World Diabetes Congress - 2009

As readers of Yada Yada newsletter , the Reality Check forum, and followers of my recent onslaught of Twittering will be well aware, I have recently had the opportunity to attend the World Diabetes Congress.  Thirteen thousand people from more than 100 countries descended on Montreal, Canada in October for this celebration and sharing of all things related to diabetes, and I was but one of them amongst the huge crowds in the Palais de Congress in downtown Montreal. 

A more comprehensive report will follow once I have had some time to catch my breath, digest it all - and get home!  But for now a few of the highlights that I want to share with you.

Islet transplantation developments are exciting - it's all about pigs

The researchers from the University of Calgary in Edmonton, Canada, were the first to do successful islet transplantations that lasted up to 12 months and publish the results in 2000 - now referred to as the Edmonton protocol.   Greg Korbutt from Edmonton gave a wide-ranging update on what types of research they are now pursuing and how it is all going.  In brief, they are focused on xenotransplantation - working out how to safely and effectively transplant insulin-producing islet cells from pigs into humans. They have successfully developed an automated process to quickly and efficiently isolate the islet cells from neonatal pig pancreases.  They have also successfully transplanted islets into baboons which survived for 364 days but the immune suppression regime (drugs to stop the cells being rejected and/or our confused immune systems killing them off again) used in this experiemnt would be way too toxic to use in humans so they are now trying to develop a safer immune suppression regime and havent had huge success yet - so far have done 5 transplants into baboons and only 2 worked at all.  They are also encountering issues with animal rights activists concerned about using baboons for this research. 

What about stem cells? Korbutt from Edmonton noted that, in their view, pigs (and within that there is the choice of adult, neonatal or fetal pigs and they are predominantly working on neonatal pigs) were a better source of iselts than stems cells as we know they produce insulin - whereas with stems cells "on a good day, you can get 10% to convert" into insulin-producing cells but still not even all the way to islet cells.  Camillo Ricordi from the Diabetes Research Institute in Miami, Florida spoke on the large amount of work they and others are doing to create islet cells from stem cells.  A lot is now known about how this works - and Ricrodi described the four stages that a cell must be made to go through to convert from an adult stem cell into an insulin-producing cell.  We're not there yet but he did say this "shows great promise for important clinical application".  Another development from Ricordi was a new method for creating microenvironments (an oxygen sandwich!) in which islet cells are better kept alive.

Teaching doctors and other health professionals to show "empathy and curiosity"

I was really impressed by some work by Professor Gregory from Cardiff who has designed a training package for health professionals to better relate to their patients.  They did a lot of talking to teenagers and young adults about what they want to happen in their interactions with their health professionals and it sounded VERY similar to a lot what we discuss at Reality Check, so it was exciting to hear that someone 'got it' and had really put his neck out to try to improve things. One part of this was that the doctors, when asked, wanted to deal with the medical stuff of diabetes then have a whole team they could refer us to who could deal with any psychological and social issues we might be experiencing.  Gregory pointed out that this team doesn't exist and there will never be enough psychologists - and instead what the people with diabetes wanted was some recognition that diabetes does impact on every aspect of your life and they wanted discussion of things outside of very medical elements of diabetes 'legitimised' by their health professionals.  Professor Gregory's health professional training program, called DEPICTED, is currently being trialled across multiple sites in the UK - let's hope it proves successful and is rolled out to our shores.  One to watch.

New treatment for retinopathy - implanting tiny capsule of drugs

Canadian ophthalmologist Susan Boyd gave a terrific presentation on new treatments for retinopathy.  To start, she said laser therapy remains the most effective of the currently available treastments.  She then spoke of a range of things in development but said the most promsing was tiny devices to be implanted into the eye with drugs (steroids) inside that release over time (otherwise these drugs have been shown to have to be re-injected every 4-6 weeks which is not feasible).  Ask your optho for more info - there are trials underway, in North America at least!

Effect of severe hypos in pregnant women on unborn babies

A Canadian study led by Dr Pacaud is looking, for the first time, at type 1 women who had severe hypos during pregnancy and the impact on the neuro cognitive outcomes of the bubs not just at birth but over time.  The long-term results arent yet available but the study showed very reliably that there are no immediate impacts on the babies when they are studied at or very soon after birth, which is very encouraging given the rate of severe hypos in pregnancy.   They also looked at whether you can predict whether a woman would have a severe hypo during pregnancy and the only reliable predictor was having had 2 or more severe hypos previously.

Insulin was actually discovered by a Hungarian not Banting & Best!

A brave presentation in the home of Banting and Best, a medical historian described how the most significant discovery about the physiology and role of insulin was actually made by a Romanian Dr Paulescu.   Canadian Dr Collip made a subsequent discovery of how to purify it which made it possible to use in humans which is considered equally significant.  But Banting and Best are widely credited, and Banting and McLeod got the Nobel prize. 

The Renoufs made me cry!

Elissa and Steve (yes, the rugby league player) Renouf from Brisbane were at the Congress and gave a terrifically frank and informative presentation about their life with four of their kids (plus Steve) all having Type 1. Some of the anecdotes were mind-blowing, leaving you not sure whether to laugh or cry at the tales of swapped blood glucose meters, treating the wrong person's hypo, a backyard strewn with pumps and much more.  I recommend going to see them speak if you get the chance.   You can also read some of their story on the website of the company Elissa started, Diabete-ezy.

How does Australia measure up against the world?

The World Diabetes Congress is designed for the sharing of information around the world - and there is a clear intention that it is especially for more developed and advanced countries to come and share what they know and what they are doing with the developing countries.   On the last day, I had several independent conversations with other Australians who like me felt a great obligation - and noted that in Australia we are incredibly lucky to have our governments and industry supporting diabetes very strongly but that we could be doing so much more with the opportunities when you see what so many countries manage to do with nothing (see my Tweets on Sudan).

A central area in the conference was the Global Village where all the world's diabetes association had displays and staff there to chat with you about what they were doing.  Through the Congress I tried to do the rounds of these stands and find out about anything that other countries were doing to support adults with Type 1 diabetes.  I have to say I was shocked and amazed at how many times this conversation ended up with me explaining that Type 1 really is very different  to Type 2 and the supports and services people with Type 1 need are also different.  That Type 1 occurred in large numbers in adults was also not well understood - when I asked about Type 1 I was often informed about children and had to push and prompt.  This appeared to be news to many of the associations I chatted with including several with high prevalence of Type 1 - Canada and Denmark, for example.  A notable exception was the Zagreb Branch of the Croatian Diabetes Society who had a group of volunteers there (I think they had worked very hard to get there, impressive stuff) and they had a very Reality Check vibe about them - they were doing interesting work to develop up an online community and were keen to learn abotu Reality Check and MP, and they were raising awareness that women with diabetes can have health pregnancies and a range of other activities.

Next month, I will try to do a more wide-ranging update with more news and ideas that I came across - and some photos!  I am also going to be writing up the talk that I presented about Diabetes Online, and the great opportunities which we have found with Reality Check and Munted Pancreas that can be developed through helping people with diabetes to connect with each other online.  But first, 23 hours on a plane and no doubt a thousand emails to deal with when I get back to work!

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