News of the Center
News Archive — Winter 2022
Message from the Director
This is a letter of thanks. We have all been through tough times lately, but there are some bright spots in the midst of all the difficulty.
For me, my best week was the week of December 6th. At the beginning of the week I learned that after several years of lobbying we managed to get continuous glucose monitors
on the formulary for our underserved patients in Los Angeles County through the LA Department of Health Services. This is a huge win—not only are we the most populous county in the United States. We have the most people with diabetes, both type 1 and type 2. Additionally, we got the life-saving, but expensive, medications known as Jardiance and Ozempic on the formulary to provide access for many people who need it.
At the end of the week I was in our clinic for people with type 1 diabetes in East LA. As always it was a mixed blessing—there are those we can help, but there are still many young people who tragically have preventable, but now permanent kidney failure and/or blindness due to their diabetes. Yet every one of our patients had a continuous glucose monitor because of the efforts of ALL of us. We received funding from the Helmsley Charitable Trust, Insulin for Life, the Hankey Foundation and of those who donated to the USC Westside Center for Diabetes to make this happen. However, even with the new availability of continuous glucose monitors through the County healthcare system we still have patients who aren’t covered by MediCal and they will need continued support.
Our biggest hurdle now it to train both the providers and the patients how to use the new medications and devices. Our amazing grant from the Hankey Foundation allows us to create a system of remote monitoring combined with telemedicine to directly help our under-resourced patients. But we still need help to provide the education and skills to our patients and providers; to create systems of care that help reduce the shocking disparities brought to light by the pandemic we have all had to endure.
We are, however, making progress. I am grateful to all of you for your help and support. I realize that living with diabetes is always a challenge although hopefully we will get through this phase of COVID onto a less-restrictive future. In addition to the progress I am making at our Eastside Center, through the Westside Diabetes Center I am working with Vertex (Medscape video to come) on the development of a novel treatment for type 1 diabetes that involves stem-cell derived islet cells, which might change the face of diabetes within the next few years. I am also starting a study on the bi-hormonal pump (insulin + glucagon) in the spring. Therefore, there is reason to celebrate 2022, for all the potential that it holds in spite of the challenges.
Once again, a COVID update: Unfortunately, my patients are catching COVID again. And the Omicron variant is increasing in the US. However, I am MUCH LESS worried than I was a year ago because the majority of my patients have been vaccinated and received a booster. Which means that most of my patients will be fine. However, until we know otherwise, age (over 65) and being overweight are still risk factors, so get tested if you feel sick and if needed you can receive treatment within the first five days of illness. But if you haven’t been vaccinated yet – now is the time. If you only have one shot, get a second and get a booster when you are eligible. The Pfizer and Moderna vaccines appear to require 3 doses to be optimally effective. Other public health measures include mask wearing, social distancing and avoiding being indoors with groups of people, unless everyone is vaccinated and has a recent negative COVID test.
I remain deeply concerned for people who are not vaccinated, but for those of us who are we can still enjoy the holidays, albeit with more precautions than I’d hoped were going to be necessary.
With much appreciation,
PS. Thank you to those of you who have donated in the past. With the help of new donors and the continuing support of previous donors we can continue to do our part to improve the lives of people with diabetes. Go to our donation page to learn more about how you can help.
Winter Research Updates
MOBILE Study update: What happens when you discontinue CGM in patients with type 2 diabetes using basal insulin?
In the first part of this study our East LA patients using basal insulin were randomized to use either a blood glucose meter or the Dexcom G6 CGM for 8 months while being managed by their primary care doctor. Patients using the Dexcom CGM improved more than those in the meter group. During the second part of the study half of the participants in the CGM group continued using the Dexcom and the other half returned to monitoring with a meter for an additional six-months.
The results of the second part of the study were reported by time in range numbers (TIR). The CGM group who returned to using a meter, originally improved their mean time in range of between 70 - 180 mg/dl from 38% to 62% and the result of stopping the CGM use, their TIR dropped back down to 50%. The group that stayed on the Dexcom started with a TIR of 44% and increased to 56% at month 8 and continued to improve slightly to 57% in the extension.
The results demonstrate the value of continuing using a CGM in this multi-ethnic population using basal insulin to promote sustained glucose control and could support insurance coverage in this population.
Omnipod 5 In People With Type 2 Diabetes
We completed the trial using the new Omnipod 5, the new tubeless hybrid closed-loop pump system that is expected to be available early in 2022. There are no results to share from the trial yet, but we have become experts in the use of the Omnipod 5 system which should help once it is approved by the FDA. In this trial we used the pump in a group of patients with type 2 diabetes who were either using basal insulin alone or a mix of basal and mealtime insulin. When the pump is finally approved and on the market, it will initially be available for our patients with type 1 diabetes. The clinical trial in that population showed an increase time in range of 2.2 hours between 70 – 180 mg/dl with a reduction in hypoglycemia. This is expected to be the first FDA approved tubeless hybrid closed-loop pump on the market.
FEEL-T1D or Function and Emotion in Everyday Life with Type 1 Diabetes
Recruitment in this study is being completed and the hard work of analyzing the vast amount of data collected in the study has started. Participants provided insights on their emotional well-being and ability to function with that will be paired with continuous glucose and activity data that is being reviewed to determine the relationship between the individualized measurements on diabetes management and everyday life.
The results will be reviewed to provide basic knowledge about these relationships that may lead to innovative treatment options.
iLet Bi-hormonal Pump
A new study will be started in the Spring to evaluate the potential benefit of adding glucagon to an automated insulin pump system for patients with type 1 diabetes. Hybrid closed-loop systems have shown improved glucose control and are now the new standard of care and the question is whether adding glucagon can improve control even more while easing the burden of managing type 1 diabetes. We will be inviting a couple of participants to start the trial in May and will expand to a larger pool of participants in August.
New “Peters on Diabetes” Videos
The continuing COVID pandemic and the new Omicron variant has reduced the travels of Dr. Peters, but she remains in demand as a remote speaker and consultant. She also keeps active providing diabetes updates on the Medscape series "Peters on Diabetes." The main audience for these videos is other healthcare providers, but many of them may be interesting to you as well.
Particularly exciting is a new video on the potential cure of type 1 diabetes using stem cell-derived islet cell transplantation. Many patients have asked her about the treatment option, and she provides the background and her opinion on the experimental procedure. Medscape requires a free registration and once you are registered you can request email updates for new videos and other diabetes news.
IDF 2021 100 Years of Insulin, but Millions Still Without Access
As we celebrate a century of insulin, we should not forget that many around the world can't afford this life-saving treatment.
Medscape Diabetes & Endocrinology, December 02, 2021
EASD 2021 Final Roadmap on Type 1 Diabetes Management in Adults
Anne Peters, MD, discusses the consensus statement on managing type 1 diabetes in adults from the American Diabetes Association and the European Association for the Study of Diabetes.
Medscape Diabetes & Endocrinology, November 15, 2021
Metformin, Then What? More Findings From the GRADE Study
Dr Anne Peters discusses updated results from the GRADE study that were presented at the 2021 European Association for the Study of Diabetes (EASD) meeting.
Medscape Diabetes & Endocrinology, November 03, 2021
CGM in Type 2 Diabetes: What I Learned From the MOBILE Study
Anne Peters discusses the benefit of CGM in patients with type 2 diabetes on basal insulin, adding that there is much to be done in educating both patients and healthcare professionals about CGM.
Medscape Diabetes & Endocrinology, June 30, 2021
Dr Anne Peters discusses results from recent studies suggesting that there may be a path to improving treatment for patients with type 1 diabetes.
Medscape Diabetes & Endocrinology, December 30, 2021
Dr Anne Peters discusses updates contained in the ADA 2022 Standards of Medical Care in Diabetes.
Medscape Diabetes & Endocrinology, December 28, 2021
Lifestyle changes including healthy diet and increased exercise can lead to remission for patients with diabetes, allowing them to stop medication. But it is not a cure, reports Dr Anne Peters.
Medscape Diabetes & Endocrinology, January 11, 2022
Updated Simple Language Guides for Insulin Pumps, Pens and Continuous Glucose Monitors for People with Type 1 Diabetes and Instructors, in English and Spanish
You may have noticed a new tab Simple Guide heading tab on our website. Our team has recently expanded the scope of the Guide’s target audience to include a set for teens and pediatric patients. There is also a new set on the use of insulin pens, how to use a CGM to manage diabetes better and all the Guides have been updated. We also made a set of guides in mmol, which are for people in Canada and Europe where the units for glucose (and other substances) are different. Additionally, we created training manuals for people who conduct diabetes education.
These Guides were created with the help of a grant from the Leona M. and Harry B. Helmsley Charitable Trust and advice from our patient and community advisors. The group was able to develop a series of simple language guides that introduced the basics of how insulin pens, pumps and CGMs work and described how people with diabetes could improve their diabetes treatment.
We recently published an article showing the results of using our guides in our East LA population. We found that they helped our patients feel better about their diabetes and it reduced rates of DKA.
Our guides have received national prominence and will be hosted on the American Diabetes Association websites, both for consumers as well as for providers. And although these guides were written with our under-resourced patients in mind, they are helpful for any patients who want a quick introduction to a new technology option. Additionally, they can help when explaining a diabetes device to a caregiver, teacher, friend or family member.
The guides are available in simple English and Spanish and there are separate guides for adults, teens and children. These guides are free to download use and share. Look for the new Simple Guide tab and see if these Guides could be useful in your life.