem cells. His research is looking at embryonic cells which can be taught to be pancreatic beta cells. He believes it is possible to make 300 million cells in a flask – a much more efficient way of growing the vast number of islet cells needed for all people with diabetes.
They both agreed that the beta cell is the problem – they disagree on the best way to obtain more beta cells.
More information to follow on Saturday sessions.
About the Author
Barbara Walz is an RN, BSN and has been a certified diabetes educator since 1986. Since 2000, Barbara has coordinated a multi-site diabetes study examining the macro-vascular effects of diabetes at the South Texas Veterans’ Healthcare System under the supervision of Dr. Ralph DeFronzo.