Savvy Updates 6/30/18: Keto vs. Mediterranean Diet, Qtern, Afrezza, OpenAPS & Loop, Whisk, SOOIL,

LOTS of news coming out of the 78th Annual American Diabetes Association Scientific Sessions, held in Orlando, FL last week. Here’s just a few great updates from diaTribe.org:

Mediterranean-Diet Meal Shows 8 Times Greater Insulin Secretion than Ketogenic Meal: Dr. Simona Bertoli presented that a classic ketogenic meal (very low carb: 2% carbs, 88% fats, and 10% protein) showed a significantly reduced insulin response than a classic Mediterranean diet meal (60% carbs, 30% fats, 10% protein). Insulin response was measured by the amount of insulin released, or secreted, by beta cells in the pancreas, after the meal. In fact, the ketogenic meals required only 12% of the insulin required by the Mediterranean meals. In other words, total insulin secretion in the three post-meal hours was eight times greater in the Mediterranean group than the ketogenic group! This study was done in people without diabetes. Dr. Bertoli posed an interesting research question – what is the effect of significantly lowering circulating levels of insulin in people without diabetes? Could it be used to prevent or treat type 2 diabetes? In that vein, Virta Health presented new data in prediabetes at ADA, showing that a very low-carb intervention paired with technology-enabled remote care and coaching resulted in about 60% of participants moving from prediabetes to normal levels of glucose at one year.

Qtern Glucose Lowering On Par with Insulin Therapy with Reduction in Weight Gain and Hypoglycemia: AstraZeneca’s Qtern, a single pill combining Farxiga and Onglyza, showed similar effectiveness to Lantus in A1C reduction: 1.7% decrease with Qtern versus 1.5% decrease with Lantus. As an added bonus, Qtern helped people lose weight (about 3 pounds), compared to Lantus, which was associated with a 5-pound weight increase. Notably, hypoglycemia was less common in the Qtern group versus the Lantus group – 21% and 38%, respectively, experienced a hypoglycemia event.

Direct Comparison of Inhaled Insulin Afrezza to NovoLog in People with Type 1: The STAT study did a head-to-head comparison of Afrezza, an inhalable insulin, to NovoLog, an injectable; Afrezza is an ultra-rapid acting insulin, and NovoLog is a rapid-acting insulin. Compared to the participants on NovoLog, Afrezza users saw a 12% increase in time-in-range (70-180 mg/dl), which translates to 1.5 more hours per day in range. Additionally, post-meal blood sugar spikes were 20% (about 24 mg/dl) lower at breakfast and 25% (about 36 mg/dl) lower at lunch.

Future Directions for the Do-It-Yourself (DIY) Community: OpenAPS and Loop, both products of the DIY community, are automated insulin delivery systems that are not recognized by the FDA. Yet, the number of DIY-product users continues to grow, suggesting that these products are serving an unmet need in the diabetes community.

Ascensia challenge winner: Whisk. Whisk is an artificial-intelligence-powered nutrition platform. Drawing from a massive database, the platform can break down foods’ nutritional content and flavor as well as retailers’ store items and prices. Once a user inputs diet preferences, Whisk makes recipe recommendations and a grocery list and adds the items to an online grocery shopping cart. Whisk will integrate this food platform into Ascensia’s Contour Diabetes app, where blood sugar data will be used to further tailor food recommendations.

Pump manufacturer SOOIL, based in Korea, hopes to submit a smartphone-controlled, “open protocol” pump to the FDA “shortly.” The pump appears similar to SOOIL’s Dana RS (not currently available in the US). An open communication protocol will allow the pump to communicate with other devices like CGMs. The company even plans to submit a version of the do-it-yourself (DIY) OpenAPS hybrid closed loop algorithm.