Diabetes Dialogue: Updates in Diabetes Management from ATTD 23, with Irl Hirsch, MD

Author(s):

Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES,Natalie Bellini, DNP, FNP-BC, BC-ADM, CDCE

Key Takeaways

The DERMIS study, funded by the Helmsley Charitable Trust, examines skin changes from insulin pump use in type 1 diabetes patients.
Findings revealed increased inflammation, vessel density, fibrosis, and fat necrosis at insulin pump sites compared to control sites.
Irl Hirsch predicts noninvasive glucose management as the next major milestone in diabetes care advancements.

In this episode, Irl Hirsch, MD, discusses a study he is conducting examining skin changes associated with insulin pump use in people with type 1 diabetes. Later in the episode, Hirsch discusses what he is most excited about in terms of ongoing and future research in diabetes management.

While on-site at the 16th annual conference on Advanced Technologies and Treatments for Diabetes (ATTD 2023), Diana Isaacs, PharmD, an endocrine clinical pharmacist and CGM program coordinator at the Cleveland Clinic, and Natalie Bellini, DNP, an endocrine nurse practitioner at R&B Medical Group, reached out to Irl Hirsch, MD, professor of medicine at the University of Washington, to be a guest for a special edition episode of Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives.

In the episode, Hirsch offers hosts perspective on some of his ongoing work, including the DERMIS study. Funded by the Helmsley Charitable Trust, the DERMIS study was launched with the intent of learning more about skin changes occurring as a result of insulin pump use.¹ The study included 30 people with type 1 diabetes who provided skin punch biopsies from their current pump site, a recovery site used 3 days prior to biopsy, and a control site that had never been used for any infusion or injection. Upon analysis, investigators found OCT and OCTA found increased inflammation and vessel density at pump sites compared to control sites. Additionally, histological analysis of pump sites revealed differences in skin architecture including fibrosis, inflammation including increased tissue eosinophils and fat necrosis. Later in the episode, Hirsch offers hosts his opinion on where he believes diabetes research is headed and what he sees as the next forthcoming milestone in care: noninvasive glucose management.

References:

1. Kalus A, Shinohara M, Wang R, et al. The Dermis Study: Evaluation of Insulin Pump Infusion sites in type 1 diabetes. The Lancet. February 2023. doi:10.2139/ssrn.4345818