Report
from the World Diabetes Congress
Cape
Town, South Africa,
December 2006
 Fresh
back in smoky Melbourne, writing to you today with a wrap-up from last
week’s enormous World Diabetes Congress in Cape Town which I attended,
thanks to a generous travel grant from the International Diabetes Federation.
This is
an incredibly brief overview of some very complex topics (hope I don’t
offend anyone whose 10 years of research is now just 10 words!). Have
included a few of my happy snaps as well.
I could
write a page or more on every dot point below, and then many more on
the experience and general impressions of a mind-blowing week, and I
have notes and memories to do so! But I don’t have time to write
up every single thing, sadly, though I do want to share some more of
this incredible experience with you.
 Please
let me know what you want to hear more about, if anything. Ask questions,
tell me what you’re interested in, and I’ll happily expand
on the bits that are most popular with a few more detailed articles.
My report
is split into two sections – New Stuff (OK, so
not all of it's incredibly new to those of us who live with D, but new
in the sense that the official world of D has gathered evidence and
all of that which is important too!) and then some not necessarily new
but still Interesting Stuff.
In
this article:
Highlights
of the World Diabetes Congress
Highlights
of the Congress for me included the following bits of news and developments.
The researcher, doctor or group whose presentation in which each issue
appeared is in the brackets.
-
 Islet
transplantation continues to progress rapidly despite the
buzz having died down in recent years – there are many barriers
but they are apparently all surmountable!! (James Shapiro, Edmonton,
Canada)
- Stem
cells. We now know the full process by which real stem cells
actually develop into cells that will produce insulin in response
to glucose levels - this is a major breakthrough towards us being
able to force stem cells to do this in a lab. (Wendy McFarlane, Brighton,
UK)
- Hypos
during exercise may be reduced by doing a 10-second sprint
during and before moderate intensity exercise. (Vanessa Bussau and
Tim Jones, Perth)
 Guidance
for exercising with Type 1 diabetes, in the form of tables
recommending carb loadings and insulin reductions needed for different
types of exercise in different sized people, have now been calculated.
Also, normal or target blood glucose range during exercise should
be considered 4.5 – 10 mmol/L. (Michael Riddell, Toronto, Canada.)
- Hypo
unawareness – 3 mmol/L seems to be the important level.
Reducing drops below 3 has been proven to restore hypo awareness.
(Stephanie Amiel, London, UK)
- Hypoglycaemia
is getting better understood: Type 1s have been shown to
lose our natural Glucagon response to hypos after 5 years and epinephrine,
the other hormone that should kick in when sugars drop low, is also
impaired in Type 1s. It’s thought hypo unawareness happens because
the stress response when the body has to fix a hypo is toxic and therefore
unawareness is a type of protective mechanism. (Rory McCrimmon, New
Haven, USA)
- If
you Smoke, and have an Hba1c of 6.5, you may as well have
an a1c of 9. (Denis Daneman, Toronto, Canada)
- Teenage
years misunderstood: Parents and health professionals think
diabetes gets easier as we get older (from childhood through teenage
years to adulthood) but teenagers themselves perceive their quality
of life to be declining at this time. (Hvidoere
Study Group, Denis Daneman, Toronto, Canada)
- Adolescents
who say their parents are over-protective have worse diabetes
control. (Hvidoere Study Group, Denis Daneman, Toronto, Canada)
- Adelaide's
very own DiabetesCounselling.com.au also featured at the
Congress, with Helen Edwards receiving an IDF grant to attend, and
presenting a poster about the evaluation of her online counselling
service. Great to see Aussie innovation being recognised!
 Nicole
Johnson, Miss America 1999, insisted her now husband wear
a pump and test his sugars and carb count for 3 days before she would
answer his proposal of marriage!
- In
25% of pregnant women with Type 1 (Nicole Johnson being one
of them) the pregnancy growth factor is so powerful it can promote
islet cell regeneration. (Lois Jovanovic, USA)
- Doctors
and nurses significantly over-estimate emotions like how
afraid, angry and overwhelmed their patients are by diabetes, and
under-estimate their willingness to take a more active role in their
management. (William Polonsky, USA)
- Family
factors are a stronger predictor of A1c in children than
gender, age or insulin regime (Chas Skinner, UK, for the Hvidoere
Study Group)
- Transferring
responsibility for diabetes management to a child early is
associated with worse self-care and more DKA (Chas Skinner, UK, for
the Hvidoere Study Group)
- “Brittle
diabetes” is no more. People
with recurrent self-destructive behaviours have for a long time been
classified as “brittle diabetics” and are more likely
suffering borderline personality disorder. (Kalida Ismail, London,
UK referencing Gill, 2001)
- Complex
algorithms to calculate insulin doses are being developed,
which could one day inform a closed-loop pump, but they have to be
individualised. (C. Mathieu, Gent, Belgium)
- Testing
for diabetic kidney disease has progressed a lot and there
appears to be a consensus now that instead of the 24 hour or 3-night
urine we should be having a Glomerular Filtration test – and
the result should be over 60. (Marg McGill, RPA, Sydney)
- A
new study, 18 years on, from the important DCCT trial, has been released.
The original DCCT people have been followed, and the two
groups (“intensive therapy” and normal therapy) have now
had their Hba1cs merge to be pretty much the same. However, the group
that had the super tight control and low HbA1c in the original study
still have less complications despite their a1cs having risen over
time – conclusion being low HbA1c at any time is beneficial
– and some are also saying that earlier in your disease course
is especially beneficial (though no big studies been done on people
who tighten up control later). (Marg McGill, RPA, Sydney)
- Ageing
on its own can create hypo unawareness. A study comparing
non-Ds who were 22-40 and another group 60-70 found the hormone responses
the same (Glucagon, epinephrine (adrenaline)) but symptoms and cognitive
dysfunction from induced hypos happened later and lower in the older
group. (Stephanie Amiel, London, UK)
- Hypo
unawareness will affect 25% of people who have had Type 1
for 15 years (Stephanie Amiel, London, UK)
- Non-invasive
continuous glucose testing is being investigated by at least
a dozen, probably many more, small companies in Canada, US, Israel,
Germany, UK and others. Most promising so far is a finger ring and
watch contraption – data was presented at American Diabetes
Association conference 2006. (J.S. Christiansen, Aarhus, Denmark)
- Diabetic
retinopathy (eye disease) screening can be done by any diabetes
trained health professional – your endo, optometrist, etc -
BUT they MUST dilate your pupils (put drops in) to check properly.
(Marg McGill, RPA, Sydney)
- Professional
unawareness of hypoglycaemia is as big a problem as patient
unawareness, in that our HPs often don’t understand the impact
of hypos and don’t ask us about it often enough. (Stephanie
Amiel, London, UK)
- Psychological
interventions for diabetes have shown to be effective for
improving glycaemic control in children (a1c reduce by 0.5%) but not
adults (only 0.2% reduction which isn’t statistically significant).
(Kalida Ismail, London, UK)
- Every
second Australian with Type 2 seeing a GP also has kidney
disease according to the NEFRON study recently done in Oz. Type 1s
weren’t looked at in this study. (M Thomas, Melbourne)
 Pancreas
transplantation should be considered for any diabetic requiring
kidney transplantation, either at same time or soon after. Evidence
is strengthening to also indicate pancreas transplantation on its
own for people with Type 1 and poor metabolic control and d complications
other than kidneys. Pancreas transplants have been shown to improve
complications. (Professor Boggi, Pisa, Italy)
- The
principles of DAFNE (in short, carb counting and insulin adjustment)
can be taught and learnt effectively in regular out-patient clinic
appointments. (Deborah Foote and Jane Overland, Sydney)
- A
psychological intervention to improve Hba1cs in Type 1 has been developed
in the UK– combining Cognitive Behavioural Therapy
and Motivational Enhancement Therapy, making 12 sessions – and
training diabetes educators to deliver it – and it achieved
0.4% reduction in a1c and therefore deemed successful. I wasn’t
quite so convinced, and from the questions I wasn’t alone, but
interesting nonetheless.
Other
interesting things from Cape Town
- Living
with Diabetes as a Muslim was a terrific presentation by
Fazlyn Samsodien from Cape Town. She discussed not being able to fast
for Ramadan (and the alternative available that not everyone seems
to be aware of – paying a fidiya which is calculated by the
Muslin Judicial Council each year - approx. 10 Rand ($2) day to feed
someone who is needy), the traditional foods that are very fatty and
sweet such as Koeksisten, and the positives such as the discipline
and control that Islam teaches as being nicely compatible with the
demands of living with diabetes.
 Stem
Cells came to life when Wendy McFarlane from University of
Brighton gave the most articulate and brilliant presentation on stem
cells I have ever seen - very complex, and didn’t dumb it down
at all – but somehow managed to pull it together so that this
incredibly complex area was still comprehensible. Magical!
- The
future is in stem cells, implantable pumps and other such research,
and according to Denis Daneman, immediate past President of the Int’l
Society for Paed & Adolescent Diabetes (ISPAD), if you are a young
health professional and want to make some significant contributions
to diabetes, this is where the most exciting area of work is going
to be in the coming years – exciting for us patients too!
- “Skin
and diabetes” was on the agenda - the first time such
a session has made it into a diabetes conference – a surprise
to those of us with necrobiosis! I went to the session, and unfortunately
it skimmed over necrobiosis very quickly. Was, however, given by a
Sydney dermatologist who seemed to know a lot about diabetes and skin,
and one assumes necrobiosis – Dr Stephen Lee.
I have had lots of questions about this, and suggest you download
Reality Check's Fact
Sheet on Necroboisis for more information.
- Living
with Complications session – Again, the first time
for such a session and the Chair in his opening remarks congratulated
the organising committee for having a session on this topic. Again,
what the ... ??
- Finnish
Diabetes Association presented some very brave data that
only 60% of their committee members who have diabetes and 66% of their
health professional committee members who knew the organisation's
policies actually supported them, and some other amazingly honest
feedback they received from a huge audit of their regional committees.
Frank and honest. Nice.
Reality
Check and the Type 1 Diabetes Network at the World Diabetes Congress
 I
have now published the stuff I presented in Cape Town, a poster and
a short talk, onto our website.
And just
to prove I was truly there, look, here's a quick pic of me doing my
talk!
Subjecting
myself to the same, harsh, summarising that I just did to everyone else,
here are the two things that I presented in Cape Town:
- Complication
screening rates are too low, and seeing more doctors doesn’t
mean we are likely to keep up with it at any better rates.
Australian adults with Type 1 use all sorts of different medical models
for managing our diabetes. Only 60% of people we surveyed in May had
had tests for kidney, eyes and nerves in the last year, like the international
guidelines say we should, which is very worrying.
- Health
professionals had very different, but helpful, ideas about
what types of information should be given to adults newly-diagnosed
with Type 1 than people who had recently been diagnosed themselves
thought that they needed, but the Starter Kit which we developed included
the information topics that both people with diabetes and health professionals
nominated as being necessary, and has been very successful: adopted
by 226 centres across Australia.
Click
here
to read more about these two pieces of work and view the slides from
my presentation.
And
then everything I missed too...
The
program alone was a 520 page book!
Ten sessions
often ran at the same time. So it is quite an art to even choose the
right session, let alone find the room it's in. And of course there
is heaps that I missed!
The IDF
are releasing over the next few weeks videocasts of a heap of featured
sessions, including the islet transplant one, a debate about GI and
lots more: http://www.sessions2view.com/idf_library/
Many of our health professionals were at the conference, so you should
ask them about it too.
Endos
such as Peter Colman, Alicia Jenkins, Paul Zimmet, Martin Silink,
Steven Colagiuri, Stephen Twigg, John Turtle, Tony Roberts and Alan
Stocks.
And
diabetes educators including Marg McGill, Victoria Stevenson, Dr Jane
Overland, Dr Trisha Dunning, Erica Wright, Lisa Sorensen, Ruth Colagiuri,
Pam Jones and Michelle Robbins.
Lots
of Diabetes Australia people that you might know including Angie Middlehurst,
Lilian Jackson, David Ledger, Chris Faulks and Peter Little, as well
as Tasmanian Senator Guy Barnett, JDRF Board Member John Gattorna,
GI guru Jenni Brand-Miller, and lots of scientists as well of course.
If
you know any of those people, you can ask them what they saw and learnt
too!
Kate
Gilbert
Founder, President & Volunteer
The Type 1 Diabetes Network, and
www.realitycheck.org.au
Melbourne, Australia
Email: kate@d1.org.au
Published
December 13, 2006
Last
reviewed
January 1, 2007
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