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The victorious Team Type 1

8-man Team Type 1 sets record, comes in first at 2009 Race Across America; Adventures for the Cure wins 2-man race

On June 26th, diabetes didn’t stop Team Type 1 from cruising to a record-setting victory in the 2009 eight-person Race Across America (RAAM). The team finished the 3000 mile race—30% longer than the Tour de France!—from Oceanside, CA to Annapolis, MD in four days, 22 hours, and 32 minutes all while managing their diabetes. Of the eight riders on the Team Type 1 RAAM team, six of them competed with the OmniPod, Insulet’s patch insulin pump. The Team Type 1 RAAM team inspired the world with their record-setting victory in the 8-person division in 2007, and proves once again how people with type 1 diabetes can overcome the difficulties of diabetes to achieve incredible success. “Our team’s mission is to show people with diabetes that they can accomplish anything if they work hard to control their disease,” said Joe Eldridge, co-founder of Team Type 1. “We hope our team’s performance inspires other people to manage their diabetes so they can achieve their own goals.” Congrats to Team Type 1 with their average 23 mph speed!

Adam Driscoll and Patrick Blair won the 2-man category, riding for the diabetes non-profit Adventures for the Cure. They completed the race in 7 days, 1 hour, and 38 minutes, beating their nearest competitor by more than 7 hours. Adventures for the Cure is a US-based non-profit and cycling organization raising money for type 1 diabetes and promoting the benefits of a healthy and active lifestyle. Our admiration to Adam and Patrick!

Monofilaments to Test for Neuropathy

You might have already encountered monofilaments before if your diabetes health care provider is meticulous about screening for peripheral neuropathy, a complication of diabetes that causes pain and numbness in the hands and feet. (We’ve written before about neuropathy – see issue 9’s Test Drive). These simple but super handy little tools usually consist of a nylon filament attached to a handle and are routinely used to test for “protective sensation” in the feet of patients with diabetes. Protective sensation means the level of feeling that a person has to have to be able to avoid injuries to his or her extremities (in this case, the feet). If your health care provider does not use a monofilament when checking your lower extremities for neuropathy, you should ask them about it! It is possible for a patient with neuropathy to maintain a level of general sensation in their feet while losing protective sensation entirely. This is exactly what the monofilament tests for—if you can’t reliably detect the monofilament on the bottom of their feet, you may be at risk for injury. However, with a little education, monofilaments can easily be used at home between checkups, giving you an early warning if you’re beginning to develop neuropathy. Your primary care provider may be able to give you a monofilament for home testing for free. You can also contact the Lower Extremity Amputation Prevention (LEAP) Program at 888-ASK-HRSA for a free test kit and great advice on how to keep your feet healthy.

JDRF Children’s Congress

We recently attended the three-day JDRF Children's Congress in Washington DC (June 22-24, 2009). The goal of the 150 young delegates (ages 4-17 years, who all have type 1 diabetes) was to raise awareness about the disease and to remind legislators to consider the importance of diabetes in children. The Children's Congress has been key in diabetes advocacy since it was founded 10 years ago.

One major highlight of the 2009 Children's Congress arose when President Obama met with the 150 delegates on June 23rd on the White House portico. This was the first time a sitting President met with the delegates, and we thought it highlighted the new administration's focus on healthcare. Rick Rosbach, one of the parents who attended with his son Ben (7), said it was an amazing experience and that he saw the “human face” of the President come out. President Obama was very personable with the children, he said, “even picking up one four year-old who was quite nervous” and putting him on his lap.

The Congress ended on June 24th with a Senate Hearing on "Type 1 Diabetes Research -- Real Progress and Real Hope for a Cure” at which many prominent figures spoke--Mary Tyler Moore (the JDRF International Chairman), Griffin P. Rodgers, MD (Director of the National Institute of Diabetes and Digestive and Kidney Diseases), “Sugar” Ray Leonard (an Olympic gold medal boxer), and even singer-songwriter Nick Jonas. Senator Susan Collins (R-ME) gave a personal promise to the children in her closing remarks, saying, “I will remember you and I will do everything I can to advance the research that will lead to a cure.” Delegates met with their representatives at the end of the Congress to thank them for their support of diabetes research, asking them to vote for the Special Diabetes Program coming up for renewal ($150 million in funding). Parents attending the Congress said that their main take-away from the event was that “we are not alone.”

Medicare Diabetes Screening Project

Type 2 diabetes is finally being recognized on a national and federal level as a major threat to the health of older individuals and as a powerful force in driving up the costs of Medicare. Former Senate Majority Leader Tom Daschle recently met with experts on diabetes education and research along with representatives of senior-living communities to discuss the need to increase awareness of free Medicare diabetes screening in the aging population. Despite the availability of free testing, reportedly less than 10% of Medicare beneficiaries are tested for diabetes each year. The Medicare Diabetes Screening Project (MDSP), supported by Novo Nordisk, is helping to change that. A new alliance between the MDSP and the National Council on Aging is promoting the launch of a new outreach program called “Diabetes Screening: Medicare Benefits for Better Health.” The new project is designed to equip leaders of organizations, agencies, and companies that serve seniors with the tools to better educate the aging population about Medicare benefits for diabetes screening. We hope this project takes off and more seniors are able to take advantage of the free screening available. If someone you know is over the age of 65, covered by Medicare, and has at least one diabetes risk factor (high blood pressure, high cholesterol, overweight, history of high glucose, history of gestational diabetes, or family history of diabetes), please encourage them to ask their health care provider for a free diabetes screening. You can find more information here.

A1c as a diagnostic tool

Most people with diabetes should be familiar with the term A1c—a measure of the glycosylated hemoglobin in blood that gives an estimate of glycemic control over a period of several months. Hemoglobin is a protein found in your red blood cells that helps carry oxygen around your body (and gives blood its red color). As red blood cells circulate, glucose present in the blood will stick to your red blood cells (a process called glycation). A1c testing is nothing new, but experts have begun thinking about using A1c as a way of diagnosing type 2 diabetes, something that until now could only be done with more difficult tests to measure fasting glucose (when a person has not eaten for eight hours or more) and post-prandial glucose (the glucose value after a meal). The argument for using A1c is that it’s easier for patients, because it requires only one blood sample, and won’t change depending on what people eat or do in the days leading up to the test. If you already have diabetes, this isn’t going to change your management. Experts at ADA set 6.5% or higher as the treshold for diagnosing diabetes. If you know someone at risk of diabetes, encourage them to ask their doctor about an A1c test.

Cycloset approved by FDA

In early May, a drug called Cycloset (also known as bromocriptine) was approved by the FDA for use in type 2 diabetes. Cycloset, developed by VeroScience, works in the brain to simulate the action of a chemical called dopamine (a neurotransmitter). It is the first drug in its class approved for the treatment of diabetes and (even more exciting for us!) the first drug approved under the FDA’s new cardiovascular guidelines—which you can read about in this issue’s Learning Curve. While the mechanism of action of dopamine in diabetes is not completely clear, the concept for the drug originated after scientists at VeroScience noticed that, while animals become obese and insulin resistant during annual periods of hibernation or migration, they automatically revert to a non-obese non-insulin resistant state when the next season arrives with no apparent side effects. After a careful analysis of brain signals from hibernating and non-hibernating animals, VeroScience noticed a variation of dopamine levels that might account for this pre-diabetes/non-diabetes transformation. Cycloset aims to take advantage of this brain chemistry by attempting to mimic mother nature in reversing diabetes. Cycloset is a once-daily therapy to be taken in the morning. It has been approved as a monotherapy (to be taken by itself) as well as with a sulfonylurea or metformin. In phase 3 trials, Cycloset produced an A1c decrease of about 0.7% after 24 weeks, without any increase in serious side effects. We are impressed by its side effect profile and mechanism of action, and think it may be a good alternative treatment for some people with diabetes. Ultimately, some experts think it may be shown to be cardioprotective (reduce the risk of heart disease), though that would need to be proven in long-term trials. You can go here for more information.

DIAdvisor

DIAdvisor is a mobile and personal device being developed in Europe over the next four years by a consortium of 13 partners (including Novo Nordisk and several research universities) to help patients with type 1 and type 2 diabetes better predict glucose levels and the risk of hyperglycemia and hypoglycemia. DIAdvisor will take information about blood glucose, insulin delivery, exercise, and food intake, crunch these numbers with prediction algorithms, and advise users on an individualized treatment regimen to better control their diabetes. The tool will also allow for information to be sent directly to the patient’s physician to help him or her manage a patient’s diabetes care. Early studies in hospitals, according to the DIAdvisor website, have shown that the use of the DIAdvisor system results in a lower incidence of complications and reduced length of stay in the hospital. In a considerable show of support for the DIAdvisor tool, The European Commission has provided 7.1 million euros to the DIAdvisor project. As the number of patients requiring insulin continues to grow and the demand for informed physician advice increases, we believe a tool such as DIAdvisor will be immensely helpful for patients in self-managing their diabetes. You can get more information about DIAdvisor by visiting www.diadvisor.eu. Unfortunately, we have no indication of when DIAdvisor plans to reach the market, but we’ll make sure to keep you updated.