Diabetes Dialogue: Advances in AID and CGM at ADA 2024, with Davida Kruger, NP

In this special edition episode of Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives from the 84th American Diabetes Association Scientific Sessions, hosts Diana Isaacs, PharmD, an endocrine clinical pharmacist, director of Education and Training in Diabetes Technology, and codirector of Endocrine Disorders in Pregnancy at the Cleveland Clinic, and Natalie Bellini, DNP, program director of Diabetes Technology at University Hospitals Diabetes and Metabolic Care Center, are joined by Davida Kruger, NP, a certified nurse practitioner in the Division of Endocrinology at Henry Ford Health System in Detroit.

During the episode, Kruger takes hosts on a deep dive into the latest in diabetes technology at the meeting, with a focus on advancement in automated insulin delivery (AID) and continuous glucose monitoring (CGM) technology. In the early half of the episode, Kruger discusses the results of the SECURE-T2D trial, which examined use of the Omnipod 5 in patients with type 2 diabetes using insulin, and, later in the episode, Kruger offers her perspective on the age of over-the-counter CGM in the wake of announcements from Dexcom and Abbott earlier this year.

SECURE-T2D

Touted by Insulet Corporation as the largest, longest, and most racially diverse study of AID in people with type 2 diabetes to date, SECURE-T2D assessed the effects of the Omnipod 5 on glycemic control among patients with type 2 diabetes requiring insulin. For inclusion, patients were required to be 18 to 75 years of age, have type 2 diabetes, have been on their current insulin regimen for 3 or more months, and have no previous AID use. Investigators pointed out HbA1c requirements required patients to have an HbA1c less than 12% among basal/bolus or pre-mix insulin users and 7% or more and less than 12% among basal-only users.

Conducted across 21 sites in the US, the trial enrolled 305 individuals—this cohort had mean age of 57 (SD, 11) years and 57% were female. The median duration of diabetes was 17 years, the mean HbA1c at screening was 8.2% (SD, 1.4), 62% were currently using CGM, and 25% had never used CGM. Regarding race and ethnicity, 50% of patients were non-Hispanic White, 24% were non-Hispanic Black, 22% were Hispanic or Latino, and 2% were Asian or Pacific Islander.

Per trial protocol, patients took part in a 14-day period of standard therapy to collect baseline data, which was followed by a 13-week period where all patients received the Omnipod 5 AID system with the Dexcom G6 continuous glucose monitoring system.

Results from the 13-week study suggested the mean HbA1c among the cohort decreased from 8.2% (SD, 1.3) at baseline to 7.4% (SD, 0.9) (treatment effect= -0.8%; 95% CI, -1.0 to -0.7; P <.001). When assessing secondary glycemic metrics, results indicated use was associated with a 20% increase in time in range of 70 to 180 mg/dL (4.8 hours per day) and a 20% decrease in time above 180 mg/dL (4.8 hours per day) (P <.001). Investigators pointed out these improvements in time in range were primarily driven by a significant reduction in hyperglycemia with no increase in hypoglycemia.

New Highlights in Diabetes Technology

In the latter portion of the episode, Kruger takes time to highlight specific key advancements she is excited about as a healthcare practitioner from the world of diabetes technology. First, Kruger discusses her experience interacting with the Twiist AID system at the Sequel MedTech booth. Later, Kruger offers insight into what she predicts the role of OTC CGMs will mean for people with diabetes as Dexcom (the Stelo) and Abbott (Libre Rio) plan rollouts for their systems, which were announced earlier this year.

Relevant disclosures for Kruger include Abbott, CeQur Corporation, Embecta, Eli Lilly and Company, MannKind Corporation, Medtronic, Inc., Novo Nordisk, and Sanofi. Relevant disclosures for Isaacs include Eli Lilly and Company, Novo Nordisk, Sanofi, Abbott Diabetes Care, Dexcom, Medtronic, and others. Relevant disclosures for Bellini include Abbott Diabetes Care, MannKind, Sanofi, and others.

References:

Pasquel FJ, Davis GM, Huffman DM, et al. Glycemic Improvement with Use of the Omnipod 5 Automated Insulin Delivery System in Adults with Type 2 Diabetes—Results of the SECURE-T2D Pivotal Trial. Presented at: American Diabetes Association (ADA) 84th Scientific Sessions. June 21 - 24, 2024. Orlando, FL.

Insulet Corporation. Insulet’s SECURE-T2D Pivotal Trial Results Demonstrate Omnipod® 5 Improves Clinical Outcomes and Quality of Life in Type 2 Diabetes. Insulet Corporation. June 21, 2024. Accessed June 22, 2024. https://investors.insulet.com/news/news-details/2024/Insulets-SECURE-T2D-Pivotal-Trial-Results-Demonstrate-Omnipod-5-Improves-Clinical-Outcomes-and-Quality-of-Life-in-Type-2-Diabetes/default.aspx.

Isaacs D, Bellini N. Diabetes dialogue: June 2024 updates in diabetes tech and type 1 diabetes. HCP Live. June 17, 2024. Accessed June 27, 2024. https://www.hcplive.com/view/diabetes-dialogue-june-2024-updates-in-diabetes-tech-and-type-1-diabetes.