Children with Diabetes Friends for Life Conference and Expo (Orlando, July 7-12, 2009)

by sanjay trehan, eric chang and kelly close

Friends for Life, the national Children with Diabetes (CWD) annual conference. As usual, CWD promoted an inspirational ‘we-can conquer-the-world’ philosophy and was supported by a fabulous A-list faculty (Dr. Barbara Anderson, Jen Block, Dr. Bruce Buckingham, Dr. Ed Damiano, Dr. David Harlan, Dr. Francine Kaufman, Dr. Richard Rubin, Dr. Henry Anhalt, Dr. William Polonsky, Dr. Jill Weissberg-Benchell, and Gary Scheiner, just to name a few—see the full list here. While themes centered on the search for a cure, the meeting also had a heavy focus on insulin pumps, continuous glucose monitoring (CGM), and the artificial pancreas, with discussions of both the latest research and perceived obstacles in the FDA approval process. There were also great sessions on the psychosocial aspects of living with diabetes.

updates from the road to a cure

Here at diaTribe, we sometimes refer to the CWD meeting as a “mini-ADA” – referring to the American Diabetes Association annual Scientific Sessions, often the largest and most detail-oriented conference of the year. And this year was certainly no exception.

On the cure-based front, we heard great updates from both Dr. Alberto Pugliese and Dr. Norma Kenyon of The Diabetes Research Institute in Miami. Dr. Kenyon described the many avenues researchers are pursuing to reverse type 1 diabetes, focusing on her specialty, islet cell transplantation (the replacement of lost pancreatic beta cells with donor cells). While initial results have been encouraging – patients have gone two to three years post-transplantation without the need for insulin – patients revert to insulin-dependence in the long-term. Dr. Kenyon noted that this relapse arises from autoimmune processes that destroy the transplanted cells. However, halting these reactions is more involved than with traditional organ transplants, as researchers must combat the general rejection that attacks the foreign donor cells as well as the residual destructive activity responsible for the initial onset of the disease. To tackle both of these processes simultaneously, researchers are using lessons from nanotechnology to design devices to encapsulate and protect the donor cells. Other sources of beta cells, such as from pigs and cultured stem cells, are being pursued as well to address the scarcity of beta cell donors.

Building on Dr. Kenyon’s presentation, Dr. Pugliese described methods to prevent and delay the onset of type 1 diabetes in early-stage and high-risk individuals, a current focus in type 1 research. Much of this work focuses on identifying markers that can help predict the development of this disease. In particular, Dr. Pugliese highlighted the role of autoantibodies, markers that signal the onset of the autoimmune activity responsible for the disease. He noted that the presence of four specific autoantibodies (Znt8A, GADA, IA2A, IAA) can properly identify 98% of type 1 cases at onset, though research is also progressing to find earlier markers that can identify diabetes prior to the triggering of autoimmunity. By identifying these individuals before the onset of type 1 diabetes, researchers may try to treat them before their beta cells are destroyed – one day, high-risk individuals may even be “vaccinated” for the disease, much like with polio or smallpox. However, such vaccines are currently showing limited success, and we still do not have a cure for any autoimmune disease. Dr. Pugliese concluded his presentation with a description of TrialNet, an international network of researchers devoted to finding ways to prevent, delay, and reverse type 1 diabetes, inviting the audience to be screened on-site for future and currently recruiting studies. For more details on TrialNet and potential treatments for type 1 diabetes, check out our dialogue with Dr. Desmond Schatz (head of the TrialNet center at the University of Florida) in diaTribe #15 – and the JDRF Clinical Trials Connection, described in this issue’s New Now Next, is also a excellent resource for anyone looking to be involved in these exciting clinical trials.

the artificial pancreas

Every year we hear more and more discussion on the artificial pancreas, which encourages us to believe that a device-based “cure” for type 1 diabetes is on the horizon – but this year, we even heard some discussion on the more practical issues of FDA approval and reimbursement, making the dream seem even closer to a reality. Both Dr. Edward Damiano (Boston University, Boston, MA) and Dr. Stuart Weinzimer (Yale School of Medicine, New Haven, CT) gave spectacular updates on the research of closed-loop solutions. Dr. Damiano focused on bihormonal systems, which deliver a careful balance of insulin and glucagon to maintain blood sugar levels. Though only carried out for about a day, early trials with the system have shown remarkable success, producing excellent blood sugar control without hypoglycemia (subjects’ average blood glucose level was 128 mg/dl, which would translate to an expected A1c of approximately 6.1%!). Dr. Weinzimer’s group suggested similar results from a 36-hour study using a modified continuous glucose monitor (CGM) and insulin pump system, with subjects spending roughly 80% of the 36 hours within target range and having average blood glucose levels between 130-148 mg/dl. However, in both studies, patients were heavily monitored, and some required outside intervention, indicating more work will be necessary to make these devices truly “input-free.” Dr. Weinzimer noted future studies with the devices will test for efficacy during exercise and during inaccurate CGM readings to further guarantee their safety.

Notably, the FDA had a strong presence at CWD, both through presentations and a booth set up in the exhibit hall – we applaud the agency for being so willing to openly discuss approval and safety issues with these very informed parents. In terms of the artificial pancreas, Arleen Pinkos led a discussion session about predicted complications in the approval and ongoing safety of a closed-loop device. For example, she noted that the components of the artificial pancreas will likely come from a variety of different companies, complicating the approval process – it could also be unclear which piece of the system is responsible for malfunctions. Parents also voiced concern about the “input-free” nature of the system – without the proper education, there is a danger that users will not know how to correct problems with the system. However, Pinkos did express hope for the approval of Medtronic’s Veo (an insulin pump integrated with CGM to stop insulin delivery when glucose levels get too low) within the next year, so we’ll see how some of these complications iron themselves out with this partially integrated system.

PJ, a dog diagnosed with diabetes, was not short on love at the conference.
Photo courtesy of Children with Diabetes.

looking ahead

All in all, hearing all of the avenues being pursued by researchers to treat type 1 diabetes truly makes the sense of innovation palpable – considering the wide array of methods in development, it is impossible to not be hopeful about the future of type 1 therapies. Certainly, there is still the need for further research – as noted by t-shirts assertively worn throughout the conference hall, “insulin is not a cure.”

We encourage everyone to consider attending next year’s CWD Friends for Life conference in Orlando – as we understand it, there will be an even more defined “Adult” track, where there is SO much to learn! We also encourage parents, families, and teens to check out other conferences sponsored by Children with Diabetes here.