Guest blogger, Dr. Curtis L. Triplitt, is a Clinical Associate Professor of Medicine at the University of Texas Health Science Center at San Antonio (UTHSCSA) and works at the Texas Diabetes Institute, San Antonio, TX as a researcher, clinician, and educator.
he 52nd Annual European Association for the Study of Diabetes (EASD) was held in Munich, Germany, September 12-16th, 2016. The Congress Center was filled with attendees from all over the globe as experts gathered to further elucidate controversial diabetes issues and several important studies were released.
Several non-diabetes medication related events and products were of high interest at the meeting.
ADVOCACY: People with Diabetes as Pilots
In 2012, the UK became the second country worldwide, after Canada, to issue insulin-treated individuals with Class 1 Medical Certificates for Commercial Pilot Licences (CPLs). Insulin-treated pilots over about 20 months had to report their blood glucose readings. Just under 9000 readings were done in ~5000 hours of flight. All but 4% of the BG readings were within their stated “safe” range of 90-270mg/dl. The ones recorded outside of the range made the pilot follow an unstated protocol to correct their blood glucose. No instances of safety concerns or pilot incapacitation occurred. Hopefully this will lead to a more serious consideration of well-controlled patients with diabetes for clearance in the U.S.
Freestyle Libre Continuous Glucose Monitoring (CGM) System
The Freestyle Libre CGM System appears to be a great step toward using a CGM to replace meters. Please note- on September 28, 2016 the FDA approved a Freestyle Libre system for health care professionals that does not allow the patient to see any glucose readings- this blog post is about the yet to be approved personal use model. The system uses a small round patch estimated to be the size of a US quarter coin. A small catheter, stated to be virtually painless, is recommended to be inserted just under the skin in the upper arm because the user has to wave or “swipe” the handset over the patch in order to obtain the latest glucose readings on the screen; this also may decrease dislodging events. The patch is water resistant and each “swipe” can also provide the latest 8 hours of glucose reading trends on the screen.
The innovative points about this system are the following:
- It does not need capillary finger stick calibrations.
- It can be worn for 14 days---it actually appears to have a countdown timer so I am not sure the user could wear it beyond the 2 weeks like some users do with the Dexcom systems.
- Start-up is easy- after the sensor is inserted you tap the new sensor on the screen and a countdown begins for 1 hour, after which readings start.
- It has a built-in glucose meter to the hand held reading device for situations where interstitial blood glucose readings may be inaccurate. The handheld reading device appeared to be easy to read and is rechargeable.
The representative stated it usually needs to be charged 1-2 times a week. Overall it appears to be a nice alternative to the full CGM devices currently on the market- this consumer based CGM product is approved in the UK and several other European countries- it may come to the US in 2017.
Accucheck Diaport System
The Accucheck Diaport System is an idea that has been around for a long time, but talking with the representatives made me more excited about this product. This is an intraperitoneal (IP) insulin infusion port for pumps touted for those with SQ set problems- whether it be insulin absorption, skin sensitivity or other issues. IP delivery of insulin can improve absorption onset and make the rapid-acting insulin have a more consistent profile. The downside is that there is not a SQ depot of insulin, and when the pump stops, it can take 15 minutes before the glucose starts to increase. The Diaport system can eliminate the SQ insertion sets. As a negative, it has to be inserted somewhere on the stomach to accommodate the IP part of the internal catheter, and yes, the placement of this titanium port is surgical (about 30 minutes under general anesthesia via the representative). The educator can help the patient decide where to place the port by asking them about:
- Where they wear their pants and move it above this line
- Avoid the car seat-belt line
- Not near the rib cage
- Not at the level where they would bump tables all the time
- Usually it is inserted on the opposite side of the dominant hand (left for right-handed people and vice versa)
The port looks like a small metal button and sits just above the skin. Nicely, if the internal catheter gets clogged it can now be replaced under sterile conditions- no more removing the whole system! Daily cleaning of the site is recommended with clean water- sterile water is not necessary- and a mild soap. The pump tubing attaches directly to the port and will take any rapid acting insulin, though the representative stated that insulin lispro (Humalog) had reported more clogs for the tubing and is not recommended.