COVID-19 Vaccine for People with Diabetes: What’s Going On?

The COVID-19 vaccine is here, and like most things dealing with the pandemic, the rollout of both the Pfizer-BioNtech and the Moderna vaccines has been a nightmare. The Trump administration’s Centers for Disease Control and Prevention (CDC) Advisory Committee for Immunization Practices (ACIP) released loose guidelines for states to follow in determining how to disseminate the vaccine but has largely left most of the decisions up to the states. Most people don’t yet know when they’ll receive the vaccine, and on the whole, most states are still in phase 1a, disseminating shots to frontline healthcare workers and those living in long-term care facilities.

In their initial recommendations, people with type 1 diabetes would receive the vaccine further down on the priority list, along with healthy individuals under 65 years old. People with type 2 diabetes are classified as, “at increased risk for severe COVID-19–associated illness”, and are thus to be given priority access in phase 1c, along with people who suffer from other conditions, such as cancer, heart failure, sickle cell disease, chronic obstructive pulmonary disease (COPD), and smoking. Type 1 diabetes is classified as, “might be at increased risk for severe COVID-19-associated illness”, to be given access in phase 2, with other conditions such as being overweight (BMI >25), and suffering from neurologic conditions.

This would put people with type 1 diabetes in the general population rollout, months after not only people with type 2 diabetes have gotten their shots, but behind many other chronic conditions, too. This is a harsh slap in the face for a community that could face so many negative consequences should they contract the virus (not to mention people with diabetes make up 40% of all COVID-19 deaths).

But recent data has come out that people with type 1 diabetes suffer from mortality from COVID-19 at similar rates as people with type 2 diabetes, and a study conducted by Vanderbilt University said people with either type 1 or type 2 diabetes who have COVID-19 have three to four times higher risk of severe complications and hospitalization as compared to people without diabetes.

Several more studies show that having type 1 diabetes is potentially even more dangerous if you contract COVID-19  than having type 2: A Lancet Diabetes & Endocrinology study published last year looked at medical records from the National Health Service in England to conclude that the risk of dying from Covid-19 was almost three times higher for people with type 1 diabetes and almost twice as high for type 2 than for those without diabetes.

In Scotland, another Lancet study said being admitted to an ICU or dying was more than twice as likely for type 1 diabetes patients and nearly 1.5 times more likely for type 2 diabetes patients than for people without diabetes.

People with type 1 diabetes have been told that they live with a disability the entire time they’ve lived with this incurable illness. We’ve sat on the sidelines while going low, been discriminated against in the school and workplace, shut out from certain industries and employers, and know the unique and awful feeling of our skin tightening from a hyperglycemic event after our pump failed for the umpteenth time in our sleep. We require special accommodations, a militant watch on our medication, exercise, insulin, and food intake, and are never offered a break, a day off, or even a hint of affordable insulin.

We live in the unique situation of a dual-reality: having a chronic condition, yet feeling its invisibility every day. We’re never quite “sick enough”; we never “look” diabetic; sometimes, we feel like we don’t even “deserve” the meager accommodations that we get (always pre-board flights, because you’re allowed to!). We live every day with the knowledge that our life expectancy is likely shorter, our days are harder, and especially during this pandemic, many of us have lived in fear of a serious complication should we contract COVID-19 and the bleak consequences we could face. Many of us have stayed home, shut-in, and waited this out, while watching some of our able-bodied peers continue to ignore public health protocols and guidelines.

The end result of the CDC’s recommendations burns and is tangible: states, including Iowa, Illinois, and Virginia, are prioritizing dissemination of the vaccination to people living with type 2 diabetes before people living with type 1 diabetes. Simply put: we’ve been told to stay in, shut up, and wait it out for the vaccine, due to our fragile health condition, and now that the vaccine is here, our disability is yet again being ignored.

Yes, type 2 diabetes is being prioritized and that is right, good, and important, but type 1 diabetes needs to be prioritized, too. They’re not mutually exclusive. Currently, the United Kingdom is not differentiating between type 1 and type 2 diabetes; they are prioritizing people who have either type. Other countries are following suit.

On Tuesday, the Trump administration reversed course, adopting part of president-elect Joe Biden’s distribution plan, advising states to prioritize everyone over the age of 65 and any person with a chronic condition to get the vaccine as soon as possible; states have yet to officially adopt these plans on a wide scale.

Recently, several letters were sent from various diabetes advocacy organizations to the CDC urging them to reconsider their guidelines. Organizations such as T1International, Mutual Aid Diabetes, The American Diabetes Association, JDRF, Beyond Type 1, Children with Diabetes, The diaTribe Foundation, DiabetesSisters, and T1D Exchange have lent their voices to make the needs of the 1.6 million people living with type 1 diabetes in America known.

The bottom line is that we need to curb the tide of this pandemic. Almost 400,000 Americans are dead, with a holiday-related surge in cases, hospitalizations, and death on the way. We need to get shots into as many arms as quickly as possible and stop telling some of our most vulnerable populations that, yet again, they aren’t sick enough to qualify, and that they can wait. We can’t.

Source: diabetesdaily.com

Feeling Helpless? Here’s What You Can Do

This content originally appeared on Beyond Type 1. Republished with permission.

By Beyond Type 1 Editorial Team

Feeling helpless in the midst of COVID-19? You’re not alone. There’s a lot we still don’t know about the virus and the situation is changing by the hour. One important thing to think about is separating what you can do from the things you cannot control. We’ve compiled a list of specific actions you can take to have a real positive impact for yourself, your family, and your community.

People with diabetes may be at higher risk should they contract COVID-19, so please take all of the personal precautions you need to at this time. Not everyone’s risk is the same, so be mindful of yourself and others. Take what works for you from this list and leave the rest.

Take Basic Precautions

Wash your hands often for a minimum of 20 seconds with soap and water. Practice social distancing, limiting travel, working from home, and rethink big events – these precautions are not solely for you but for those around you who may be susceptible.

Stay up-to-date with your local health department about COVID-19 in your area.

Connect With Family

Stay in touch with friends and family virtually. Up the frequency that you communicate, and be clear about how you’d like to stay in touch. FaceTime or video chatting can be an awesome tool to feel close to those who are far away – without adding any risk for you or your loved one. Other ideas for staying in touch: start a family or friend group text, find games you can play together remotely, or set a regularly scheduled phone call.

Talk to the children in your life about what’s going on. Tell them we’re washing our hands and keeping to ourselves to protect ourselves and others to help them understand that this is about all of us, not just one of us. Ask if they have any questions and explain as best you can. For older kids and adolescents, asking “what are your friends saying about the coronavirus?” might be a good jumping-off point for starting a conversation to help clear up any misinformation.

Make a list of projects for children to help you with around the house, and teach them how to cook with your extra time at home – you’d be amazed at what they want to help with and how good they will feel knowing they are contributing.

Reach out to People Who Are Most Vulnerable

Think about the people you know, and be mindful of how the current situation might be impacting their specific circumstances. Elderly neighbors, grandparents, older relatives, friends with health conditions, anyone going through chemotherapy or the many, many, other circumstances that might contribute to the current level of anxiety. Reach out and ask how they are. Offer to listen or lend a hand — helping with simple tasks like grocery shopping and limiting the time they spend in public could make a huge difference. If you’re limiting your time in public, too, even just lending an ear at this time can help keep anxiety and loneliness at bay.

Don’t tolerate or perpetuate racism, particularly towards those of Asian or Chinese descent. Referring to COVID-19 as the “Wuhan” or “Chinese” virus may perpetuate racism and xenophobia. If you hear or read others referring to COVID-19 using those terms, please correct them. The importance and impact of being kind to one another cannot be overlooked.

Support Your Local Community

Follow local public health departments and support local news. Journalists everywhere are working hard to keep the public informed about this rapidly-evolving situation. Now is a great time to purchase a subscription to your local news source if it is in your budget. Please also think about the sources of information you read, and try to verify their trustworthiness before you repeat it – the CDC and WHO are good for receiving global updates you can trust.

Donate to your local food bank (find one here). Donating money might be more helpful than donating goods, as food banks often get their items at wholesale cost (in many cases, a $1 donation is equivalent to 5 meals). If you’re well, experiencing no symptoms, and have low risk, ask what volunteer opportunities are available to assist with food distribution.

Support local businesses. If you are fortunate to have uninterrupted income during this time (i.e. can do their jobs from home) and have it to spare, consider transitioning purchases from chains to local businesses, buying groceries from local stores rather than large online retailers.

Consider purchasing gift cards now for use later at a gift store, book store, or local restaurant. Call and ask what they need, or if they’ll accept the transaction over the phone. Ask if they deliver or ship.

If you’re out and about, tip your waiters and waitresses, Uber and taxi drivers, stylists, barbers, and other service industry workers as generously as you can afford. 

Offer support in other creative ways, like buying yourself or others a gift card online to use later, and shopping local businesses online if they have the capability. Reach out and ask what support these businesses need that you might be able to offer (i.e. even just sharing online about what they do).

Support the Diabetes Community

Help drive research + innovation. Sign up for the T1D Exchange Registry, a research study that pulls from your personal experiences and data to help accelerate the development of new treatments. Previous T1D Exchange research efforts have led to things like insurance coverage for test strips and changes in guidelines for A1C goals – your input has the power to make a difference.

Donate your data + impact others. Join the Tidepool Big Data Donation Project, helping further the reach of our collective knowledge about diabetes. Your data gets anonymized and Tidepool will also give back 10% of proceeds to the nonprofit organization(s) of your choice.

Share your voice. Talk to your network about the importance of social distancing and other steps you’re taking to minimize contact and stop the spread of this virus.

Connect with the Beyond Type 1 Community. Download the the Beyond Type 1 App and chat with others living with diabetes. We need connection with others now more than ever.

If You’re Facing Challenges Around Work + Income

If your work hours were cut, file an unemployment claim.

Contact your creditors, electric, phone, and cable companies to see if any accommodations or payment arrangements can be made to make up for lost hours or pay shortages at work.

Worried about homelessness or evictions? Reach out to organizations dedicated to fighting homelessness and their plans to deal with the pandemic. Also, stay informed on if your city’s policies on halting evictions due to COVID-19.

What You Can Do to Support Mental Health

Look into telehealth options for mental and physical care. Check your insurance to see if there is a telehealth service offered, contact your doctor to find out if they have an option for remote visits, or check out services like DoctorOnDemandBetterHelp, or TalkSpace.

Find a new daily routine. Keep getting up early, making coffee, eating breakfast, getting ready for the day and choosing a space to work. Going about your day to day as regularly as you can will only do you and your family good.

Volunteer with animals. Dogs and cats appear to not be susceptible to the virus*, so if you are able to walk dogs at your local shelter or visit the cats, consider it. Animals can help reduce stress, and you might even end up with a new friend to take home.

*the virus may be able to survive on the animal if it has been touched by an infected individual, so know the risks here 

Volunteer your time remotely to help others experiencing distress. You can take the training to become a Crisis Counselor with Crisis Text Line from home, and work to support those in crisis.

Source: diabetesdaily.com

The Biggest News in Diabetes Technology from ATTD 2020 – A Deep Dive on CGM and more!

This content originally appeared on diaTribe. Republished with permission.

By Jimmy McDermott, Eliza Skoler, Divya Gopisetty, Emily Fitts, Frida Velcani, Kelly Close, and Albert Cai

The diaTribe team is on the ground in Madrid, Spain to cover the latest news in diabetes technology from ATTD. Here are our top highlights from the conference so far …!

The 13th annual Advanced Technologies and Treatments in Diabetes (ATTD) conference brought together many great minds in diabetes in Madrid, Spain. With nearly 3,800 attendees from more than 81 countries, ATTD continues to grow dramatically; while it has been since the start in Prague in 2008 one of the most impactful meetings in diabetes, it is now considered one of the top three in the world. Why? It shows the powerful momentum behind diabetes technology in so many respects, from CGM and BGM to automated insulin delivery (AID) to smart pens to new therapies to new learnings in behavioral medicine. Here are some of diaTribe’s key highlights from the conference – we’ve focused on learnings about CGM and the closed loop and will be back with even more after the conference concludes!

Click to jump to a section!

1. Dr. Rich Bergenstal shares tips for understanding CGM data 

2. Data shows use of CGM features is linked to increased time in range

3. Dexcom announces big milestone for G6 in pregnancy, the CE-Mark; available in UK “starting spring 2020”

4. Results show benefits of DIY closed-loop systems: lower A1C and more time in range using Loop

5. WISDM Trial: CGM helps older adults with type 1 diabetes reduce hypoglycemia and improve time in range 

6. Increased FreeStyle Libre scanning frequency is associated with reduced time with both high and low blood sugar

7. MiniMed 670G data shows time in range increases with Auto Mode

8. Tandem’s Control-IQ increases time in range in children

1. Dr. Rich Bergenstal shares tips for understanding CGM data

Dr. Rich Bergenstal from the International Diabetes Center gave tips for interpreting continuous glucose monitor (CGM) data. The audience responded enthusiastically when Dr. Bergenstal explained “FNIR” (Flat, Narrow, In-Range) to describe “ideal” blood sugar: high time in range and flat glucose levels with few ups and downs. To learn more about FNIR, check out our resource page on time in range. Dr. Bergenstal shared a few more catchphrases:

Time in Range

Image source: diaTribe

  • MGLR: More Green, Less Red; refers to the stacked time in range bars (pictured right).
  •  “Thinking fast and slow” – this refers to making “fast”, in-the-moment medication or behavioral changes based on real-time CGM numbers, and “slow” analyses of blood sugar data to understand and act on trends over time. It also recalls the famous prize-winning book from 2011.
  • STAR: Steady, Tight, And in-Range; this is another one we’ve heard lately, and even though it wasn’t in Dr. Bergenstal’s presentation, it’s also very aspirational, just like FNIR!
Screenshot

Image source: diaTribe

2. Data shows use of CGM features is linked to increased time in range

Time in Range

Image source: diaTribe

Dexcom presented real-world data from G6 CGM users showing that people who were most engaged with G6 features (such as alerts, the share-follow platform, and Dexcom Clarity) showed significant improvements in their blood glucose management. These highly-engaged users had the highest time in range and spent 38% less time each day in hypoglycemia (pictured right).

Here are the G6 features that Dexcom highlighted:

  • Alert Settings: Users can set their own target blood glucose range and the G6 will automatically notify them if their glucose levels cross the high or low threshold. This means that users don’t have to constantly self-monitor their blood sugar; 55% of G6 users used this feature to customized their settings.
  • Time in Range

    Image source: diaTribe

    Urgent Low Soon (ULS) alert: This predicts and notifies a user 20 minutes before they cross their low blood glucose threshold. Real-world user data shows that people using ULS spent less time in hypoglycemia (six minutes less below 55 mg/dl and ten minutes less below 70 mg/dl).

  • Dexcom Follow: People with diabetes can share CGM data with their family, friends, and care partners to help monitor glucose levels (with the iPhone app or Android app). This feature was especially helpful among children, whose time in range increased proportionally to the number of people able to view their data.
  • Dexcom Clarity: Weekly reports allow people with diabetes and healthcare professionals to see blood glucose trends and develop insights into their diabetes management (with the iPhone app or Android app). Users can receive encouraging notifications when they achieve their blood glucose goals. The data shows that more understanding of how one’s glucose levels change over time correlates with better outcomes: using weekly Clarity reports led to an increase in time in range by 9%. Additionally, in a study of 26,000 people, those who used Clarity with mobile notifications had 64% time in range, compared to 52% time in range for people who only used the CGM. Learn more about Clarity here!

3. Dexcom announces CE-Mark for G6 in pregnancy; available in UK “starting spring 2020”

Dexcom announced European approval (formally called the “CE Mark”) for its G6 CGM for use during pregnancy for women living with type 1, type 2, or gestational diabetes. This is so exciting! The official “label” is set to launch in spring of 2020. The G6 now joins Abbott’s FreeStyle Libre as approved CGM for pregnant women in Europe – as a reminder, the FreeStyle Libre 2 has alarms (better for pregnancy), and has been approved in Europe for some time. While no CGM is yet approved for pregnant women in the US (though many are using it off-label), the European announcement should help to increase awareness and education around the world. Every pregnant woman in the world with diabetes or pre-diabetes should have CGM in the opinion of many experts (virtually all the ones we know).

  • Mt. Sinai’s Dr. Carol Levy shared compelling data from the T1D Exchange around CGM in pregnancy. Comparing 2010-2013 to 2016-2018, self-reported CGM use in pregnant women increased from 35% to 65% and average A1C in pregnant women dropped from 6.9% to 6.6%. We bet if time in range data were available, we’d see a big increase.
  • Dr. Levy showed the outcomes of 50 women who used Dexcom CGM during pregnancy. 93% of these women recorded no diabetic ketoacidosis (DKA) or severe hypoglycemia. Typically, about 50% of women with gestational diabetes have a baby with a high birth weight. This percentage was 12% in the group of women using CGM in this trial.
  • As we’ve seen at previous conferences, data supporting CGM during pregnancy is overwhelmingly positive. The CONCEPTT trial examined Medtronic’s Guardian CGM in pregnant women and showed many encouraging results, including:
    • Reduced birth weight of the baby
    • 100 more minutes per day in target glucose range for the pregnant mother
    • 72 fewer minutes per day in hyperglycemia for the pregnant mother

Experts believe that even these encouraging results underestimate the impact of CGM on positive health outcomes for pregnant women and their children. Broadly speaking, pregnancy can cause multiple challenges to diabetes management that CGM can help ease. Pregnant women experience more blood glucose variability with increased insulin resistance and are at a greater risk of hypoglycemia. Learn more here about gestational diabetes.

4. Results show benefits of DIY closed-loop systems: lower A1C and more time in range using Loop

An observational study on Loop, a do-it-yourself (DIY) closed-loop system, found that Loop improved diabetes management significantly. The study followed people using an automated insulin delivery (AID) system, continuous glucose monitor (CGM) readings, and a communications bridge device, called “RileyLink.”

New users (people in the study who had never used this closed-loop system before) showed:

  • An A1C reduction from 6.8% to 6.5% after three months and to 6.4% after six months – and if you think that is not very much, think again!
  • An increase in time in range from 68% to 73%, which is more than one hour per day spent in-range! These time in range benefits occurred in the first month of closed-loop use and were constant throughout the rest of the study.
  • Benefits in A1C and time in range across all age groups.
  • Improvements in user-reported outcomes, including measures of diabetes management distress, sleep quality, and fear of hypoglycemia. Not too many details were shared on this part and we look so forward to learning more!

It is important to note that people in the study were classified as having “well-managed” diabetes at the start of the study, meaning they had relatively low A1Cs (6.8% baseline) and were close to meeting time in range goals, and came from high education levels and socioeconomic status backgrounds. This underscores the need to improve access to closed-loop systems for broader groups of people with diabetes.

Looking ahead, the study will end on March 31, 2020 and all participants will complete a six-month follow-up, so full results will not be available until later this year.

5. WISDM Trial: CGM helps older adults with type 1 diabetes reduce hypoglycemia and improve time in range

The WISDM study examined the impact of continuous glucose monitor (CGM) use in people with type 1 diabetes above the age of 60. Participants used either the Dexcom G5 CGM or standard blood glucose meters (BGM). After six months, the CGM group spent less time in hypoglycemia (with blood glucose below 70 mg/dl) and two more hours per day in-range (70-180 mg/dl), compared to the BGM group. There was also a greater A1C reduction in the CGM group (0.3% decrease compared to no change in the BGM group). Importantly, people using CGM reported significantly fewer severe hypoglycemia events (defined as requiring assistance of another person). These benefits were seen whether people were using insulin pumps or multiple daily injections (MDI).

For the next six months of the study, the individuals using standard blood glucose meters switched over to CGM. New data shows that the people who switched to CGM spent significantly less time in hypoglycemia and more time in range. The CGM-only group maintained the outcomes from the six-month mark, which was also positive to see.

The WISDM study continues to show that CGM is as important, desired, and effective for older adults as it is for younger adults. Indeed, participants who used CGM in this study reported using it 95% of the time. As CGM becomes easier to use and more affordable in the coming years, we look for this valuable technology to be adopted by more people of all ages and backgrounds. That can’t come soon enough!

6. Increased FreeStyle Libre scanning frequency is associated with reduced time with both high and low blood sugar

Dr. Ramzi Ajjan of University of Leeds presented data across many countries and regions showing that more FreeStyle Libre scans each day was associated with reduced time in both hyperglycemia (high blood sugar) and hypoglycemia (low blood sugar).

Unlike traditional CGM, FreeStyle Libre does not continuously send real-time glucose data to the reader; instead, the sensor patch must be “scanned” with the reader to get the real-time glucose value, trend arrow, and trend graph. By scanning more frequently, people are viewing their blood sugar data in real-time more often. This allows them to make adjustments to avoid highs and lows, whether by introducing a new habit or working to change a longstanding behavior.

The data shows that as the number of scans per day increased, time spent in hyperglycemia and hypoglycemia decreased. For example, in the UK, the lowest number of scans (about five per day) resulted in 44% time in hyperglycemia, which fell to 24% time in hyperglycemia with the higher number of scans (about 45 per day – obviously on the high end, but you get the idea!). Find more data here.

7. MiniMed 670G data shows time in range increases with Auto Mode

Screenshot

Image source: diaTribe

Medtronic presented data from 7,847 people with diabetes across Europe who used the Auto Mode function of Medtronic’s MiniMed 670G AID system. Among 3,139 670G users, average time in range increased from 62% to 71% before and after using Auto Mode – that’s 2.3 hours more time in-range each day!

The increase in time in range corresponded with a drop in time spent in hypoglycemia and hyperglycemia. These users spent just 1.8% of their time with blood glucose levels under 70 mg/dl, and 0.6% of their time with blood glucose levels under 54 mg/dl. On the hyperglycemia side, users spent 21% of their time with blood glucose levels over 180 mg/dl, and 6% of their time with blood glucose levels over 250 mg/dl. Time in range improvements were seen one month after enabling Auto Mode.

Screenshot

Image source: diaTribe

8. Control-IQ increases time in range in children ages 6-13

Dr. R. Paul Wadwa of the Barbara Davis Center for Diabetes presented highly anticipated results from the DCLP-5 trial of Control-IQ in children ages 6-13 years old. Over 16 weeks, time in range increased from:

  • 53% to 67% in the group using Control-IQ
  • 51% to 55% in the group using a pump and CGM, without Control-IQ.

This means that the children using Control-IQ spent about two and a half more hours each day in their target blood sugar range, compared to the kids using a standard pump and CGM.

Like the adult trial of Control-IQ, most of the increase in time in range occurred at night. At night, the Control-IQ group reached an astounding 80% time in range compared to 54% in the standard pump and CGM group. Overall, time spent above 180 mg/dl was 31% for the Control-IQ group, compared to 43% in the standard pump and CGM group. Time below 70 mg/dl was not changed in either group. There were no cases of diabetic ketoacidosis (DKA) or severe hypoglycemia in the trial.

Dr. Boris Kovatchev from the University of Virginia gave a more detailed comparison of the adult and child Control-IQ trials in the slide below:

Screenshot

Image source: diaTribe

Control-IQ was cleared in December for people ages 14 years and older. Control-IQ is expected to be submitted for approval in children in early 2020.

Thank you so much to the conference organizers Professors Moshe Philip and Tadej Battelino – what an outstanding gathering, and much appreciation for making so many people with diabetes and advocates feel so welcome. You can see so much more on the ATTD Facebook homepage, including the compelling opening ceremony with keynote speaker Dr. Jay Skyler giving a moving talk about technology past and present, as well as a video of talented Spanish musicians and dancers to close out the first night! The live stream was also much appreciated. Thank you so much to technology watcher Albert Cai and his team for their brilliant help in identifying key themes at this memorable conference. We’ll be back with more learnings on therapies, behavior, insulin and more …

Source: diabetesdaily.com

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