32
VOLUME 8 NUMBER 1 • MARCH 2011
CUTTING EDGE OF DIABETES TECHNOLOGY
SA JOURNAL OF DIABETES & VASCULAR DISEASE
It found that the most commonly used
agents were diuretics (42%) and ACE inhibi-
tors (27%) and that these prescriptions corre-
lated well with supply data for these frequently
used medications. Calcium channel blockers
and beta-blocker usage was 6% each.
Clearly, as ARBs become more available in
the public sector, the opportunities offered
by the combination of telmisartan and HCTZ
should receive wider use. Publicity given to
the lack of dialysis facilities for kidney failure
in the public sector in South Africa should also
add to the imperative to improve hypertension
control.
The blood pressure of patients who are at
particular risk of cardiovascular disease, such
as those who are obese or have type 2 diabe-
tes, are often difficult to control. The SMOOTH
study (Study of Micardis on Obese/Overweight
Type 2 diabetes patients with HypErtension)
showed the superior effect of telmisartan 80
mg plus HCTZ 12.5 mg, compared to valsartan
160 mg plus HCTZ 12.5 mg over 24 hours and
especially in the early morning period.
12
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Cutting Edge of Diabetes Technology
Report from the Advanced Technologies and Treatments for Diabetes
meeting, London, 16–19 February 2011
A
fter completion of yet another success-
ful ATTD conference, the mind is suitably
topped up with the latest advances in diabe-
tes care. This is the fourth annual conference,
which has grown from a mere 250 delegates
in 2008 to over 1 200 delegates in 2011,
testimony to the thirst for knowledge in the
diabetes field and the calibre of the content
of this meeting. The ATTD meeting provides a
forum for exchange of ideas with chief opinion
leaders and researchers in diabetes and what
follows is a summary of some of the major
themes and sessions.
Let us begin by setting the stage. We have
known since the publication of the landmark
DCCT and UKPDS studies that intensive gly-
caemic control can reduce or delay both the
macro- and definitely the microvascular com-
plications of diabetes. In the pre-insulin era,
long-term complications were unheard of as
nobody lived long enough to get them, but
glycaemic control through ‘starvation’ diets
could prolong life. In 1922 the discovery and
rapid deployment of insulin across the globe
turned a ruthless quick-acting killer into a
stalker, and provided the hunted with the abil-
ity to evade the stalker for periods of time.
Limiting our ability to prevent long-term
complications, caused from prolonged periods
of hyperglycaemia, is the ever-present spec-
tre of hypoglycaemia that limits our ability to
maintain blood sugars within a ‘safe’ range.
After the publication of the DCCT in 1993, the
recommendation for tighter and more inten-
sive management brought about an impressive
decline in HbA
1c
, but was accompanied by an
equally impressive rise in rates of severe hypo-
glycaemia. The trend in improved glycaemia has
continued to today, while the rates of severe
hypoglycaemia have been reigned in, through
the introduction of rapid-acting analog insulin
in 1996, long-acting basal analog insulin and
insulin pumps. A further advance has been the
introduction of continuous glucose monitoring
(CGM) and in some cases coupling this to csii
(continuous subcutaneous insulin infusion aka
pump) therapy.
CGM has the potential to allow the user
to spend more time within a safe target zone,
with fewer highs, fewer lows and less time
spent in both of these extremes. Not every-
one benefits from this more expensive therapy
though. Only those who wear the CGM almost
continuously achieve benefit. CGM is currently
being integrated into closed-loop systems
where interstitial blood sugars are sampled,
sent through to a receiver where a computer
algorithm integrates the rate and direction of
change in blood glucose and alters the rate of
insulin delivery to keep the blood sugars within
a predefined range. A number of teams have
such closed-loop systems undergoing human
tests, with impressive early results. Problems
still encountered with all of these systems
include:
• the absence of extremely rapid-acting insu-
