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__necrobiosis 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:
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Published December 13, 2006
Last reviewed
January 1, 2007
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