As the annual European Association for the Study of Diabetes (EASD) conference wraps up for another year, Eleanor Sherwood, our Research Communications and Engagement Officer, shares her thoughts on the best type 1 diabetes research announced in Barcelona.
EASD is a conference which attracts over 15,000 people from a wide range of professions focussed on type 1 and type 2 diabetes. This year’s event took place in the vibrant city of Barcelona in a conference hall the size of a small festival. Indeed, the EASD conference could be described as a ‘Glastonbury’ for people involved in the study and research of diabetes.
Director of Research Partnerships Rachel Connor and I were in attendance as Press, meaning our key aim was to hunt out interesting type 1 diabetes research and relay it back to our team at JDRF and our supporters. With seven cavernous seminar halls simultaneously holding talks throughout all four days of EASD, this was going to be a busy week!
DIY Looping – what’s that?
The first morning of EASD was spent hearing interesting talks ranging from viral associations with type 1 diabetes to the effects of nutritional supplement GABA on the health of insulin-producing beta cells. However, Tuesday’s main highlight was an afternoon dash across the city to attend a Hacking Health Artificial Pancreas Meet-up – an event which shone a light on the world of ‘DIY loopers’. For the uninitiated, ‘loopers’ are people with type 1 who, like many, use a continuous glucose monitor (CGM) and an insulin pump to manage their blood glucose. However, instead of inputting insulin amounts based on CGM data into the insulin pump themselves, loopers download an open-source (free) algorithm to a smartphone which allows the CGM and pump to ‘talk’ to each other. Glucose measurements, insulin calculations and delivery are therefore mostly done automatically, creating a closed-loop ‘artificial pancreas’.
In a crammed room a stone’s throw from the Sagrada Familia, I listened to a number of high-profile loopers speak about the benefits – and drawbacks – of DIY looping. Dana Lewis, a founder of the OpenAPS project which provides free access to artificial pancreas technology, described how she set up her own looping system to manage her type 1 diabetes. She praised its ability to tighten her blood glucose whilst eliminating a lot of the day to day management. However, she also stressed that the Open APS system is unregulated and operates a ‘use at your own risk’ approach.
Many more speakers went on to praise the benefits of DIY looping, however JDRF affiliate Professor Roman Hovorka of Cambridge University presented a different view. As a researcher currently testing his own artificial pancreas within controlled clinical trials, Professor Hovorka emphasised the importance of regulation of the system as well as the need for commercialisation in order to provide widespread access for all eligible people with type 1. After the event, I got the chance to record a short interview with Roman, where he talked about his highlights of the afternoon – you can watch below.
The second day of EASD started with a morning devoted to hypo-unawareness. This is when a person with type 1 doesn’t experience the symptoms of hypoglycaemia despite having very low blood glucose. Affecting around a quarter of people with type 1, it can lead to severe hypoglycaemic events and even coma. Munachiso Nwokolo from the labs of JDRF researchers Stephanie Amiel and Pratik Choudhary explained how structured cognitive therapy not only reduced the number of severe hypos and improved hypo-awareness, but also altered brain function. Following this, Catriona Farrell from JDRF researcher Rory McCrimmon’s lab described how high-intensity exercise could also restore hypo-awareness by stimulating the return of hypo symptoms.
Apps for type 1
A highlight of the afternoon was a session focussed on the use of digital apps and diabetes. Echoing the discussion from Tuesday’s Hacking Health event, many speakers discussed the potential benefits that mobile apps could bring to glucose management in type 1 diabetes, for example by calculating meal boluses, logging blood glucose and CGM data. However, emphasis was also placed on the need for evidence on their effectiveness and safety, as well as concerns over the data security and technical reliability of the apps.
Type 1 and the NHS
With many talks centring on type 2 diabetes, I spent Thursday morning catching up on the press releases that had come out over the past 24 hours. A study which took data from the 2017-2018 NHS Digital Hospital Episode Statistics in England found that while over 10% of the NHS budget was spent on diabetes-associated care in hospitals, increased investment of diabetes management by GP surgeries reduced these costs and improved HbA1c of people in their care with type 1 diabetes. This evidence therefore underscores the need for further training in diabetes management – for the benefit people living with type 1, as well as the health service.
In the afternoon, I had a walk round the HUGE poster hall where over a thousand research projects were on display – incredible, and also very encouraging to see a range of innovative therapies and technologies for type 1. I was also able to catch up with Rachel to hold a Facebook Live session through the JDRF UK Facebook account. This was a great way of relaying some of the interesting research news we’d heard so far to our supporters whilst being able to field questions from viewers!
Psychology in type 1 management
The last day of EASD came around all too soon, yet there were still some exciting talks on the programme. A session surrounding the integration of psychology into diabetes care was particularly interesting, with research covering different aspects of what seems to be a rapidly growing area. Chaired by Stephanie Amiel, we heard a talk about how personality traits may influence glucose management – pointing to a potential need for personalised care based on personality. A key point raised by the audience was that the doctor-patient relationship dynamic was also of great importance to glucose management and should be looked into.
A trigger for type 1?
For the final session of EASD, I chose to head to an update on the JDRF part-funded TEDDY study. Standing for The Environmental Determinants of Diabetes in the Young, the TEDDY study is a long-term, international study which follows children who have a high genetic risk of developing type 1 to see a) if they develop the condition and b) if so, what environmental factors are associated with development. Viruses have long been thought of as a potential trigger of type 1 diabetes, and the recent update identified two possible viruses that were associated with development of the autoimmune response which drives type 1. Although more work needs to be done to find out why the link exists, this is an exciting finding as it throws open the possibility of being able to vaccinate against or treat a viral infection in the future with the aim of preventing type 1 development.
And just like that, it was over! A whirlwind of diverse, innovative and forward-thinking research, EASD was a conference that showcased the very best that science and technology has to offer people living with type 1 diabetes. It was very encouraging to see that so much of research was funded by JDRF: we really do play a key role in the discovery of new treatments and the pursuit of a cure for type 1. This is only possible due to the support from our volunteers, fundraisers and staff around the world.