ADA 2022: Racial Residential Segregation, DKA During COVID, and More

Some of the latest studies in diabetes research presented at the American Diabetes Association (ADA) annual meeting included major weight loss seen with tirzepatide (Mounjaro) in patients with obesity, dulaglutide (Trulicity) for kids with type 2 diabetes, and success with a DIY insulin delivery system. Below are a few more highlights from this year's meeting.

Racial Residential Segregation

Among Black youth with type 1 diabetes, racial residential segregation was tied to HbA1c level (r=0.28, P=0.001), even after adjustment for family income and adversity of the neighborhood. However, it wasn't significantly associated with diabetes management, measured via a self-reported questionnaire of daily diabetes management tasks completed.

Led by Deborah Ellis, PhD, of Wayne State University in Detroit, the study included 144 kids ages 10 to 15 who self-identified as Black and had a type 1 diabetes duration of at least 6 months. All youth were recruited from one of seven pediatric diabetes clinics in Detroit and Chicago.

Racial residential segregation was measured using U.S. census data with Location Quotients that calculated the ratio of Black to total population in the block group versus the greater metro area.

"Our findings indicate that persistent residential segregation is contributing to health inequity for U.S. children with diabetes," Ellis explained in a statement. "This reinforces the need for healthcare providers to screen for and address social determinants of health in order to effectively address children's care needs as we work to reduce the burden of type 1 diabetes nationwide."

DKA During COVID-19

According to a meta-analysis of 18 studies, risk for severe diabetic ketoacidosis (DKA) among children with type 1 diabetes increased by 76% during the COVID-19 pandemic (risk ratio 1.76, 95% CI 1.33-2.33, I²=44%).

Furthermore, the risk of severe DKA was 44% higher for newly diagnosed patients with type 1 diabetes compared with pre-pandemic risk, said Osamah M. Alfayez, PharmD, of Qassim University in Saudi Arabia, and colleagues.

"We were surprised to find such a drastic increase in severe DKA cases during the pandemic, in particular among children who were newly diagnosed with type 1 diabetes," said Alfayez in a statement.

"It is imperative that healthcare providers are educated on the increased cases and there is increased public awareness of the signs and symptoms of type 1 diabetes, as this might play an important role in recognizing the early stage of the disease and seeking medical attention before the medical condition deteriorates to DKA," he added.

Twin Precision Treatment Technology

Compared with a 0.39% drop in HbA1c after 180 days seen with standard of care, twin precision treatment technology (TPT) helped people with type 2 diabetes achieve a 3.3% drop, a late-breaking study showed. Among the 262 patients on this intervention, 83.9% achieved diabetes remission.

TPT was based on the Whole Body Digital Twin platform, powered in part by artificial intelligence, aimed at helping people with type 2 diabetes achieve remission. TPT collects daily data via non-invasive sensors to provide the user with individualized diet and health recommendations, like sleep and breathing guidance, on the app. Continuous glucose monitoring was also incorporated into the feedback. The system was developed to provide patients with unique feedback on metabolic markers.

"Our results demonstrate the potential of Whole Body Digital Twin technology to change the conventional, medication-driven management of type 2 diabetes to achieving remission of type 2 diabetes with a life free of medication," said lead author Paramesh Shamanna, MD, MBBS, of Bangalore Diabetes Centre in India, in a statement. "The impact of the program on patient satisfaction, quality of life, and total cost of care is substantial and holds significant promise for large populations suffering from metabolic disease globally."