What it felt like to forget about diabetes for a week
Later this week, our entire team here at diaTribe and its sister company, Close Concerns, will be heading to Chicago for the 73rd Scientific Sessions of the American Diabetes Association (ADA). Every year we go to ADA, and every year we learn so much about all aspects of diabetes, obesity, and their complications. This year isn’t going to have the landmark ORIGIN trial results that defined last year’s ADA meeting in Philadelphia, but I’m hopeful that it will leave more room for nuanced discussion of many different smaller but crucial topics – new therapies (and newer therapies) like SGLT inhibitors and GLP-1 agonists, the artificial pancreas, digital health, and the list goes on. If you’re going to be in Chicago during the week of ADA, I hope to see you around! There will also be two big product launches to watch out for, including Invokana (the first FDA approved SGLT-2 inhibitor) and Insulet’s smaller pod, out very recently in the US.
While the ADA meeting always dominates our schedule this time of year, there’s been lots else ongoing as well, including a pair of key meetings this month. Earlier in June, a large, 26-person panel met to discuss the future of GlaxoSmithKline’s thiazolidinedione (TZD) Avandia. The panel’s vote to change restrictions on who can be prescribed Avandia is unlikely to affect very many patients since relatively few take Avandia these days. What our team had hoped for was a greater discussion on the FDA’s process for drug approval. There were certainly times when the debate seemed to highlight larger questions related to clinical trial design, the integrity of the data, and the FDA’s past regulatory proceedings – all of which are very critical. Unfortunately, since most of the meeting focused mostly on Avandia, the more important issue of how to weigh safety concerns in an ever-evolving medication landscape were largely left unaddressed and certainly unresolved. This was frustrating given that problems with Avandia’s safety were what led to cardiovascular outcomes trials for new antihyperglycemic drugs that are clearly going to be hard to analyze. Issues have already come up, such as what to do with trial interim results – should the FDA examine these? Will patients and doctors get the results? If so, this will affect the trial as well as patient and doctor decisions outside the trial. Lots to think about.
The second meeting this month was the Workshop on Pancreatitis-Diabetes-Pancreatic Cancer held by the National Institute of Diabetes and Digestive and Kidney Diseases and National Cancer Institute. At this meeting, researchers discussed how the risks associated with incretins (such as Byetta, Januvia, and Victoza) and pancreatitis and pancreatic cancer (which we cover in more detail in new now next). From our diaTribe team’s coverage of the workshop, the consensus was that there is simply not know enough known about the matter to give patients any further blanket advice.
It is sad to see that, more frequently than not, the broader media’s coverage of incretins has been misleading about what the scientific community knows. The headlines often overstate what is known related to the safety of these therapies, even when the articles themselves are quite balanced. Many people only read headlines. Articles often also trumpet the importance of speaking to doctors, without acknowledging that sometimes doctors themselves haven’t made up their individual or collective minds. Indeed, diaTribe advisors with whom we spoke before and after the meeting emphasized the need to wait for results from additional large randomized controlled trials before we can fully understand the safety questions about how incretins affect the pancreas. And even then, we would still need to understand why some cases of pancreatitis become chronic pancreatitis, and why only 5% of those with chronic pancreatitis develop pancreatic cancer and 95% do not. So many questions remain, and our hope is that the media will be more candid about the complexities and tradeoffs of these drugs. There are undoubtedly risks related to taking incretins, but for people with diabetes, there are also critical risks with unmanaged diabetes stemming from a decision to stay away from incretins due to potential risks.
Last! I’d love to share about my transformative experience with the bionic pancreas. I go into more detail about how the bionic pancreas works and my reactions in this issue’s test drive, but I want to reflect on just what those days meant to me.
While I was in the trial, the bionic pancreas’s algorithm automatically recalculated my insulin and glucagon needs every five minutes! Its constant adjustments meant I didn’t have to worry about all the little things I’ve spent the last 26+ years worrying about. I suddenly found myself in a world in which my day was no longer dominated by all the constant micro-adjustments necessary to manage my diabetes – I couldn’t believe how much less noise was around me! What a fundamentally different life I had for those five days.
And that’s really what this trial was all about for me. Like some of you reading this, while I like to think I do as good a job as I can with these daily challenges, the reality is that I’m still slightly out of control pretty much all of the time. We’re all chasing the best control possible, but that’s a long way from even close to perfect, and an even longer way from “normal.” However, that’s what I got with the bionic pancreas – a week of not having to worry about diabetes, of not feeling hyperglycemic or hypoglycemic, ever. I didn’t have to monitor or track or worry or compensate or, well, think about my diabetes very much. That’s just about the most incredible thing that’s happened to me in the nearly three decades that I’ve been managing this disease.
And what was amazing to me? For that week, I was a nicer person – even, a cooler person. I only understood all the myriad subtle, subconscious ways in which diabetes shapes who I am when they were removed. I really liked the person that emerged when all the challenges of diabetes were removed, and I hope to meet her again. If nothing else comes of this, I’ll still always have those five days. With any luck, many more days and weeks and months and years like that lie ahead for all of us.
Kelly L. Close