ATTD 2024 — What the Conference Told Us About Diabetes Technology

1. Diabetes Technology

Accu-Chek SmartGuide CGM by Roche

Roche’s Accu-Chek SmartGuide CGM for adults requires only a one-hour warmup and a one-time calibration. With a MARD of 9.2%, this system — presented by Professor Julia Mader — integrates AI to generate glucose predictions and prevention indicators over two hours during the day and up to seven hours overnight. Accuracy and usability studies are awaited before the full clinical impact can be assessed.

Neural-Net AID Algorithm — Dr. Boris Kovatchev

A randomised controlled trial of a fully closed-loop system using a neural network algorithm achieved comparable Time in Range (TIR) to standard AID systems without requiring meal announcements, while needing six times less processing power. The approach uses a learning algorithm rather than an adapting one. Multiple presentations on neural-net approaches suggested this may represent a meaningful future direction for fully automated insulin delivery.

Advances in Paediatric Diabetes Technology — Dr. David Maahs

Dr. David Maahs reviewed key developments for children, highlighting findings from the CLVer trial on automated insulin delivery and verapamil in newly diagnosed paediatric type 1 diabetes. AID from diagnosis does not preserve C-peptide, but verapamil does show C-peptide preservation in the trial data. Verapamil may have a role as an adjunct to insulin at diagnosis in the coming years.

2. Glucose Measurements: HbA1c and Time in Range

Rethinking Glycaemic Variability — Dr. Rich Bergenstal

Dr. Bergenstal proposed lowering the coefficient of variation (CV) target from 36% to 32% to improve TIR without increasing hypoglycaemia risk. The key point: to push towards 50% or more time in tight range (TITR, 3.9–7.8 mmol/L / 70–140 mg/dL), CV needs to be 32% or below — otherwise the risk of hypoglycaemia increases substantially.

The Synergy of HbA1c and CGM — Drs. Irl Hirsch and Gregg Simonson

The session emphasised a dual approach — combining HbA1c with CGM data for comprehensive management. Notably, if the Glucose Management Indicator (GMI) is 5 mmol/mol lower than actual HbA1c over 90 days, this pattern may indicate faster glycation and potentially higher complication risk. People of Black ethnic origin appear more prone to fast glycation, which may explain a meaningful proportion of the observed HbA1c difference between white and Black children and young people. HbA1c remains important because it predicts future complications more directly than CGM metrics.

Emotional Impacts of TIR Metrics — Dr. Molly Tanenbaum

Dr. Tanenbaum explored how TIR and TITR metrics are experienced emotionally, highlighting the importance of careful framing. The current position: 70% TIR is a good target, and exploring 50% TITR is reasonable only when CV is below 32% and it will not create undue psychological stress for the individual.

3. Novel Drug Therapies

Lyumjev with Control-IQ 1.5 — Dr. Carol Levy

Dr. Carol Levy’s trial showed improved patient satisfaction and a modest 2% TIR increase with Lyumjev used alongside Tandem’s Control-IQ 1.5. Whether TITR showed a larger benefit remains an open question.

Verapamil and Beta-Cell Preservation — Prof. Desmond Schatz

CLVer trial data, presented by Prof. Schatz, showed that verapamil partially preserved beta-cell function in children and adolescents with type 1 diabetes. As a potentially low-cost intervention, this area of research is developing quickly.

Incretin-Based Therapies and GLP-1 Receptor Agonists — Prof. Satish Garg

Prof. Garg discussed progress in incretin-based therapies, including data on retatrutide and semaglutide showing significant weight loss and improved glucose management in people with type 1 diabetes. These agents may be particularly relevant for individuals aiming to achieve 50% or more TITR.

4. Type 1 Diabetes Prevention

Immune Interventions and Restorative Therapies — Prof. Desmond Schatz

Prof. Schatz reviewed clinical studies on immune interventions, including abatacept and the TEDDY study’s insights into genetic and family history factors. Immune-modulating therapies are advancing rapidly. Teplizumab (Tzield) is expected to reach the UK within approximately 12 months.

Managing Obesity in Type 1 Diabetes

Drs. Satish Garg, Jeremy Pettus, Kirsten Norgaard, and Victor Gerdes explored the interplay between weight, insulin resistance, and diabetes management in type 1 diabetes. GLP-1 receptor agonists appear to be an emerging approach for weight management in this group.

Skin Care in the Era of Devices

A comprehensive review article outlines the prevalence and management of medical adhesive-related skin injuries (MARSI), with recommendations for prevention, assessment, and treatment. Key themes from the session:

Exercise and Type 1 Diabetes

A session on moving from general principles to individualised plans echoed themes from EXTOD 2023. Simple frameworks for managing glucose around exercise — 50/50/20 for pump and MDI, T25/T25 for hybrid closed loops — were presented. For more detail, the EXTOD 2023 review covers these principles.

An EASD/ISPAD position statement on exercise and automated insulin delivery, led by Othmar Moser and Dessi Zaharieva, was anticipated for 2024. Updates will follow on publication.