The first full day, Monday 14th September was the EASD 2015 conference ‘symposia’ day, as is typically the format for these kinds of events. Our first session of the day was at Dexcom’s launch event, announcing the amazing new G5 continuous glucose monitoring system (CGM) for Europe.
For the first time Dexcom CGM will be supported as a mobile app rather than as a receiver like the previous generations, following the addition of a Bluetooth transmitter in the sensor. This advance also means Dexcom systems could now potentially be far more accessible than ever before, for thousands of people with Type-1 and Type-2 Diabetes, thanks to potentially lower initial costs.
Dexcom also unveiled the first details following their partnership with Google, on future devices that they are creating together. While only a brief segment, the first image of Dexcom’s proposed disposable CGM sensor was revealed, offering new affordable, discrete ways for patients to wear CGM.
The big talking point however is the removal of the Dexcom receiver device, with transmitters instead connecting to mobile devices. Launching on Apple IOS in a matter of weeks and Android in 2016, the updated Dexcom Share app will now act as your primary reader, with 5 designated users able to access a single account. This is a clear case of Dexcom recognising the success of the #WeAreNotWaiting movement, by bringing the idea to a simple interface and on a global scale. In our eyes anything that gets patients sharing information with each other and improving outcomes can only be a good thing, so it is refreshing to see a company like Dexcom acting so progressively and proactively with the community’s needs.
Too high or too low: The risks of hyperglycaemia vs hypoglycaemia
Our first academic session of the day was a shared session between Dr Pratik Choudhary (@DrPratikC on Twitter) of Kings, London, and Dr Silvio Inzucchi of Yale University, under the banner of ‘Too high or too low: The risks of hyperglycaemia vs hypoglycaemia’. While the main focus of the two studies was on the micro-vascular effects of hypo and hyperglycaemia, a major point that emerged was from one of the virtual case studies presented, in a type-1 mother with HBA1c of 9% and a fear of hypos, and what we can do in order to eliminate the fear in order to help patients lower HBA1c and improve daily blood glucose management.
Dr Inzucchi and Dr Choudhary discuss the risks of hypo and hyperglycaemia and the cardiovascular effects
Different Patients, Different Needs, Different Approaches
This wasn’t so much a single session, but a collective of speakers on a range of subjects addressing, as the title suggests, different approaches for different patients.
Individualised care is an increasingly common topic at these events and in general conversation amongst peers; the realisation that not everybody can be treated effectively under a single solution model, and social media in particular is driving a new way of thinking.
Partha Kar began the session talking about patient engagement, by saying ‘the best medicine you can have is the medicine you are taking’. Putting aside wrongly prescribed medicines for a moment, the point of the statement was to say that if a patient is taking the medication recommended, they have listened and are cooperating to find a solution to whatever the issue may be. Especially in the current climate where there is a focus on whether people are ‘wasting’ prescriptions and whether funds are being used appropriately, the point resonated particularly strongly. However terms such as ‘non-compliant’ regardless of the context sound unnecessarily aggressive, and it is difficult to see how patients would be willing to engage in future when they have already been labelled as such.
Dr Athena Philis – Tsimikas led a segment on community based Diabetes care, which as we have seen from the #GBdoc and all of the other Diabetes Online Communities worldwide, is vital to the continued improvement and success of an individual’s Diabetes management. Addressing the concept of ‘motivational interviews’ with patients to establish their needs proved a popular point, finding out if patients have needle phobias, what are their pre-conceived thoughts on medication plans could really affect adopting early engagement in Diabetes management.
A growing conversation in American healthcare (it is a different set up, but some theory can still be applied to the UK) is that of community led healthcare discussion. We do of course do this daily in the GBdoc, but it rarely occurs with healthcare professionals. What Tsimikas has suggested and trialled is community-led conversation between patients and healthcare professionals, an opportunity to work together and find the best combined solution.
Dr Steven Endelman led the next segment titled ‘Technologies that improve how patients interact with their disease’, obviously a topic that sits close to the heart of GBdoc!
Again ‘individual patient care’ continued to be a frequent discussion, with Endelman referring to the case of Ted Ryder, one of the first people to EVER use insulin and in the grand scheme of Diabetes, a very important individual. What Endelman said was that when deciding how to administer the insulin to Ryder, his individual needs were considered, and not a generalised opinion…he lived for 75 years. Endelman’s argument was a profound one, going back to the very beginning of Diabetes treatment and how somewhere along the way perhaps the very reason for its success has been lost; so how do we reconnect and rediscover it?
A recent bionic pancreas study comparing the effects on blood glucose management versus a regular pump
Endelman’s presentation also included a brief period discussing an event similar to the PWD conference we held in Nottingham, where healthcare professionals are also welcome. Operating on a ‘good doctor, bad patient; bad doctor, good patient’ dynamic whereby everybody can learn from each other and there is no superiority, Endelman demonstrated that it is possible for HCPs and patients to learn together from each other, rather than sticking to the all too familiar ‘us versus them’ attitude.
The benefits of social media and how it is being used by patients around the world
In a session hosted by AstraZeneca, Dr Richard Pratley also talked about engaging patients, and looked at barriers to effective diabetes management, such as fear of hypos. The key to overcoming such barriers is ‘comprehensive lifestyle management,’ and consideration of patients’ individual attitudes to their diabetes management (similar to the idea of individualised care in the ‘Different Patients, Different Needs, Different Approaches’ session).
One year on from the launch of their Freestyle Libre, Abbott hosted a discussion amongst type 1 and type 2 patients, and their clinicians, about the benefits of the system. They unanimously agreed that the amount of data the Libre gives a patient, and the ease with which that data can be accessed was invaluable for effective self-management. Clearly, the Libre has been deemed a success amongst its users.
The opening day of EASD 2015 proved to be a valuable source of information direct from healthcare professionals and where they stand on the subject of patient engagement. Everybody appears to agree that community-led conversation needs to happen and that individualised care is the best solution, but how can it be implemented effectively? As Partha Kar said in his talk, ‘when Facebook and Twitter are mentioned, healthcare professionals freeze’; but the patients are less likely to go into a hospital setting for group discussion as it feels formal, it feels like a lecture. Us as the community of patients and healthcare professionals need to work together to create a cohabitable ecosystem whereby each side can have their own say, and give the advice that is needed, without fear of offence or damage being caused, and most importantly without endangering individuals.