World Diabetes Congress

MELBOURNE – A diagnosis of type 2 diabetes before age 50 was associated with an increased risk of microvascular complications, based on a secondary analysis of data from the international ADVANCE trial.

In ADVANCE, the risk of microvascular complications, such as eye and kidney disease, increased with disease duration but not with patient age. The risk of macrovascular complications, such as myocardial infarction, stroke, and cardiovascular events, as well as all-cause mortality, increased with both patient age and disease duration, Dr. John Chalmers, principal investigator for ADVANCE, said at the World Diabetes Congress.

"The findings tell you that if you get [type 2 diabetes] early, you’re in for a rougher time. If you’re younger at the time of diagnosis, then you may have a slightly more progressive, aggressive, resistant-to-treatment form of type 2 diabetes. It’s important to be aware of that, to control the glucose and to keep looking at the kidneys and eyes," said Dr. Chalmers, senior director of the George Institute, Sydney, and emeritus professor of medicine at the University of Sydney.

ADVANCE is a randomized trial across 20 countries of blood pressure lowering and intensive versus standard glucose control in 11,140 adults with type 2 diabetes who were followed up for 5 years. Mean age at study entry was 66 years, and average diabetes duration was 7.9 years. However when patients were stratified in 5-year increments of disease duration, researchers observed that the average age for each increment was roughly the same, around 66 years.

"You might guess a priori that people with the longest duration might be the oldest, but they’re not necessarily," Dr. Chalmers said in an interview.

In ADVANCE, 7.5% of patients with disease duration of less than 5 years had a history of major microvascular disease, as did 18.6% of those with disease duration of more than 15 years. The patients with the longest duration of disease – more than 15 years – started at a mean age of 47, and those with less than 5 years’ disease duration started at a mean age of 63.

The study also noted that those with the longest duration of disease had the highest mean hemoglobin A_1c at baseline, 7.9%, compared with 7.2% in patients with less than 5 years’ disease duration.

"Major macrovascular events rise steeply as patients get older and as the duration of diabetes increases; they both have independent effects," he said. "The microvascular complications are more influenced by the glycemic burden, whereas the macrovascular events are probably more affected by the traditional risk factors of blood pressure, cholesterol, and smoking."

The ADVANCE study was partly funded by Servier, the maker of Preterax (perindopril arginine plus indapamide). Dr. Chalmers declared that he received research grants and honoraria from Servier as the principal investigator for the study.

MELBOURNE – A diagnosis of type 2 diabetes before age 50 was associated with an increased risk of microvascular complications, based on a secondary analysis of data from the international ADVANCE trial.

In ADVANCE, the risk of microvascular complications, such as eye and kidney disease, increased with disease duration but not with patient age. The risk of macrovascular complications, such as myocardial infarction, stroke, and cardiovascular events, as well as all-cause mortality, increased with both patient age and disease duration, Dr. John Chalmers, principal investigator for ADVANCE, said at the World Diabetes Congress.

"The findings tell you that if you get [type 2 diabetes] early, you’re in for a rougher time. If you’re younger at the time of diagnosis, then you may have a slightly more progressive, aggressive, resistant-to-treatment form of type 2 diabetes. It’s important to be aware of that, to control the glucose and to keep looking at the kidneys and eyes," said Dr. Chalmers, senior director of the George Institute, Sydney, and emeritus professor of medicine at the University of Sydney.

ADVANCE is a randomized trial across 20 countries of blood pressure lowering and intensive versus standard glucose control in 11,140 adults with type 2 diabetes who were followed up for 5 years. Mean age at study entry was 66 years, and average diabetes duration was 7.9 years. However when patients were stratified in 5-year increments of disease duration, researchers observed that the average age for each increment was roughly the same, around 66 years.

"You might guess a priori that people with the longest duration might be the oldest, but they’re not necessarily," Dr. Chalmers said in an interview.

In ADVANCE, 7.5% of patients with disease duration of less than 5 years had a history of major microvascular disease, as did 18.6% of those with disease duration of more than 15 years. The patients with the longest duration of disease – more than 15 years – started at a mean age of 47, and those with less than 5 years’ disease duration started at a mean age of 63.

The study also noted that those with the longest duration of disease had the highest mean hemoglobin A_1c at baseline, 7.9%, compared with 7.2% in patients with less than 5 years’ disease duration.

"Major macrovascular events rise steeply as patients get older and as the duration of diabetes increases; they both have independent effects," he said. "The microvascular complications are more influenced by the glycemic burden, whereas the macrovascular events are probably more affected by the traditional risk factors of blood pressure, cholesterol, and smoking."

The ADVANCE study was partly funded by Servier, the maker of Preterax (perindopril arginine plus indapamide). Dr. Chalmers declared that he received research grants and honoraria from Servier as the principal investigator for the study.

MELBOURNE – A diagnosis of type 2 diabetes before age 50 was associated with an increased risk of microvascular complications, based on a secondary analysis of data from the international ADVANCE trial.

In ADVANCE, the risk of microvascular complications, such as eye and kidney disease, increased with disease duration but not with patient age. The risk of macrovascular complications, such as myocardial infarction, stroke, and cardiovascular events, as well as all-cause mortality, increased with both patient age and disease duration, Dr. John Chalmers, principal investigator for ADVANCE, said at the World Diabetes Congress.

"The findings tell you that if you get [type 2 diabetes] early, you’re in for a rougher time. If you’re younger at the time of diagnosis, then you may have a slightly more progressive, aggressive, resistant-to-treatment form of type 2 diabetes. It’s important to be aware of that, to control the glucose and to keep looking at the kidneys and eyes," said Dr. Chalmers, senior director of the George Institute, Sydney, and emeritus professor of medicine at the University of Sydney.

ADVANCE is a randomized trial across 20 countries of blood pressure lowering and intensive versus standard glucose control in 11,140 adults with type 2 diabetes who were followed up for 5 years. Mean age at study entry was 66 years, and average diabetes duration was 7.9 years. However when patients were stratified in 5-year increments of disease duration, researchers observed that the average age for each increment was roughly the same, around 66 years.

"You might guess a priori that people with the longest duration might be the oldest, but they’re not necessarily," Dr. Chalmers said in an interview.

In ADVANCE, 7.5% of patients with disease duration of less than 5 years had a history of major microvascular disease, as did 18.6% of those with disease duration of more than 15 years. The patients with the longest duration of disease – more than 15 years – started at a mean age of 47, and those with less than 5 years’ disease duration started at a mean age of 63.

The study also noted that those with the longest duration of disease had the highest mean hemoglobin A_1c at baseline, 7.9%, compared with 7.2% in patients with less than 5 years’ disease duration.

"Major macrovascular events rise steeply as patients get older and as the duration of diabetes increases; they both have independent effects," he said. "The microvascular complications are more influenced by the glycemic burden, whereas the macrovascular events are probably more affected by the traditional risk factors of blood pressure, cholesterol, and smoking."

The ADVANCE study was partly funded by Servier, the maker of Preterax (perindopril arginine plus indapamide). Dr. Chalmers declared that he received research grants and honoraria from Servier as the principal investigator for the study.

MELBOURNE – Diabetic ketoacidosis was associated with swelling of white brain matter and shrinkage of gray matter, and the degree of change was associated with neurocognitive outcomes up to 6 months after the event, based on a study of children who were newly diagnosed with type 1 diabetes and did not have cerebral edema.

In a prospective cohort study of children newly diagnosed with type 1 diabetes, 36 patients presented with and 59 without diabetic ketoacidosis. Researchers performed magnetic resonance imaging (T1 weighted, diffusion tensor imaging, and fractional anisotropy) and a battery of psychometric tests at the time of diagnosis, then again at 1 week, 4 weeks, and 6 months after diagnosis in both groups.

Although there was no net change in brain volume, total gray matter volume was reduced and total cortical white matter volume was increased on day 1 in the diabetic ketoacidosis group.

Compared with those without ketoacidosis, children with ketoacidosis had lower levels of a marker of neuronal density, lower activity in the frontal gray matter and basal ganglia on day 1, and lower mental state scores on days 1 and 5.

"Swelling had resolved by the end of the first week but was associated with neurocognitive outcomes at 6 months. So even though the brain looked normal, [those with ketoacidosis at diagnosis] were still performing less well on neuropsychological testing, especially in terms of long-term memory," said Dr. Fergus Cameron, head of diabetes services at the Royal Children’s Hospital, Melbourne.

"Changes in white matter volume were associated with poorer divided attention, sustained attention, and long-term memory, while the changes in gray matter in the parietal lobe were associated with poorer sustained attention," Dr. Cameron said in an interview.

"The younger and more acidotic the patient, the more marked the morphologic brain changes," Dr. Cameron said.

The findings highlight a need for neuroprotective adjunct therapies that might reduce the degree of neuronal damage, he said. Also, given their cognitive state, children with ketoacidosis might be less able to process detailed information immediately after their diagnosis.

When trying to implement diabetic education with these children, it might be better to focus on survival skills in the first week or two after diagnosis, and then turn to more advanced diabetes education a few weeks later, he said at the World Diabetes Congress.

"We should also be aware of how these kids are functioning in the school room," he added. At 6 months after diagnosis, it might be good to measure progress with teachers.

The study was funded by the Juvenile Diabetes Research Foundation and the National Health and Medical Research Council. No other conflicts of interest were reported.

MELBOURNE – Diabetic ketoacidosis was associated with swelling of white brain matter and shrinkage of gray matter, and the degree of change was associated with neurocognitive outcomes up to 6 months after the event, based on a study of children who were newly diagnosed with type 1 diabetes and did not have cerebral edema.

In a prospective cohort study of children newly diagnosed with type 1 diabetes, 36 patients presented with and 59 without diabetic ketoacidosis. Researchers performed magnetic resonance imaging (T1 weighted, diffusion tensor imaging, and fractional anisotropy) and a battery of psychometric tests at the time of diagnosis, then again at 1 week, 4 weeks, and 6 months after diagnosis in both groups.

Although there was no net change in brain volume, total gray matter volume was reduced and total cortical white matter volume was increased on day 1 in the diabetic ketoacidosis group.

Compared with those without ketoacidosis, children with ketoacidosis had lower levels of a marker of neuronal density, lower activity in the frontal gray matter and basal ganglia on day 1, and lower mental state scores on days 1 and 5.

"Swelling had resolved by the end of the first week but was associated with neurocognitive outcomes at 6 months. So even though the brain looked normal, [those with ketoacidosis at diagnosis] were still performing less well on neuropsychological testing, especially in terms of long-term memory," said Dr. Fergus Cameron, head of diabetes services at the Royal Children’s Hospital, Melbourne.

"Changes in white matter volume were associated with poorer divided attention, sustained attention, and long-term memory, while the changes in gray matter in the parietal lobe were associated with poorer sustained attention," Dr. Cameron said in an interview.

"The younger and more acidotic the patient, the more marked the morphologic brain changes," Dr. Cameron said.

The findings highlight a need for neuroprotective adjunct therapies that might reduce the degree of neuronal damage, he said. Also, given their cognitive state, children with ketoacidosis might be less able to process detailed information immediately after their diagnosis.

When trying to implement diabetic education with these children, it might be better to focus on survival skills in the first week or two after diagnosis, and then turn to more advanced diabetes education a few weeks later, he said at the World Diabetes Congress.

"We should also be aware of how these kids are functioning in the school room," he added. At 6 months after diagnosis, it might be good to measure progress with teachers.

The study was funded by the Juvenile Diabetes Research Foundation and the National Health and Medical Research Council. No other conflicts of interest were reported.

MELBOURNE – Diabetic ketoacidosis was associated with swelling of white brain matter and shrinkage of gray matter, and the degree of change was associated with neurocognitive outcomes up to 6 months after the event, based on a study of children who were newly diagnosed with type 1 diabetes and did not have cerebral edema.

In a prospective cohort study of children newly diagnosed with type 1 diabetes, 36 patients presented with and 59 without diabetic ketoacidosis. Researchers performed magnetic resonance imaging (T1 weighted, diffusion tensor imaging, and fractional anisotropy) and a battery of psychometric tests at the time of diagnosis, then again at 1 week, 4 weeks, and 6 months after diagnosis in both groups.

Although there was no net change in brain volume, total gray matter volume was reduced and total cortical white matter volume was increased on day 1 in the diabetic ketoacidosis group.

Compared with those without ketoacidosis, children with ketoacidosis had lower levels of a marker of neuronal density, lower activity in the frontal gray matter and basal ganglia on day 1, and lower mental state scores on days 1 and 5.

"Swelling had resolved by the end of the first week but was associated with neurocognitive outcomes at 6 months. So even though the brain looked normal, [those with ketoacidosis at diagnosis] were still performing less well on neuropsychological testing, especially in terms of long-term memory," said Dr. Fergus Cameron, head of diabetes services at the Royal Children’s Hospital, Melbourne.

"Changes in white matter volume were associated with poorer divided attention, sustained attention, and long-term memory, while the changes in gray matter in the parietal lobe were associated with poorer sustained attention," Dr. Cameron said in an interview.

"The younger and more acidotic the patient, the more marked the morphologic brain changes," Dr. Cameron said.

The findings highlight a need for neuroprotective adjunct therapies that might reduce the degree of neuronal damage, he said. Also, given their cognitive state, children with ketoacidosis might be less able to process detailed information immediately after their diagnosis.

When trying to implement diabetic education with these children, it might be better to focus on survival skills in the first week or two after diagnosis, and then turn to more advanced diabetes education a few weeks later, he said at the World Diabetes Congress.

"We should also be aware of how these kids are functioning in the school room," he added. At 6 months after diagnosis, it might be good to measure progress with teachers.

The study was funded by the Juvenile Diabetes Research Foundation and the National Health and Medical Research Council. No other conflicts of interest were reported.

MELBOURNE – Diabetic ketoacidosis was associated with swelling of white brain matter and shrinkage of gray matter, and the degree of change was associated with neurocognitive outcomes up to 6 months after the event, based on a study of children who were newly diagnosed with type 1 diabetes and did not have cerebral edema.

In a prospective cohort study of children newly diagnosed with type 1 diabetes, 36 patients presented with and 59 without diabetic ketoacidosis. Researchers performed magnetic resonance imaging (T1 weighted, diffusion tensor imaging, and fractional anisotropy) and a battery of psychometric tests at the time of diagnosis, then again at 1 week, 4 weeks, and 6 months after diagnosis in both groups.

Although there was no net change in brain volume, total gray matter volume was reduced and total cortical white matter volume was increased on day 1 in the diabetic ketoacidosis group.

Compared with those without ketoacidosis, children with ketoacidosis had lower levels of a marker of neuronal density, lower activity in the frontal gray matter and basal ganglia on day 1, and lower mental state scores on days 1 and 5.

"Swelling had resolved by the end of the first week but was associated with neurocognitive outcomes at 6 months. So even though the brain looked normal, [those with ketoacidosis at diagnosis] were still performing less well on neuropsychological testing, especially in terms of long-term memory," said Dr. Fergus Cameron, head of diabetes services at the Royal Children’s Hospital, Melbourne.

"Changes in white matter volume were associated with poorer divided attention, sustained attention, and long-term memory, while the changes in gray matter in the parietal lobe were associated with poorer sustained attention," Dr. Cameron said in an interview.

"The younger and more acidotic the patient, the more marked the morphologic brain changes," Dr. Cameron said.

The findings highlight a need for neuroprotective adjunct therapies that might reduce the degree of neuronal damage, he said. Also, given their cognitive state, children with ketoacidosis might be less able to process detailed information immediately after their diagnosis.

When trying to implement diabetic education with these children, it might be better to focus on survival skills in the first week or two after diagnosis, and then turn to more advanced diabetes education a few weeks later, he said at the World Diabetes Congress.

"We should also be aware of how these kids are functioning in the school room," he added. At 6 months after diagnosis, it might be good to measure progress with teachers.

The study was funded by the Juvenile Diabetes Research Foundation and the National Health and Medical Research Council. No other conflicts of interest were reported.

MELBOURNE – Diabetic ketoacidosis was associated with swelling of white brain matter and shrinkage of gray matter, and the degree of change was associated with neurocognitive outcomes up to 6 months after the event, based on a study of children who were newly diagnosed with type 1 diabetes and did not have cerebral edema.

In a prospective cohort study of children newly diagnosed with type 1 diabetes, 36 patients presented with and 59 without diabetic ketoacidosis. Researchers performed magnetic resonance imaging (T1 weighted, diffusion tensor imaging, and fractional anisotropy) and a battery of psychometric tests at the time of diagnosis, then again at 1 week, 4 weeks, and 6 months after diagnosis in both groups.

Although there was no net change in brain volume, total gray matter volume was reduced and total cortical white matter volume was increased on day 1 in the diabetic ketoacidosis group.

Compared with those without ketoacidosis, children with ketoacidosis had lower levels of a marker of neuronal density, lower activity in the frontal gray matter and basal ganglia on day 1, and lower mental state scores on days 1 and 5.

"Swelling had resolved by the end of the first week but was associated with neurocognitive outcomes at 6 months. So even though the brain looked normal, [those with ketoacidosis at diagnosis] were still performing less well on neuropsychological testing, especially in terms of long-term memory," said Dr. Fergus Cameron, head of diabetes services at the Royal Children’s Hospital, Melbourne.

"Changes in white matter volume were associated with poorer divided attention, sustained attention, and long-term memory, while the changes in gray matter in the parietal lobe were associated with poorer sustained attention," Dr. Cameron said in an interview.

"The younger and more acidotic the patient, the more marked the morphologic brain changes," Dr. Cameron said.

The findings highlight a need for neuroprotective adjunct therapies that might reduce the degree of neuronal damage, he said. Also, given their cognitive state, children with ketoacidosis might be less able to process detailed information immediately after their diagnosis.

When trying to implement diabetic education with these children, it might be better to focus on survival skills in the first week or two after diagnosis, and then turn to more advanced diabetes education a few weeks later, he said at the World Diabetes Congress.

"We should also be aware of how these kids are functioning in the school room," he added. At 6 months after diagnosis, it might be good to measure progress with teachers.

The study was funded by the Juvenile Diabetes Research Foundation and the National Health and Medical Research Council. No other conflicts of interest were reported.

MELBOURNE – Diabetic ketoacidosis was associated with swelling of white brain matter and shrinkage of gray matter, and the degree of change was associated with neurocognitive outcomes up to 6 months after the event, based on a study of children who were newly diagnosed with type 1 diabetes and did not have cerebral edema.

In a prospective cohort study of children newly diagnosed with type 1 diabetes, 36 patients presented with and 59 without diabetic ketoacidosis. Researchers performed magnetic resonance imaging (T1 weighted, diffusion tensor imaging, and fractional anisotropy) and a battery of psychometric tests at the time of diagnosis, then again at 1 week, 4 weeks, and 6 months after diagnosis in both groups.

Although there was no net change in brain volume, total gray matter volume was reduced and total cortical white matter volume was increased on day 1 in the diabetic ketoacidosis group.

Compared with those without ketoacidosis, children with ketoacidosis had lower levels of a marker of neuronal density, lower activity in the frontal gray matter and basal ganglia on day 1, and lower mental state scores on days 1 and 5.

"Swelling had resolved by the end of the first week but was associated with neurocognitive outcomes at 6 months. So even though the brain looked normal, [those with ketoacidosis at diagnosis] were still performing less well on neuropsychological testing, especially in terms of long-term memory," said Dr. Fergus Cameron, head of diabetes services at the Royal Children’s Hospital, Melbourne.

"Changes in white matter volume were associated with poorer divided attention, sustained attention, and long-term memory, while the changes in gray matter in the parietal lobe were associated with poorer sustained attention," Dr. Cameron said in an interview.

"The younger and more acidotic the patient, the more marked the morphologic brain changes," Dr. Cameron said.

The findings highlight a need for neuroprotective adjunct therapies that might reduce the degree of neuronal damage, he said. Also, given their cognitive state, children with ketoacidosis might be less able to process detailed information immediately after their diagnosis.

When trying to implement diabetic education with these children, it might be better to focus on survival skills in the first week or two after diagnosis, and then turn to more advanced diabetes education a few weeks later, he said at the World Diabetes Congress.

"We should also be aware of how these kids are functioning in the school room," he added. At 6 months after diagnosis, it might be good to measure progress with teachers.

The study was funded by the Juvenile Diabetes Research Foundation and the National Health and Medical Research Council. No other conflicts of interest were reported.

MELBOURNE – A closed-loop system of continuous glucose monitoring coupled with an insulin pump significantly improved glucose control in adolescents with type 1 diabetes, with less time spent in hypoglycemia.

In a real-world, at-home study of the so-called artificial pancreas, 24-hour mean glucose levels were significantly lower among patients using the closed-loop device (8.5 mmol/L), compared with those using sensor-augmented pump therapy (9.0 mmol/L).

The closed-loop system also led to significantly more time in blood glucose targets (64% vs. 47%) and fewer nights with hypoglycemia (10% vs. 17%) over 21 days, Roman Hovorka, Ph.D., said at the World Diabetes Congress.

The randomized crossover trial enrolled 16 individuals with type 1 diabetes who had a mean age of 15.4 years. Subjects were trained in use of the device, and there was a 2- to 3-week washout period between crossovers.

Dr. Hovorka, director of research at the University of Cambridge (England) Metabolic Research Laboratories, said that 5 years of research had demonstrated the utility, safety, and efficacy of the closed-loop system in the clinical research facility setting, and now this study had shown it in the home setting against a sensor-augmented pump.

The artificial pancreas consists of a continuous glucose monitor that measures blood glucose every 1-5 minutes and transmits this information to a control algorithm, which instructs an insulin pump to release the required amount of insulin into the body.

"The algorithm is the brain and it mimics in principle what a beta cell would do in terms of reacting to glucose levels and secreting the right amount of insulin," Dr. Hovorka said in an interview.

"The advantage is that it’s glucose-responsive insulin delivery, which is what we need to achieve with glucose control," he added.

The study also showed that, while the closed-loop device delivered slightly more insulin at night (8.1 units vs. 7.2 units, P less than .001), 24-hour insulin was lower with the closed-loop device than with the pump (49.9 units vs. 53.2 units, P = .009), he said.

Researchers used off-the-shelf devices to build their artificial pancreas system, and while no single unit is yet available, several prototype devices are in development. Dr. Hovorka said that some groups also are looking at combining glucose sensing and insulin delivery into a single port.

Patients reported greater reassurance, confidence, and better sleep with the closed-loop system, although there were some issues with calibration of the system, size of the device, and discomfort.

Session chair Dr. Kavita Kumareswaran, consultant endocrinologist at the Baker IDI Heart and Diabetes Institute, Melbourne, said that the development of a closed-loop system was hugely important and patients were already asking when such a device was likely to become available.

"The biggest thing for patients is their fear of hypoglycemia, so that’s where the biggest utility will be, particularly overnight where they’re asleep and can’t check their sugars. That’s where the greatest benefit will be," Dr. Kumareswaran said in an interview.

The researchers declared research support from Minimed Medtronic, Abbott Diabetes Care, Animas, and Edwards Lifesciences, as well as advisory panel memberships and speakers’ engagements for other pharmaceutical and medical device companies.

MELBOURNE – A closed-loop system of continuous glucose monitoring coupled with an insulin pump significantly improved glucose control in adolescents with type 1 diabetes, with less time spent in hypoglycemia.

In a real-world, at-home study of the so-called artificial pancreas, 24-hour mean glucose levels were significantly lower among patients using the closed-loop device (8.5 mmol/L), compared with those using sensor-augmented pump therapy (9.0 mmol/L).

The closed-loop system also led to significantly more time in blood glucose targets (64% vs. 47%) and fewer nights with hypoglycemia (10% vs. 17%) over 21 days, Roman Hovorka, Ph.D., said at the World Diabetes Congress.

The randomized crossover trial enrolled 16 individuals with type 1 diabetes who had a mean age of 15.4 years. Subjects were trained in use of the device, and there was a 2- to 3-week washout period between crossovers.

Dr. Hovorka, director of research at the University of Cambridge (England) Metabolic Research Laboratories, said that 5 years of research had demonstrated the utility, safety, and efficacy of the closed-loop system in the clinical research facility setting, and now this study had shown it in the home setting against a sensor-augmented pump.

The artificial pancreas consists of a continuous glucose monitor that measures blood glucose every 1-5 minutes and transmits this information to a control algorithm, which instructs an insulin pump to release the required amount of insulin into the body.

"The algorithm is the brain and it mimics in principle what a beta cell would do in terms of reacting to glucose levels and secreting the right amount of insulin," Dr. Hovorka said in an interview.

"The advantage is that it’s glucose-responsive insulin delivery, which is what we need to achieve with glucose control," he added.

The study also showed that, while the closed-loop device delivered slightly more insulin at night (8.1 units vs. 7.2 units, P less than .001), 24-hour insulin was lower with the closed-loop device than with the pump (49.9 units vs. 53.2 units, P = .009), he said.

Researchers used off-the-shelf devices to build their artificial pancreas system, and while no single unit is yet available, several prototype devices are in development. Dr. Hovorka said that some groups also are looking at combining glucose sensing and insulin delivery into a single port.

Patients reported greater reassurance, confidence, and better sleep with the closed-loop system, although there were some issues with calibration of the system, size of the device, and discomfort.

Session chair Dr. Kavita Kumareswaran, consultant endocrinologist at the Baker IDI Heart and Diabetes Institute, Melbourne, said that the development of a closed-loop system was hugely important and patients were already asking when such a device was likely to become available.

"The biggest thing for patients is their fear of hypoglycemia, so that’s where the biggest utility will be, particularly overnight where they’re asleep and can’t check their sugars. That’s where the greatest benefit will be," Dr. Kumareswaran said in an interview.

The researchers declared research support from Minimed Medtronic, Abbott Diabetes Care, Animas, and Edwards Lifesciences, as well as advisory panel memberships and speakers’ engagements for other pharmaceutical and medical device companies.

MELBOURNE – A closed-loop system of continuous glucose monitoring coupled with an insulin pump significantly improved glucose control in adolescents with type 1 diabetes, with less time spent in hypoglycemia.

In a real-world, at-home study of the so-called artificial pancreas, 24-hour mean glucose levels were significantly lower among patients using the closed-loop device (8.5 mmol/L), compared with those using sensor-augmented pump therapy (9.0 mmol/L).

The closed-loop system also led to significantly more time in blood glucose targets (64% vs. 47%) and fewer nights with hypoglycemia (10% vs. 17%) over 21 days, Roman Hovorka, Ph.D., said at the World Diabetes Congress.

The randomized crossover trial enrolled 16 individuals with type 1 diabetes who had a mean age of 15.4 years. Subjects were trained in use of the device, and there was a 2- to 3-week washout period between crossovers.

Dr. Hovorka, director of research at the University of Cambridge (England) Metabolic Research Laboratories, said that 5 years of research had demonstrated the utility, safety, and efficacy of the closed-loop system in the clinical research facility setting, and now this study had shown it in the home setting against a sensor-augmented pump.

The artificial pancreas consists of a continuous glucose monitor that measures blood glucose every 1-5 minutes and transmits this information to a control algorithm, which instructs an insulin pump to release the required amount of insulin into the body.

"The algorithm is the brain and it mimics in principle what a beta cell would do in terms of reacting to glucose levels and secreting the right amount of insulin," Dr. Hovorka said in an interview.

"The advantage is that it’s glucose-responsive insulin delivery, which is what we need to achieve with glucose control," he added.

The study also showed that, while the closed-loop device delivered slightly more insulin at night (8.1 units vs. 7.2 units, P less than .001), 24-hour insulin was lower with the closed-loop device than with the pump (49.9 units vs. 53.2 units, P = .009), he said.

Researchers used off-the-shelf devices to build their artificial pancreas system, and while no single unit is yet available, several prototype devices are in development. Dr. Hovorka said that some groups also are looking at combining glucose sensing and insulin delivery into a single port.

Patients reported greater reassurance, confidence, and better sleep with the closed-loop system, although there were some issues with calibration of the system, size of the device, and discomfort.

Session chair Dr. Kavita Kumareswaran, consultant endocrinologist at the Baker IDI Heart and Diabetes Institute, Melbourne, said that the development of a closed-loop system was hugely important and patients were already asking when such a device was likely to become available.

"The biggest thing for patients is their fear of hypoglycemia, so that’s where the biggest utility will be, particularly overnight where they’re asleep and can’t check their sugars. That’s where the greatest benefit will be," Dr. Kumareswaran said in an interview.

The researchers declared research support from Minimed Medtronic, Abbott Diabetes Care, Animas, and Edwards Lifesciences, as well as advisory panel memberships and speakers’ engagements for other pharmaceutical and medical device companies.

MELBOURNE – Secure messaging can achieve similar outcomes in terms of behavioral goal achievement, self-reported health maintenance exam completion, and hemoglobin A_1c level testing, compared with telephone and in-person support, new data suggest.

A study of different methods of diabetes self-management support found no significant differences in outcomes such as completion of foot and eye exams and HbA_1c testing across the three follow-up methods at the 9-month follow-up, although there were some feasibility issues with the secure messaging service.

Presenter Deborah Greenwood told the World Diabetes Congress that the study arose out of a need to improve their ability to provide ongoing support for patients with type 2 diabetes.

"Because of the vast number of patients with diabetes, just trying to get people in for initial education is almost a barrier, so trying to add in ongoing support is a challenge," said Ms. Greenwood, diabetes program coordinator for the Sutter Health Integrated Diabetes Education Network.

Ms. Greenwood said the use of secure messaging was an attempt to tap into the so-called e-patient phenomenon: the growing number of patients who want to use online tools to help manage their disease.

The study recruited 146 patients with type 2 diabetes who had completed their diabetes education class at the clinic, and asked them to participate in a 9-month posteducation program via their choice of secure messaging, telephone, or the usual in-person follow-up.

Secure messages and telephone calls were timed at 3, 6, and 9 months, while the usual care involved an in-person follow-up between 3 and 6 months.

Secure message, via the clinic’s My Health Online personal health record system, proved the most popular patient choice, followed by in-person and then telephone follow-up.

However, there were significantly fewer successful contacts made via the secure messaging system. Researchers found that while 61% of subjects overall completed the intervention, only 44% of those in the secure message group completed it, compared with 71% of the in-person group and 75% of the telephone group.

When researchers did manage to engage with patients via the secure messaging system, they spent significantly less time with the patient than was spent in the other two groups.

Ms. Greenwood said while the secure message service was popular, it was more complex than a simple e-mail message, which may have contributed to the poor contact rates.

"They have to log into their account, they have to remember their password, so I think that was part of it," Ms. Greenwood said in an interview. She also suggested that the long gap between contacts may have played a role, and suggested that weekly contacts, at least initially, may have helped establish contact better.

Despite this, the online contact cost considerably less per participant ($27) than the telephone contact ($54) and the 1-hour in-person visit ($50).

Session chair Dr. Matthew Cohen, diabetes specialist at the Baker IDI Heart and Diabetes Institute, Melbourne, said telehealth solutions were really about convenience and patients avoiding having to travel to see a doctor.

"I think it’s becoming very popular, and [there is] a large group of younger patients who I think are going to expect to have access to medical care through e-mails and Skype and so on," Dr. Cohen said in an interview.

Although data from the telehealth studies did measure improvements in diabetes control, Dr. Cohen said there were huge advantages for patients, particularly for those who faced difficulties in getting to a doctor’s office.

Ms. Greenwood is on the board of the American Association of Diabetes Educators, which provided a grant for the study.

MELBOURNE – Secure messaging can achieve similar outcomes in terms of behavioral goal achievement, self-reported health maintenance exam completion, and hemoglobin A_1c level testing, compared with telephone and in-person support, new data suggest.

A study of different methods of diabetes self-management support found no significant differences in outcomes such as completion of foot and eye exams and HbA_1c testing across the three follow-up methods at the 9-month follow-up, although there were some feasibility issues with the secure messaging service.

Presenter Deborah Greenwood told the World Diabetes Congress that the study arose out of a need to improve their ability to provide ongoing support for patients with type 2 diabetes.

"Because of the vast number of patients with diabetes, just trying to get people in for initial education is almost a barrier, so trying to add in ongoing support is a challenge," said Ms. Greenwood, diabetes program coordinator for the Sutter Health Integrated Diabetes Education Network.

Ms. Greenwood said the use of secure messaging was an attempt to tap into the so-called e-patient phenomenon: the growing number of patients who want to use online tools to help manage their disease.

The study recruited 146 patients with type 2 diabetes who had completed their diabetes education class at the clinic, and asked them to participate in a 9-month posteducation program via their choice of secure messaging, telephone, or the usual in-person follow-up.

Secure messages and telephone calls were timed at 3, 6, and 9 months, while the usual care involved an in-person follow-up between 3 and 6 months.

Secure message, via the clinic’s My Health Online personal health record system, proved the most popular patient choice, followed by in-person and then telephone follow-up.

However, there were significantly fewer successful contacts made via the secure messaging system. Researchers found that while 61% of subjects overall completed the intervention, only 44% of those in the secure message group completed it, compared with 71% of the in-person group and 75% of the telephone group.

When researchers did manage to engage with patients via the secure messaging system, they spent significantly less time with the patient than was spent in the other two groups.

Ms. Greenwood said while the secure message service was popular, it was more complex than a simple e-mail message, which may have contributed to the poor contact rates.

"They have to log into their account, they have to remember their password, so I think that was part of it," Ms. Greenwood said in an interview. She also suggested that the long gap between contacts may have played a role, and suggested that weekly contacts, at least initially, may have helped establish contact better.

Despite this, the online contact cost considerably less per participant ($27) than the telephone contact ($54) and the 1-hour in-person visit ($50).

Session chair Dr. Matthew Cohen, diabetes specialist at the Baker IDI Heart and Diabetes Institute, Melbourne, said telehealth solutions were really about convenience and patients avoiding having to travel to see a doctor.

"I think it’s becoming very popular, and [there is] a large group of younger patients who I think are going to expect to have access to medical care through e-mails and Skype and so on," Dr. Cohen said in an interview.

Although data from the telehealth studies did measure improvements in diabetes control, Dr. Cohen said there were huge advantages for patients, particularly for those who faced difficulties in getting to a doctor’s office.

Ms. Greenwood is on the board of the American Association of Diabetes Educators, which provided a grant for the study.

MELBOURNE – Secure messaging can achieve similar outcomes in terms of behavioral goal achievement, self-reported health maintenance exam completion, and hemoglobin A_1c level testing, compared with telephone and in-person support, new data suggest.

A study of different methods of diabetes self-management support found no significant differences in outcomes such as completion of foot and eye exams and HbA_1c testing across the three follow-up methods at the 9-month follow-up, although there were some feasibility issues with the secure messaging service.

Presenter Deborah Greenwood told the World Diabetes Congress that the study arose out of a need to improve their ability to provide ongoing support for patients with type 2 diabetes.

"Because of the vast number of patients with diabetes, just trying to get people in for initial education is almost a barrier, so trying to add in ongoing support is a challenge," said Ms. Greenwood, diabetes program coordinator for the Sutter Health Integrated Diabetes Education Network.

Ms. Greenwood said the use of secure messaging was an attempt to tap into the so-called e-patient phenomenon: the growing number of patients who want to use online tools to help manage their disease.

The study recruited 146 patients with type 2 diabetes who had completed their diabetes education class at the clinic, and asked them to participate in a 9-month posteducation program via their choice of secure messaging, telephone, or the usual in-person follow-up.

Secure messages and telephone calls were timed at 3, 6, and 9 months, while the usual care involved an in-person follow-up between 3 and 6 months.

Secure message, via the clinic’s My Health Online personal health record system, proved the most popular patient choice, followed by in-person and then telephone follow-up.

However, there were significantly fewer successful contacts made via the secure messaging system. Researchers found that while 61% of subjects overall completed the intervention, only 44% of those in the secure message group completed it, compared with 71% of the in-person group and 75% of the telephone group.

When researchers did manage to engage with patients via the secure messaging system, they spent significantly less time with the patient than was spent in the other two groups.

Ms. Greenwood said while the secure message service was popular, it was more complex than a simple e-mail message, which may have contributed to the poor contact rates.

"They have to log into their account, they have to remember their password, so I think that was part of it," Ms. Greenwood said in an interview. She also suggested that the long gap between contacts may have played a role, and suggested that weekly contacts, at least initially, may have helped establish contact better.

Despite this, the online contact cost considerably less per participant ($27) than the telephone contact ($54) and the 1-hour in-person visit ($50).

Session chair Dr. Matthew Cohen, diabetes specialist at the Baker IDI Heart and Diabetes Institute, Melbourne, said telehealth solutions were really about convenience and patients avoiding having to travel to see a doctor.

"I think it’s becoming very popular, and [there is] a large group of younger patients who I think are going to expect to have access to medical care through e-mails and Skype and so on," Dr. Cohen said in an interview.

Although data from the telehealth studies did measure improvements in diabetes control, Dr. Cohen said there were huge advantages for patients, particularly for those who faced difficulties in getting to a doctor’s office.

Ms. Greenwood is on the board of the American Association of Diabetes Educators, which provided a grant for the study.

MELBOURNE – Secure messaging can achieve similar outcomes in terms of behavioral goal achievement, self-reported health maintenance exam completion, and hemoglobin A_1c level testing, compared with telephone and in-person support, new data suggest.

A study of different methods of diabetes self-management support found no significant differences in outcomes such as completion of foot and eye exams and HbA_1c testing across the three follow-up methods at the 9-month follow-up, although there were some feasibility issues with the secure messaging service.

Presenter Deborah Greenwood told the World Diabetes Congress that the study arose out of a need to improve their ability to provide ongoing support for patients with type 2 diabetes.

"Because of the vast number of patients with diabetes, just trying to get people in for initial education is almost a barrier, so trying to add in ongoing support is a challenge," said Ms. Greenwood, diabetes program coordinator for the Sutter Health Integrated Diabetes Education Network.

Ms. Greenwood said the use of secure messaging was an attempt to tap into the so-called e-patient phenomenon: the growing number of patients who want to use online tools to help manage their disease.

The study recruited 146 patients with type 2 diabetes who had completed their diabetes education class at the clinic, and asked them to participate in a 9-month posteducation program via their choice of secure messaging, telephone, or the usual in-person follow-up.

Secure messages and telephone calls were timed at 3, 6, and 9 months, while the usual care involved an in-person follow-up between 3 and 6 months.

Secure message, via the clinic’s My Health Online personal health record system, proved the most popular patient choice, followed by in-person and then telephone follow-up.

However, there were significantly fewer successful contacts made via the secure messaging system. Researchers found that while 61% of subjects overall completed the intervention, only 44% of those in the secure message group completed it, compared with 71% of the in-person group and 75% of the telephone group.

When researchers did manage to engage with patients via the secure messaging system, they spent significantly less time with the patient than was spent in the other two groups.

Ms. Greenwood said while the secure message service was popular, it was more complex than a simple e-mail message, which may have contributed to the poor contact rates.

"They have to log into their account, they have to remember their password, so I think that was part of it," Ms. Greenwood said in an interview. She also suggested that the long gap between contacts may have played a role, and suggested that weekly contacts, at least initially, may have helped establish contact better.

Despite this, the online contact cost considerably less per participant ($27) than the telephone contact ($54) and the 1-hour in-person visit ($50).

Session chair Dr. Matthew Cohen, diabetes specialist at the Baker IDI Heart and Diabetes Institute, Melbourne, said telehealth solutions were really about convenience and patients avoiding having to travel to see a doctor.

"I think it’s becoming very popular, and [there is] a large group of younger patients who I think are going to expect to have access to medical care through e-mails and Skype and so on," Dr. Cohen said in an interview.

Although data from the telehealth studies did measure improvements in diabetes control, Dr. Cohen said there were huge advantages for patients, particularly for those who faced difficulties in getting to a doctor’s office.

Ms. Greenwood is on the board of the American Association of Diabetes Educators, which provided a grant for the study.

MELBOURNE – Secure messaging can achieve similar outcomes in terms of behavioral goal achievement, self-reported health maintenance exam completion, and hemoglobin A_1c level testing, compared with telephone and in-person support, new data suggest.

A study of different methods of diabetes self-management support found no significant differences in outcomes such as completion of foot and eye exams and HbA_1c testing across the three follow-up methods at the 9-month follow-up, although there were some feasibility issues with the secure messaging service.

Presenter Deborah Greenwood told the World Diabetes Congress that the study arose out of a need to improve their ability to provide ongoing support for patients with type 2 diabetes.

"Because of the vast number of patients with diabetes, just trying to get people in for initial education is almost a barrier, so trying to add in ongoing support is a challenge," said Ms. Greenwood, diabetes program coordinator for the Sutter Health Integrated Diabetes Education Network.

Ms. Greenwood said the use of secure messaging was an attempt to tap into the so-called e-patient phenomenon: the growing number of patients who want to use online tools to help manage their disease.

The study recruited 146 patients with type 2 diabetes who had completed their diabetes education class at the clinic, and asked them to participate in a 9-month posteducation program via their choice of secure messaging, telephone, or the usual in-person follow-up.

Secure messages and telephone calls were timed at 3, 6, and 9 months, while the usual care involved an in-person follow-up between 3 and 6 months.

Secure message, via the clinic’s My Health Online personal health record system, proved the most popular patient choice, followed by in-person and then telephone follow-up.

However, there were significantly fewer successful contacts made via the secure messaging system. Researchers found that while 61% of subjects overall completed the intervention, only 44% of those in the secure message group completed it, compared with 71% of the in-person group and 75% of the telephone group.

When researchers did manage to engage with patients via the secure messaging system, they spent significantly less time with the patient than was spent in the other two groups.

Ms. Greenwood said while the secure message service was popular, it was more complex than a simple e-mail message, which may have contributed to the poor contact rates.

"They have to log into their account, they have to remember their password, so I think that was part of it," Ms. Greenwood said in an interview. She also suggested that the long gap between contacts may have played a role, and suggested that weekly contacts, at least initially, may have helped establish contact better.

Despite this, the online contact cost considerably less per participant ($27) than the telephone contact ($54) and the 1-hour in-person visit ($50).

Session chair Dr. Matthew Cohen, diabetes specialist at the Baker IDI Heart and Diabetes Institute, Melbourne, said telehealth solutions were really about convenience and patients avoiding having to travel to see a doctor.

"I think it’s becoming very popular, and [there is] a large group of younger patients who I think are going to expect to have access to medical care through e-mails and Skype and so on," Dr. Cohen said in an interview.

Although data from the telehealth studies did measure improvements in diabetes control, Dr. Cohen said there were huge advantages for patients, particularly for those who faced difficulties in getting to a doctor’s office.

Ms. Greenwood is on the board of the American Association of Diabetes Educators, which provided a grant for the study.

MELBOURNE – Secure messaging can achieve similar outcomes in terms of behavioral goal achievement, self-reported health maintenance exam completion, and hemoglobin A_1c level testing, compared with telephone and in-person support, new data suggest.

A study of different methods of diabetes self-management support found no significant differences in outcomes such as completion of foot and eye exams and HbA_1c testing across the three follow-up methods at the 9-month follow-up, although there were some feasibility issues with the secure messaging service.

Presenter Deborah Greenwood told the World Diabetes Congress that the study arose out of a need to improve their ability to provide ongoing support for patients with type 2 diabetes.

"Because of the vast number of patients with diabetes, just trying to get people in for initial education is almost a barrier, so trying to add in ongoing support is a challenge," said Ms. Greenwood, diabetes program coordinator for the Sutter Health Integrated Diabetes Education Network.

Ms. Greenwood said the use of secure messaging was an attempt to tap into the so-called e-patient phenomenon: the growing number of patients who want to use online tools to help manage their disease.

The study recruited 146 patients with type 2 diabetes who had completed their diabetes education class at the clinic, and asked them to participate in a 9-month posteducation program via their choice of secure messaging, telephone, or the usual in-person follow-up.

Secure messages and telephone calls were timed at 3, 6, and 9 months, while the usual care involved an in-person follow-up between 3 and 6 months.

Secure message, via the clinic’s My Health Online personal health record system, proved the most popular patient choice, followed by in-person and then telephone follow-up.

However, there were significantly fewer successful contacts made via the secure messaging system. Researchers found that while 61% of subjects overall completed the intervention, only 44% of those in the secure message group completed it, compared with 71% of the in-person group and 75% of the telephone group.

When researchers did manage to engage with patients via the secure messaging system, they spent significantly less time with the patient than was spent in the other two groups.

Ms. Greenwood said while the secure message service was popular, it was more complex than a simple e-mail message, which may have contributed to the poor contact rates.

"They have to log into their account, they have to remember their password, so I think that was part of it," Ms. Greenwood said in an interview. She also suggested that the long gap between contacts may have played a role, and suggested that weekly contacts, at least initially, may have helped establish contact better.

Despite this, the online contact cost considerably less per participant ($27) than the telephone contact ($54) and the 1-hour in-person visit ($50).

Session chair Dr. Matthew Cohen, diabetes specialist at the Baker IDI Heart and Diabetes Institute, Melbourne, said telehealth solutions were really about convenience and patients avoiding having to travel to see a doctor.

"I think it’s becoming very popular, and [there is] a large group of younger patients who I think are going to expect to have access to medical care through e-mails and Skype and so on," Dr. Cohen said in an interview.

Although data from the telehealth studies did measure improvements in diabetes control, Dr. Cohen said there were huge advantages for patients, particularly for those who faced difficulties in getting to a doctor’s office.

Ms. Greenwood is on the board of the American Association of Diabetes Educators, which provided a grant for the study.

MELBOURNE – Approximately half of adults who meet the eligibility for glucose testing according to four different guidelines are not being tested for type 2 diabetes, according to data from a large survey of U.S. adults.

Researchers from the Centers for Disease Control and Prevention analyzed data from 3,623 adults without diabetes who participated in the 2007-2010 National Health and Nutrition Examination Survey (NHANES).

They then used four screening and glucose testing guidelines to identify the proportion of adults who met the criteria for glucose testing, and compare this with subjects’ self-reports of glucose testing.

According to data presented at the World Diabetes Congress, the percentage of adults found eligible for glucose testing varied from 36% with the U.S. Preventive Services Task Force (USPSTF) guidelines to 80% using the U.K. National Institute for Health and Clinical Excellence (NICE) guidelines.

The other guidelines examined were the American Diabetes Association (ADA) guidelines, which found 74% were eligible, and the International Diabetes Federation/U.S. National Diabetes Prevention Program (IDF) risk test, which found 43% were eligible.

However, when researchers then examined whether eligible individuals had in fact received glucose testing, they found that approximately half did not recall being tested.

"Of those eligible according to the ADA, USPSTF, IDF, and NICE guidelines, 49.1%, 57.7%, 55.2%, and 48.9%, respectively, reported receiving a glucose test within the past 3 years," according to Dr. Giuseppina Imperatore.

Dr. Imperatore said she was surprised by the significant gap in testing practices.

"You have to take this with caution because maybe there is a recall bias, but definitely, if this is the case, it is a concern because these people should be receiving treatment or they should be receiving lifestyle modification," said Dr. Imperatore of the division of diabetes translation, CDC.

NHANES involves a questionnaire and an at-home interview and assessment, including the taking of a blood sample, which enabled the researchers to measure individuals’ blood glucose levels.

Dr. Imperatore said one of the reasons why some individuals may not have been tested was their health insurance status.

"When we looked at the percentage of tested and nontested in terms of health care insurance, those that were not tested were more likely not to have health insurance, so this is probably one of the reasons they didn’t get tested, although they were at high risk for diabetes or prediabetes," Dr. Imperatore said in an interview.

The study also found a wide range of sensitivities and specificities across the guidelines. The NICE guidelines were the most sensitive at 92% but had the lowest specificity at 31%, while the U.S. Preventive Services Task Force guidelines had the highest specificity (83%) but lowest sensitivity (31%).

Dr. Imperatore said she would opt for the American Diabetes Association guidelines, which had the highest sensitivity of the U.S. guidelines.

There were no conflicts of interest reported.

MELBOURNE – Approximately half of adults who meet the eligibility for glucose testing according to four different guidelines are not being tested for type 2 diabetes, according to data from a large survey of U.S. adults.

Researchers from the Centers for Disease Control and Prevention analyzed data from 3,623 adults without diabetes who participated in the 2007-2010 National Health and Nutrition Examination Survey (NHANES).

They then used four screening and glucose testing guidelines to identify the proportion of adults who met the criteria for glucose testing, and compare this with subjects’ self-reports of glucose testing.

According to data presented at the World Diabetes Congress, the percentage of adults found eligible for glucose testing varied from 36% with the U.S. Preventive Services Task Force (USPSTF) guidelines to 80% using the U.K. National Institute for Health and Clinical Excellence (NICE) guidelines.

The other guidelines examined were the American Diabetes Association (ADA) guidelines, which found 74% were eligible, and the International Diabetes Federation/U.S. National Diabetes Prevention Program (IDF) risk test, which found 43% were eligible.

However, when researchers then examined whether eligible individuals had in fact received glucose testing, they found that approximately half did not recall being tested.

"Of those eligible according to the ADA, USPSTF, IDF, and NICE guidelines, 49.1%, 57.7%, 55.2%, and 48.9%, respectively, reported receiving a glucose test within the past 3 years," according to Dr. Giuseppina Imperatore.

Dr. Imperatore said she was surprised by the significant gap in testing practices.

"You have to take this with caution because maybe there is a recall bias, but definitely, if this is the case, it is a concern because these people should be receiving treatment or they should be receiving lifestyle modification," said Dr. Imperatore of the division of diabetes translation, CDC.

NHANES involves a questionnaire and an at-home interview and assessment, including the taking of a blood sample, which enabled the researchers to measure individuals’ blood glucose levels.

Dr. Imperatore said one of the reasons why some individuals may not have been tested was their health insurance status.

"When we looked at the percentage of tested and nontested in terms of health care insurance, those that were not tested were more likely not to have health insurance, so this is probably one of the reasons they didn’t get tested, although they were at high risk for diabetes or prediabetes," Dr. Imperatore said in an interview.

The study also found a wide range of sensitivities and specificities across the guidelines. The NICE guidelines were the most sensitive at 92% but had the lowest specificity at 31%, while the U.S. Preventive Services Task Force guidelines had the highest specificity (83%) but lowest sensitivity (31%).

Dr. Imperatore said she would opt for the American Diabetes Association guidelines, which had the highest sensitivity of the U.S. guidelines.

There were no conflicts of interest reported.

MELBOURNE – Approximately half of adults who meet the eligibility for glucose testing according to four different guidelines are not being tested for type 2 diabetes, according to data from a large survey of U.S. adults.

Researchers from the Centers for Disease Control and Prevention analyzed data from 3,623 adults without diabetes who participated in the 2007-2010 National Health and Nutrition Examination Survey (NHANES).

They then used four screening and glucose testing guidelines to identify the proportion of adults who met the criteria for glucose testing, and compare this with subjects’ self-reports of glucose testing.

According to data presented at the World Diabetes Congress, the percentage of adults found eligible for glucose testing varied from 36% with the U.S. Preventive Services Task Force (USPSTF) guidelines to 80% using the U.K. National Institute for Health and Clinical Excellence (NICE) guidelines.

The other guidelines examined were the American Diabetes Association (ADA) guidelines, which found 74% were eligible, and the International Diabetes Federation/U.S. National Diabetes Prevention Program (IDF) risk test, which found 43% were eligible.

However, when researchers then examined whether eligible individuals had in fact received glucose testing, they found that approximately half did not recall being tested.

"Of those eligible according to the ADA, USPSTF, IDF, and NICE guidelines, 49.1%, 57.7%, 55.2%, and 48.9%, respectively, reported receiving a glucose test within the past 3 years," according to Dr. Giuseppina Imperatore.

Dr. Imperatore said she was surprised by the significant gap in testing practices.

"You have to take this with caution because maybe there is a recall bias, but definitely, if this is the case, it is a concern because these people should be receiving treatment or they should be receiving lifestyle modification," said Dr. Imperatore of the division of diabetes translation, CDC.

NHANES involves a questionnaire and an at-home interview and assessment, including the taking of a blood sample, which enabled the researchers to measure individuals’ blood glucose levels.

Dr. Imperatore said one of the reasons why some individuals may not have been tested was their health insurance status.

"When we looked at the percentage of tested and nontested in terms of health care insurance, those that were not tested were more likely not to have health insurance, so this is probably one of the reasons they didn’t get tested, although they were at high risk for diabetes or prediabetes," Dr. Imperatore said in an interview.

The study also found a wide range of sensitivities and specificities across the guidelines. The NICE guidelines were the most sensitive at 92% but had the lowest specificity at 31%, while the U.S. Preventive Services Task Force guidelines had the highest specificity (83%) but lowest sensitivity (31%).

Dr. Imperatore said she would opt for the American Diabetes Association guidelines, which had the highest sensitivity of the U.S. guidelines.

There were no conflicts of interest reported.

MELBOURNE – Approximately half of adults who meet the eligibility for glucose testing according to four different guidelines are not being tested for type 2 diabetes, according to data from a large survey of U.S. adults.

Researchers from the Centers for Disease Control and Prevention analyzed data from 3,623 adults without diabetes who participated in the 2007-2010 National Health and Nutrition Examination Survey (NHANES).

They then used four screening and glucose testing guidelines to identify the proportion of adults who met the criteria for glucose testing, and compare this with subjects’ self-reports of glucose testing.

According to data presented at the World Diabetes Congress, the percentage of adults found eligible for glucose testing varied from 36% with the U.S. Preventive Services Task Force (USPSTF) guidelines to 80% using the U.K. National Institute for Health and Clinical Excellence (NICE) guidelines.

The other guidelines examined were the American Diabetes Association (ADA) guidelines, which found 74% were eligible, and the International Diabetes Federation/U.S. National Diabetes Prevention Program (IDF) risk test, which found 43% were eligible.

However, when researchers then examined whether eligible individuals had in fact received glucose testing, they found that approximately half did not recall being tested.

"Of those eligible according to the ADA, USPSTF, IDF, and NICE guidelines, 49.1%, 57.7%, 55.2%, and 48.9%, respectively, reported receiving a glucose test within the past 3 years," according to Dr. Giuseppina Imperatore.

Dr. Imperatore said she was surprised by the significant gap in testing practices.

"You have to take this with caution because maybe there is a recall bias, but definitely, if this is the case, it is a concern because these people should be receiving treatment or they should be receiving lifestyle modification," said Dr. Imperatore of the division of diabetes translation, CDC.

NHANES involves a questionnaire and an at-home interview and assessment, including the taking of a blood sample, which enabled the researchers to measure individuals’ blood glucose levels.

Dr. Imperatore said one of the reasons why some individuals may not have been tested was their health insurance status.

"When we looked at the percentage of tested and nontested in terms of health care insurance, those that were not tested were more likely not to have health insurance, so this is probably one of the reasons they didn’t get tested, although they were at high risk for diabetes or prediabetes," Dr. Imperatore said in an interview.

The study also found a wide range of sensitivities and specificities across the guidelines. The NICE guidelines were the most sensitive at 92% but had the lowest specificity at 31%, while the U.S. Preventive Services Task Force guidelines had the highest specificity (83%) but lowest sensitivity (31%).

Dr. Imperatore said she would opt for the American Diabetes Association guidelines, which had the highest sensitivity of the U.S. guidelines.

There were no conflicts of interest reported.

MELBOURNE – Approximately half of adults who meet the eligibility for glucose testing according to four different guidelines are not being tested for type 2 diabetes, according to data from a large survey of U.S. adults.

Researchers from the Centers for Disease Control and Prevention analyzed data from 3,623 adults without diabetes who participated in the 2007-2010 National Health and Nutrition Examination Survey (NHANES).

They then used four screening and glucose testing guidelines to identify the proportion of adults who met the criteria for glucose testing, and compare this with subjects’ self-reports of glucose testing.

According to data presented at the World Diabetes Congress, the percentage of adults found eligible for glucose testing varied from 36% with the U.S. Preventive Services Task Force (USPSTF) guidelines to 80% using the U.K. National Institute for Health and Clinical Excellence (NICE) guidelines.

The other guidelines examined were the American Diabetes Association (ADA) guidelines, which found 74% were eligible, and the International Diabetes Federation/U.S. National Diabetes Prevention Program (IDF) risk test, which found 43% were eligible.

However, when researchers then examined whether eligible individuals had in fact received glucose testing, they found that approximately half did not recall being tested.

"Of those eligible according to the ADA, USPSTF, IDF, and NICE guidelines, 49.1%, 57.7%, 55.2%, and 48.9%, respectively, reported receiving a glucose test within the past 3 years," according to Dr. Giuseppina Imperatore.

Dr. Imperatore said she was surprised by the significant gap in testing practices.

"You have to take this with caution because maybe there is a recall bias, but definitely, if this is the case, it is a concern because these people should be receiving treatment or they should be receiving lifestyle modification," said Dr. Imperatore of the division of diabetes translation, CDC.

NHANES involves a questionnaire and an at-home interview and assessment, including the taking of a blood sample, which enabled the researchers to measure individuals’ blood glucose levels.

Dr. Imperatore said one of the reasons why some individuals may not have been tested was their health insurance status.

"When we looked at the percentage of tested and nontested in terms of health care insurance, those that were not tested were more likely not to have health insurance, so this is probably one of the reasons they didn’t get tested, although they were at high risk for diabetes or prediabetes," Dr. Imperatore said in an interview.

The study also found a wide range of sensitivities and specificities across the guidelines. The NICE guidelines were the most sensitive at 92% but had the lowest specificity at 31%, while the U.S. Preventive Services Task Force guidelines had the highest specificity (83%) but lowest sensitivity (31%).

Dr. Imperatore said she would opt for the American Diabetes Association guidelines, which had the highest sensitivity of the U.S. guidelines.

There were no conflicts of interest reported.

MELBOURNE – Approximately half of adults who meet the eligibility for glucose testing according to four different guidelines are not being tested for type 2 diabetes, according to data from a large survey of U.S. adults.

Researchers from the Centers for Disease Control and Prevention analyzed data from 3,623 adults without diabetes who participated in the 2007-2010 National Health and Nutrition Examination Survey (NHANES).

They then used four screening and glucose testing guidelines to identify the proportion of adults who met the criteria for glucose testing, and compare this with subjects’ self-reports of glucose testing.

According to data presented at the World Diabetes Congress, the percentage of adults found eligible for glucose testing varied from 36% with the U.S. Preventive Services Task Force (USPSTF) guidelines to 80% using the U.K. National Institute for Health and Clinical Excellence (NICE) guidelines.

The other guidelines examined were the American Diabetes Association (ADA) guidelines, which found 74% were eligible, and the International Diabetes Federation/U.S. National Diabetes Prevention Program (IDF) risk test, which found 43% were eligible.

However, when researchers then examined whether eligible individuals had in fact received glucose testing, they found that approximately half did not recall being tested.

"Of those eligible according to the ADA, USPSTF, IDF, and NICE guidelines, 49.1%, 57.7%, 55.2%, and 48.9%, respectively, reported receiving a glucose test within the past 3 years," according to Dr. Giuseppina Imperatore.

Dr. Imperatore said she was surprised by the significant gap in testing practices.

"You have to take this with caution because maybe there is a recall bias, but definitely, if this is the case, it is a concern because these people should be receiving treatment or they should be receiving lifestyle modification," said Dr. Imperatore of the division of diabetes translation, CDC.

NHANES involves a questionnaire and an at-home interview and assessment, including the taking of a blood sample, which enabled the researchers to measure individuals’ blood glucose levels.

Dr. Imperatore said one of the reasons why some individuals may not have been tested was their health insurance status.

"When we looked at the percentage of tested and nontested in terms of health care insurance, those that were not tested were more likely not to have health insurance, so this is probably one of the reasons they didn’t get tested, although they were at high risk for diabetes or prediabetes," Dr. Imperatore said in an interview.

The study also found a wide range of sensitivities and specificities across the guidelines. The NICE guidelines were the most sensitive at 92% but had the lowest specificity at 31%, while the U.S. Preventive Services Task Force guidelines had the highest specificity (83%) but lowest sensitivity (31%).

Dr. Imperatore said she would opt for the American Diabetes Association guidelines, which had the highest sensitivity of the U.S. guidelines.

There were no conflicts of interest reported.

MELBOURNE – The benefits of bariatric surgery in people with type 2 diabetes are significantly reduced with longer disease duration at the time of surgery and with time since surgery, a long-running, prospective, controlled study has found.

The Swedish Obese Subjects study showed that 72% of surgery patients achieved remission at 2 years after treatment, compared with 16% of control patients.

Furthermore, 15 years after surgery, 31% of the surgery patients remained in remission, compared to 7% of control patients, according to data presented at the International Diabetes Federation world congress.

When stratified by disease duration at baseline, newly diagnosed patients maintained significantly higher remission rates at 2, 10 and 15 years’ follow-up (roughly 94%, 60%, and 47%, respectively) than did those who had had diabetes for more than 3 years at baseline (about 39%, 12%, and 9%).

These data came from the SOS (Swedish Obese Subjects) study, a nonrandomized, prospective, observational study involving 2,010 obese subjects who underwent bariatric surgery in 1987-2001, when they were 37-60 years old. A total of 68% of the bariatric surgery recipients had vertical band gastroplasty, 19% underwent gastric banding, and 13% had a Roux en-Y gastric bypass. They were extensively matched by 18 variables to 2,037 obese controls. The SOS study is being conducted at 25 surgical departments and 480 primary care clinics across Sweden. Follow-up is ongoing.

There were 343 individuals with type 2 diabetes in the surgical group and 260 in the control group, enabling a secondary analysis of the impact of bariatric surgery in type 2 diabetes.

Presenter Markku Peltonen said that although bariatric surgery achieves impressive results in the short-term, there is considerable relapse in the longer term.

"It’s typical of bariatric surgery that you achieve the greatest weight loss initially, after 2 years, then there is a slow regain again and this was observed in this study," said Dr. Peltonen, director of the department of chronic disease prevention at the National Institute for Health and Welfare, Helsinki.

"Even in the long term, they are doing much better than the controls who were treated with traditional weight management means," he said in an interview.

This also extended to the microvascular and macrovascular complications of diabetes, with the study showing a significant 47% lower incidence of complications in the surgery group, compared with the control group.

However, these benefits were also attenuated by disease duration. Patients who had had diabetes for more than 3 years and were treated with surgery showed no significant differences in diabetes complication rates, compared with the patients given medical care only.

Dr. Peltonen said he was surprised by the degree of impact that disease duration had on the outcomes of surgery.

"Somehow the expectation would be that we would see an effect even in those people with long diabetes duration, because they have a serious, advanced disease but it looks like, based on our results, that maybe it’s so that the disease has advanced for so long that bariatric surgery cannot reverse that development."

Session chair John Dixon said the SOS study represented the pinnacle of long-term data for bariatric surgery, and offered impressive insights.

"The fact that 31% of these patients are still in remission from diabetes some 15 years down the track is extraordinary, because we know the deterioration of beta cells is significant and this group has held it off for a long time," said Dr. Dixon, head of clinical obesity research at the Baker IDI Heart and Diabetes Institute in Melbourne.

Dr. Dixon said the finding that patients treated early fared better and had a reduction in long-term complications was also a very important clinical finding, suggesting that bariatric surgery should be considered earlier in obese patients not getting good control with conventional therapy.

SOS was supported by the Swedish Research Council, the Swedish Foundation for Strategic Research, and the Swedish government. Some study investigators authors had received paid lectureships, held stock in, or were on the advisory boards for pharmaceutical companies.

MELBOURNE – The benefits of bariatric surgery in people with type 2 diabetes are significantly reduced with longer disease duration at the time of surgery and with time since surgery, a long-running, prospective, controlled study has found.

The Swedish Obese Subjects study showed that 72% of surgery patients achieved remission at 2 years after treatment, compared with 16% of control patients.

Furthermore, 15 years after surgery, 31% of the surgery patients remained in remission, compared to 7% of control patients, according to data presented at the International Diabetes Federation world congress.

When stratified by disease duration at baseline, newly diagnosed patients maintained significantly higher remission rates at 2, 10 and 15 years’ follow-up (roughly 94%, 60%, and 47%, respectively) than did those who had had diabetes for more than 3 years at baseline (about 39%, 12%, and 9%).

These data came from the SOS (Swedish Obese Subjects) study, a nonrandomized, prospective, observational study involving 2,010 obese subjects who underwent bariatric surgery in 1987-2001, when they were 37-60 years old. A total of 68% of the bariatric surgery recipients had vertical band gastroplasty, 19% underwent gastric banding, and 13% had a Roux en-Y gastric bypass. They were extensively matched by 18 variables to 2,037 obese controls. The SOS study is being conducted at 25 surgical departments and 480 primary care clinics across Sweden. Follow-up is ongoing.

There were 343 individuals with type 2 diabetes in the surgical group and 260 in the control group, enabling a secondary analysis of the impact of bariatric surgery in type 2 diabetes.

Presenter Markku Peltonen said that although bariatric surgery achieves impressive results in the short-term, there is considerable relapse in the longer term.

"It’s typical of bariatric surgery that you achieve the greatest weight loss initially, after 2 years, then there is a slow regain again and this was observed in this study," said Dr. Peltonen, director of the department of chronic disease prevention at the National Institute for Health and Welfare, Helsinki.

"Even in the long term, they are doing much better than the controls who were treated with traditional weight management means," he said in an interview.

This also extended to the microvascular and macrovascular complications of diabetes, with the study showing a significant 47% lower incidence of complications in the surgery group, compared with the control group.

However, these benefits were also attenuated by disease duration. Patients who had had diabetes for more than 3 years and were treated with surgery showed no significant differences in diabetes complication rates, compared with the patients given medical care only.

Dr. Peltonen said he was surprised by the degree of impact that disease duration had on the outcomes of surgery.

"Somehow the expectation would be that we would see an effect even in those people with long diabetes duration, because they have a serious, advanced disease but it looks like, based on our results, that maybe it’s so that the disease has advanced for so long that bariatric surgery cannot reverse that development."

Session chair John Dixon said the SOS study represented the pinnacle of long-term data for bariatric surgery, and offered impressive insights.

"The fact that 31% of these patients are still in remission from diabetes some 15 years down the track is extraordinary, because we know the deterioration of beta cells is significant and this group has held it off for a long time," said Dr. Dixon, head of clinical obesity research at the Baker IDI Heart and Diabetes Institute in Melbourne.

Dr. Dixon said the finding that patients treated early fared better and had a reduction in long-term complications was also a very important clinical finding, suggesting that bariatric surgery should be considered earlier in obese patients not getting good control with conventional therapy.

SOS was supported by the Swedish Research Council, the Swedish Foundation for Strategic Research, and the Swedish government. Some study investigators authors had received paid lectureships, held stock in, or were on the advisory boards for pharmaceutical companies.

MELBOURNE – The benefits of bariatric surgery in people with type 2 diabetes are significantly reduced with longer disease duration at the time of surgery and with time since surgery, a long-running, prospective, controlled study has found.

The Swedish Obese Subjects study showed that 72% of surgery patients achieved remission at 2 years after treatment, compared with 16% of control patients.

Furthermore, 15 years after surgery, 31% of the surgery patients remained in remission, compared to 7% of control patients, according to data presented at the International Diabetes Federation world congress.

When stratified by disease duration at baseline, newly diagnosed patients maintained significantly higher remission rates at 2, 10 and 15 years’ follow-up (roughly 94%, 60%, and 47%, respectively) than did those who had had diabetes for more than 3 years at baseline (about 39%, 12%, and 9%).

These data came from the SOS (Swedish Obese Subjects) study, a nonrandomized, prospective, observational study involving 2,010 obese subjects who underwent bariatric surgery in 1987-2001, when they were 37-60 years old. A total of 68% of the bariatric surgery recipients had vertical band gastroplasty, 19% underwent gastric banding, and 13% had a Roux en-Y gastric bypass. They were extensively matched by 18 variables to 2,037 obese controls. The SOS study is being conducted at 25 surgical departments and 480 primary care clinics across Sweden. Follow-up is ongoing.

There were 343 individuals with type 2 diabetes in the surgical group and 260 in the control group, enabling a secondary analysis of the impact of bariatric surgery in type 2 diabetes.

Presenter Markku Peltonen said that although bariatric surgery achieves impressive results in the short-term, there is considerable relapse in the longer term.

"It’s typical of bariatric surgery that you achieve the greatest weight loss initially, after 2 years, then there is a slow regain again and this was observed in this study," said Dr. Peltonen, director of the department of chronic disease prevention at the National Institute for Health and Welfare, Helsinki.

"Even in the long term, they are doing much better than the controls who were treated with traditional weight management means," he said in an interview.

This also extended to the microvascular and macrovascular complications of diabetes, with the study showing a significant 47% lower incidence of complications in the surgery group, compared with the control group.

However, these benefits were also attenuated by disease duration. Patients who had had diabetes for more than 3 years and were treated with surgery showed no significant differences in diabetes complication rates, compared with the patients given medical care only.

Dr. Peltonen said he was surprised by the degree of impact that disease duration had on the outcomes of surgery.

"Somehow the expectation would be that we would see an effect even in those people with long diabetes duration, because they have a serious, advanced disease but it looks like, based on our results, that maybe it’s so that the disease has advanced for so long that bariatric surgery cannot reverse that development."

Session chair John Dixon said the SOS study represented the pinnacle of long-term data for bariatric surgery, and offered impressive insights.

"The fact that 31% of these patients are still in remission from diabetes some 15 years down the track is extraordinary, because we know the deterioration of beta cells is significant and this group has held it off for a long time," said Dr. Dixon, head of clinical obesity research at the Baker IDI Heart and Diabetes Institute in Melbourne.

Dr. Dixon said the finding that patients treated early fared better and had a reduction in long-term complications was also a very important clinical finding, suggesting that bariatric surgery should be considered earlier in obese patients not getting good control with conventional therapy.

SOS was supported by the Swedish Research Council, the Swedish Foundation for Strategic Research, and the Swedish government. Some study investigators authors had received paid lectureships, held stock in, or were on the advisory boards for pharmaceutical companies.