Experts Cover the Latest on Diabetes Technology and Medications

If you missed the 18th Annual Diabetes Forum & Reception, we’ve put together all the highlights for you.

Every year, diaTribe and Taking Control of Your Diabetes (TCOYD) host a riveting discussion with experts in the diabetes field moderated by Kelly Close, Close Concerns president and diaTribe founder, and Dr. Steven Edelman, University of California San Diego endocrinologist and founder of TCOYD.

“Forum has become the night at ADA,” Edelman said. “It’s a great symbiosis between diaTribe and TCOYD.”

“Dr. Steve Edelman is one of the most knowledgeable and inspirational people in diabetes, and having the opportunity to share the stage with him for these many years as co-moderator of the Diabetes Forum has been a huge honor,” Close said. 

This year’s panelists were a range of experts who cover all the major parts of diabetes care – this includes a balance between type 1 and type 2 diabetes. The lineup included:

• Dr. Jennie Luna, an endocrinologist at Scripps Clinic Center for Weight Management, specializes in the clinical management of obesity and related conditions. She integrates the latest research into her practice and is deeply interested in the role of artificial intelligence (AI) in medicine and in expanding diabetes and obesity care to underserved communities.
• Dr. Chantal Mathieu, a professor of medicine at Katholieke Universiteit Leuven in Belgium and president of the European Association for the Study of Diabetes. Mathieu brings strong experience in type 1 and type 2 diabetes and a passion for advancing treatment through new technology and therapies. 
• Dr. Jeremy Pettus, an endocrinologist and associate professor of medicine at the University of California San Diego. He is “the ultimate type 1 key opinion leader,” said Edelman (if you haven’t seen them yet, Edelman and Pettus make some hilarious diabetes videos). Pettus lives with type 1 diabetes and researches adjunctive therapies like SGLT-2s and GLP-1s for type 1 diabetes. 
• Dr. Richard Pratley, director at AdventHealth Diabetes Institute in Florida, brings a wealth of expertise. Pratley is especially knowledgeable about large clinical trials focusing on type 2 diabetes, as well as new obesity medications. 
• Dr. Ralph DeFronzo, professor of medicine at the University of Texas Southwestern, is an outspoken long-time expert on all things diabetes. 

The need for adjunctive therapies in type 1 diabetes

Throughout the discussion, panelists emphasized the need for adjunctive therapies – such as SGLT-2 inhibitors and GLP-1 receptor agonists – to help manage type 1 diabetes. 

“I think it’s a disgrace that we haven’t done more for people with type 1 diabetes,” DeFronzo said. 

“In particular, I’m talking about SGLT-2 inhibitors and GLP-1 receptor agonists. People with type 1 diabetes develop kidney disease – it’s not any different from people with type 2 diabetes. They also develop cardiovascular disease. It’s a shame that SGLT-2 inhibitors are not approved for people with type 1 diabetes,” he said. 

As a person living with type 1, Pettus echoed these feelings. He emphasized that managing type 1 diabetes isn’t just about glycemic control – it’s also important to consider protecting the heart and kidneys. 

While there are some safety concerns related to using these medications in type 1 diabetes, Pettus and Mathieu expressed excitement about continuous ketone monitoring (CKM) as a way to enable the widespread use of adjunctive therapies. 

The need for type 1 diabetes screening

Panelists also touched on Tzield (teplizumab), the first drug approved to delay the onset of type 1 diabetes, and the question of how best to screen for type 1. 

“Screening is a very big effort, of course,” Mathieu said. “What materials will we have? How will we train our pediatricians? How would we train our educators? How would we train our primary care providers?” 

Currently, researchers are testing different approaches to screening children for type 1 diabetes in Europe in a project called EDENT1FI. Some countries, like Italy, have already launched nationwide screening for all newborns. In the U.S., progress is more varied: only certain areas, like the state of Colorado and the city of Orlando, offer free screening. 

Personalizing diabetes and obesity care

Panelists, Luna in particular, explored how AI may help healthcare providers make care for diabetes and obesity more personalized. 

Luna highlighted the importance of taking a comprehensive approach to obesity care that recognizes a person’s individual strengths and needs. No two people with obesity are the same – the reality is that everyone is dealing with different challenges, from food access to finding a safe place to exercise. 

Some companies are already offering nutrition and exercise plans tailored to individual people with diabetes or obesity, she noted. 

“It’s nice to see how quickly our industry is embracing AI for personalized diabetes care,” Luna said. “There is still a lot of work that needs to get done.”

A staunch advocate for combination drug therapy, DeFronzo highlighted the potential for personalized approaches to managing type 2 diabetes with GLP-1s, SGLT-2s, and the TZD drug Actos (pioglitazone), which can help improve insulin sensitivity. 

Likewise, in type 1 diabetes, optimizing insulin could be viewed as a form of personalized medicine. As rapid-acting insulins continue to get faster and if once-weekly insulins become available, insulin therapy could become even more individualized. 

“There’s nothing more personalized than insulin therapy in type 1 diabetes,” Pratley said. “But I like the idea of moving it forward and thinking about how to do it most effectively.” 

Expanding access to clinical trials and new technologies

This year’s ADA conference reflected a growing exploration of diabetes treatment in special populations, such as pregnant people, older adults, and racial/ethnic minorities. For instance, his colleagues presented research on the use of automated insulin delivery (AID) systems in older adults. 

While many clinical trials have tended to enroll mostly white participants, Pratley emphasized that there are many other people who could benefit from new therapies and be enrolled in trials. 

“We have gaps that we need to address, and continued work ahead of us,” he said. 

Some companies are already making headway in enrolling more diverse participants in clinical trials. For instance, Close highlighted Insulet’s SECURE-T2D trial testing Omnipod 5 in adults with type 2 diabetes, which included 24% Black and 22% Hispanic participants – making it one of the most racially and ethnically diverse trials in diabetes technology. 

Broadly, panelists expressed hope for using AI to enhance diabetes and obesity care and even help healthcare providers avoid burnout. That said, much is still unknown about AI and Luna cautioned that ethics, privacy, and monitoring of different AI models will be crucial. 

“We need to make sure that AI is diverse and inclusive,” Luna said. “We need to know how AI makes decisions [to come up with treatment plans]. This will build trust with healthcare providers and patients.” 

Hear from the panelists on what struck them as most impactful at ADA 2024: 

• Pettus: “I think in a good way, how difficult it is to keep up with what’s going on in type 1 diabetes. Think about all the big topics we’re addressing – hybrid closed loop, metabolic therapy like GLP-1s, beta cell replacement, immunotherapy. It wasn’t long ago that the biggest development in type 1 diabetes was new basal insulin. It’s overwhelming in a very positive way to have these monumental changes and developments.” 
• Mathieu: “Confirming the place of incretin therapies [in diabetes care] and the indeed painful scene that we are missing them in type 1 diabetes. Also, the coming of age of cell replacement therapies and hybrid closed loop recognized in pregnancy in type 1 diabetes. All of that to me was really the confirmation of what we thought before.”
• Luna: “It was rewarding to see the use of GLP-1 in people with type 1 diabetes who struggle with obesity or excess weight. To see that there was an improvement in time in range and A1C, and now to be able to offer these treatments to patients, is life-saving. Another study was the SELECT trial and the use of semaglutide reduced progression to type 2 diabetes for those with prediabetes by 73%, which is great to have a therapy with such a significant impact.”
• Pratley: “[ADA 2024] pushed the boundaries for medications like GLP-1s in type 2 diabetes, chronic kidney disease, now obstructive sleep apnea, and probably other conditions in the near term. What’s exciting is now there are lots of people talking about using these therapies in type 1 diabetes. It’s high time that people with type 1 diabetes are not left behind and have access to these life-changing, life-saving therapies.”
• Edelman: “I don't think I’ve ever seen a conference with so much type 1 diabetes action. We’re really taking hold of Tzield to delay the onset of type 1…I do think it represents the first human disease-modifying drug, and that is really exciting. So many companies are working on prevention, preservation, and replacement of islet cells.”
• Close: “My favorite session was on health equity and the amazing things that we have to think about, to listen, to learn,” Close said. “And my second favorite one was about diversity in clinical trials. We can do it, we can do it.” 
• DeFronzo: “I think the entire ADA approach to treating diabetes is decades behind, and we should have been thinking about combination therapy a long time ago. GLP-1 must be part of combination therapy and they should be used in conjunction with an SGLT-2 inhibitor and pioglitazone. GLP-1s are fantastic drugs, especially the newer drugs.”

“I think the entire ADA approach to treating diabetes is decades behind, and we should have been thinking about combination therapy a long time ago. GLP-1 must be part of combination therapy… I think we should have an SGLT-2 inhibitor and pioglitazone. GLP-1s are fantastic drugs, especially the newer drugs.”

If you weren’t able to attend the Forum, fear not. In recent years, TCOYD has shared the discussion in video format for those who were not able to attend the event in person. 

Learn more about diaTribe events past and present: 

• Is It Time for Time in Tight Range?
• Connecting the Pieces for Better Cardiovascular, Kidney, and Metabolic Health
• Clinical Trials: Improving the Lives of People with Diabetes