One of the biggest diabetes happenings of the year is Europe's Advanced Technologies and Treatments for Diabetes (ATTD) conference, and this year, thousands gathered for the recent event held in Vienna, Austria, to talk shop.

ATTD 2018 logoWhile the "latest and greatest" in tech and treatments are the name of the game, even overseas you can't seem to take two steps these days without also running into discussions about access, affordability and overall patient engagement related to D-tools.

Although our team wasn't able to attend in person, we queried a number of key folks in the D-Community who did, and we appreciate them sharing their observations and insights with us here at the 'Mine!

(Of course, we were also following Twitter hashtag #ATTD2018 closely, and you too can still review all that was coming out of that feed.)


Dr. George GrunbergerDr. George Grunberger, an endo in Michigan and past president of the American Association of Clinical Endocrinologists (AACE)

The show is getting ever more impressive, and diabetes technology progress has been amazing.

The presence of both the NIH and the FDA there is telling and quite encouraging.

Unveiling of the pivotal closed-loop trials, sponsored by the NIH, was exciting as was the loud call by the JDRF's Aaron Kowalski for support of DIY technology.

For me, I also had a chance to unveil the new AACE project on educating the entire -- and I mean the entire, from clinicians to patients -- Diabetes Community on the standardized glucose reports to finally start changing diabetes management using the 21st Century tools.


Ohio D-Dad Jeff Hitchcock, founder of Children With Diabetes

Jeff HitchcockThere were many wonderful presentations about advances in automated insulin delivery that demonstrate clearly that this technology will be life-changing -- as long as we can afford it.

Which brings me to what I thought was the most interesting session: Dr. Irl Hirsch's talk on health economics. Therewere some amazing points he included:

  • Looking at the cost to decrease A1C by 1% in adults with type 2 diabetes: three older, off-patent drugs cost between $3 and $8 per month. Meanwhile, three new, on-patent drugs cost between $500 and $800 per month. These drugs are not equal in terms of cardiovascular risk reduction, so all things are not equal, but for patients who do not have an increased CV risk, it's hard -- if not impossible -- to justify using the more expensive medications.
  • Looking at the QALY (quality-adjusted life-year) cost for insulin analogs in adults with type 1 and type 2 paints an even starker picture. The QALY for analogs in adults with type 1 is about $27,000 -- well below the $50,000 threshold for cost-effectiveness. For adults with type 2, it's over $450,000 -- not even close. Based on that, it's essentially impossible to justify the cost of using insulin analogs in adults with type 2 diabetes.
  • Every one of us knows that the increasing cost of healthcare is not sustainable. But few, if any, of us have an understanding of this kind of health economics. Clearly we need to, both as consumers (patients) and as providers. 


Adam Brown, longtime type 1 and Technology Editor at The diaTribe Foundation in San Francisco

We heard from many that one of the most eye-opening slides came from D-peep Adam Brown in a session where he spoke about the surprisingly small portion of PWDs across the world who actually have access to CGM systems.

Adam Brown of diaTribe at #ATTD2018

This is definitely something we all must keep in mind, as we talk about the race to faster, better, more automated diabetes control systems.


RenzaT1D Renza Scibilia in Australia, who blogs at Diabetogenic

There was lots about diabetes technologies. Yes, there was heaps about open source protocols. And yes, there were bells, whistles, sensors and everything in between.

But it was (JDRF chief mission officer) Aaron Kowalski’s talk in the Access to Novel Technologies session, where he emphasized the significant role people with diabetes play in increasing access to new treatments, that had me cheering. Aaron’s talk was very centered on patient engagement and he highlighted how JDRF and other diabetes organizations work with PWDs to accelerate life-changing breakthroughs for people with type 1 diabetes. Aaron also mentioned patient-led initiatives driving conversations around diabetes as being critical in setting the agenda for advocacy initiatives.

Still, I was disappointed a couple of times throughout the conference at the sheer lack of PWD-involvement in sessions – especially when the topic was ‘patient empowerment.' I’m not sure what it’s going to take for diabetes conference organizers to adopt and understand the #NothingAboutUsWithoutUs mantra, but it was sadly lacking at ATTD.

{Thanks to Renza for also blogging about her experiences here}


The Grumpy PumperChris Aldred, British longtime T1 aka The Grumpy Pumper -- who was actually reporting on the conference for Ascensia Diabetes

'Time in range' was talked about a lot more than HbA1c, which is encouraging and about time. A single-number target will only do one thing if "missed" -- make you feel like a failure and demotivate you. OK, so actually that's two things... Good job I never got a medical condition that requires me to do math (he, he). 

Technology focus was of course on CGM and flash glucose monitoring systems. These are great. They can make life with T1D so much easier, if you can afford them and they are accessible. I get why it's the focus at this type of conference, but what about those who had an insulin pen and BG meter 10 years ago and still have that same technology today? They deserve to have the best advances in the kit they have and use, and have access to whatever they want.

I'm sure this (access discrepancy) was apparent to all at ATTD, but it wasn't obvious to me. And if it wasn't obvious to me, then was it obvious to the healthcare professionals? If it wasn't, then how do they know about it to help the PWDs in their clinics?!

DIY (do-it-yourself) closed looping was discussed more than I've ever heard at a conference before. That can only be a good thing, in my opinion -- as long as the #WeAreNotWaiting is balanced out by the #WeAreWaiting side of the discussion, too. An informed decision can only ever be made if you have all of the information. Looping needs to be talked about with healthcare professionals. Regardless of their views on it or the regulatory side of things, they need to know about it. At some point, they may be sitting in clinic with a PWD who's looping and that person needs their help and support, regardless of their chosen way of managing their diabetes. 


Brandon ArbiterBrandon Arbiter, longtime type 1 and VP of Product at Tidepool in California

Some exciting things on my list:

  • Roche talked about thinking of mySugr as its "face to the patient" {remember, Roche acquired mySugr last year.}
  • For CGM metrics, Coefficient of Variation seems to be replacing Standard Deviation, because the latter correlates with Mean Glucose and Time Above 180, so it doesn't add any unique value.


Dr. Jennifer DyerDr. Jen Dyer, a pediatric endo in Columbus, Ohio

A central theme to the conference was that we, the healthcare industry, are not doing a good job for people with diabetes. Glucose levels after meals and overall blood glucoses are just too high. We must do better.

Compared to last year, which was almost exclusively Artificial Pancreas data discussion, there was much more focus on the benefits of CGM in clinical practice: monitoring time-in-range, using CGM with or without pumps, assessing post-prandial highs that improve with faster insulins, such as Fiasp or Afrezza. I would have loved to see Dr. Steve Ponder’s Sugar Surfing included in the discussions, but I guess Europe hasn’t met the surfing principle yet!

I was interested to learn more about experiences with Abbott Freestyle Libre (Flash Glucose Monitoring) sensor, pros and cons, and to learn about a new implantable sensor by Roche called Eversense that is currently approved for six months usage in Europe. To me, the cons are that the device has to be charged each day and is a bit bulky. This has been submitted to the FDA here in the USA but hasn't yet been approved by regulators. 

I was also impressed with the #DIYPS #OpenAPS being discussed ‘openly’ and enthusiastically, especially with JDRF's statement and Roche’s announcement of support for the movement. Would have liked to see more patients on the stages however discussing their stories and experiences (pros, cons) rather than just from a physician point of view. 

Of course, the Artificial Pancreas was a big part of the conference. It was exciting to see that future Tandem and Omnipod Horizon data suggests time in range was 88%. I am very much looking forward to the commercialization of their systems with the Dexcom G6 sensor, hopefully in the next year or so.

I was particularly impressed with the amount psychosocial data that is being evaluated with current AP projects… they are looking to define more specifically how these systems help (or hurt) people with diabetes to achieve their life goals. In other words, it was said that good health is not a specific A1C or even just time-in-range but rather "having the health to live the life one wants to live."

Access to technologies was also discussed with Dr. Irl Hirsh’s call to action being that physicians should immerse themselves in economics nomenclature so as to better advocate for our patients with payers.


Thanks all, for sharing your thoughts on the ATTD conference! We're encouraged by the progress, but echo your call for more patient involvement.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.


This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.