7/18/2017

Leveraging Diabetes & Digital Technology to Develop Pro Cyclists with Diabetes & Eliminate Diabetes Stigma

Disclosure to Participants Charlotte Hayes • Notice of Requirements For Successful Completion MMSc, MS, RDN, CDE – Please refer to learning goals and objectives – Learners must attend the full activity and complete the evaluation in order to claim continuing education credit/hours Director of Education and Research • Conflict of Interest (COI) and Financial Relationship Disclosures: – Presenter: Charlotte Hayes MMSc, MS, RDN, CDE, ACSM CCEP is a employee; Pharmaceutical Company Novo Nordisk is Team Novo Nordisk’s title sponsor Team Novo Nordisk – Presenter: Zach Monette BA - is a Team Novo Nordisk employee; Pharmaceutical Company Novo Nordisk is Team Novo Nordisk’s title sponsor Atlanta, GA • Non-Endorsement of Products: – Accredited status does not imply endorsement by AADE, ANCC, ACPE or CDR of any commercial products displayed in conjunction with this educational activity • Off-Label Use: – Participants will be notified by speakers to any product used for a purpose other than for which it was approved by the Food and Drug Administration.

Zach Monette DIABETES IS Senior Director of Digital Media Team Novo Nordisk INCREASING TO Atlanta, GA EPIDEMIC LEVELS ACROSS THE GLOBE

Does it have to mean a ‘life abbreviated'?

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BUILDING A PIPELINE OF ALL-DIABETES ATHLETES / 2016 TEAMS

PRO DEVELOPMENT JUNIOR TALENT ID CAMP ELITE RACING TO Cycling, Run, Tri, T2 INSPIRE, EDUCATE & EMPOWER EVERYONE AFFECTED BY DIABETES

18 cyclists 19 cyclists 12 cyclists 48 49 15 from pipeline 19 from pipeline 12 from pipeline athletes athletes (75%) (100%) (100%)

TEAM HISTORY INSPIRING CHANGE AT LE

2005 2006 2007 2008 2009 2010 2011 2012 • 3.5 billion viewers over the three-week

Team Type 1 Founded Set World Record RAAM Overall Pro Team Launched Competed in 5+ World Tour of California- KOM Pro Conti status 28th ranked in world race RAAM champions, new world (mixed diabetes) Tour Races jersey 34th ranked in the world Team Novo Nordisk record Elite Team Launched Launched World’s • Celebrate the 100th anniversary of First All-Diabetes Team insulin and of life people with diabetes • Globalize hope, inspiration and 2013 2014 2015 2016 2017 empowerment for everyone affected by type 1 and type 2 diabetes • Fight for global access to medicine for all with diabetes in the world • Change the world of diabetes and

First season with all-diabetes squad Tour of California podium 130th First World Tour race / First stage First World Tour stage race 2nd Goal: Five World Tour Events inspire healthy living 140th ranked in world ranked in world win 83rd ranked in world overall at Tour de Korea 91st ranked in the world

AT LEAST ONE RIDER WITH DIABETES IN EVERY RACE ALL DIABETES SQUAD

SOCIAL MEDIA GROWTH SOCIAL MEDIA ENGAGEMENT

31M REACHED / 6,072,937 1.5M ENGAGEMENTS AS OF APRIL 2017 AS OF APRIL 2017

2016 / 4,800,000 + 2015 / 2,000,000 + 2014 / 1,000,000 + 2013 / 334,000 + 2012 / 0 2016 TOTAL / REACH: 58M / ENGAGEMENTS: 2.5

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MORE FACEBOOK FOLLOWERS THAN ALL WORLD TOUR CYCLING TEAMS COMBINED ENGAGING A DEDICATED & ACTIVE FAN BASE

Team Novo Nordisk UCI World Tour PRO CYCLING QUOTES FROM FANS

“My son met TNN at the Tour of Britain and it inspired him to take up cycling.” –UK CYCLING FAN 176,631 319,210 31,202 454,615 101,167 253,083 97%

ACTIVELY PARTICIPATE IN SPORT “TNN has inspired me to keep on despite my 95% (CYCLING, RUNNING, TRIATHLON, diabetes.” –UK ETC) 163,802 368,765 86,937 172,271 462,111 207,096 “If it wasn’t for TNN I wouldn’t have bought my AGREE TT1 IS INSPIRING bikes. I was inspired to do something about 94% my health and my life.” –Denmark TT1 FANS WITH DIABETES ARE 112,659 3,897 205,834 191,139 851,960 617,309 88% INSPIRED TO MANAGE EXERCISE AND TOTAL FOLLOWERS DIABETES TOTAL FOLLOWERS “TNN helped me realize that diabetes was no SOURCE: TEAM NOVO NORDISK DIGITAL SURVEY. 1827 RESPONDENTS. impediment to keep up with my dreams and OCT 2014-JAN 2015. 5,721,384 4,779,688 goals as an athlete.” –Portugal *FACEBOOK FOLLOWERS ON 4/27/2017

TALENT ID CAMPS GOALS AND EXPECTATIONS: DIABETES MANAGEMENT

Recruit young, talented endurance athletes with diabetes Develop diabetes self- • 45 athletes – cyclists, triathletes & runners management skills • Aged 15-26 • 19 countries represented in 2016 • Frequent blood glucose (BG) • Learn how to manage diabetes while training and racing monitoring • Reporting BGs to Medical 2017 Camps June 27-July 2, 2017 & July 11-July 16, 2017 Team • Eating for performance

“I LEARNED NEW SKILLS THAT WILL HELP • Adjusting insulin 91% ME BETTER MANAGE MY DIABETES” • Preventing and treating highs “I FEEL MORE CONFIDENT ABOUT and lows MANAGING MY BLOOD GLUCOSE WHILE 80% CYCLING”

“I PLAN TO MAKE CHANGES IN MY DIABETES MANAGEMENT BASED ON THINGS I LEARNED AT CAMP” 80% Exercise management of type 1 diabetes: a consensus statement. ttp://dx.doi.org/10/1016/S2213- 8587(17)30014-1. accessed 3-5-2017.

COMPLETE YOUR DIABETES LOG TNN BLOOD GLUCOSE SCORING SYSTEM

Three checkpoints: 1. 30 minutes pre-race (self-monitored blood glucose) 2. Average during the race (continuous glucose monitoring) 3. End of the race (self-monitored blood glucose)

Scoring at each checkpoint:

3 Points: 0 1 2 2 1 0

mg/dL: 0 80 100 120 180 200 220 mmol/L: 0 4.4 5.6 6.7 10 11.1 12.2

Total score (0-9 points): 0–3 = out of target 4–6 = in target 7–9 = optimal

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EXERCISE AND INSULIN EXERCISE AND INSULIN MDI CSII • For endurance rides longer than • For endurance rides longer 30-45 minutes, rapid acting than 30-45 minutes, pre-ride insulin may need to be reduced meal bolus may need to be by 20% -50% (or more) reduced by 20% -50% (or more) • Long acting (basal) insulin may need to be adjusted based on • Set a reduced temporary basal rate starting 45-60 hard training/easy minutes pre-ride or training/recovery day suspending the pump are options

Exercise management of type 1 diabetes: a consensus statement. ttp://dx.doi.org/10/1016/S2213- Exercise management of type 1 diabetes: a consensus statement. ttp://dx.doi.org/10/1016/S2213-8587(17)30014-1. 8587(17)30014-1. accessed 3-5-2017. accessed 3-5-2017. Horton WB, Subauste JS. Care of the athlete with type 1 diabetes: a clinical review. Int J endocrinol Metab. 2016; Horton WB, Subauste JS. Care of the athlete with type 1 diabetes: a clinical review. Int J endocrinol Metab. 2016; 14(2): 14(2): e36091. e36091.

NUTRITION IDENTIFYING GLUCOSE TRENDS AND PATTERNS

Refuel, Replace, Repair • Carbohydrates • Protein • Electrolytes – sodium • Hydrate with fluids

Nutrition and Athletic Performance. J Acad Nutr Diet 2016; 116: 501-528.

ENTERING THE PIPELINE ADVANCING USE OF DIABETES AND PERFORMANCE TECHNOLOGY

PRO DEVELOPMENT JUNIOR TALENT ID CAMP ELITE Cycling, Run, Tri, T2

18 cyclists 19 cyclists 12 cyclists 48 49 15 from pipeline 19 from pipeline 12 from pipeline athletes athletes (75%) (100%) (100%)

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PHYSICAL ACTIVITY & NUTRITION TRACKERS RACE DATA CAPTURE AND EVALUATION

RACERACE DATA DATA CAPTURE CAPTURE AND AND EVALUATION EVALUATION CGM DATA YEAR 1

Statistics Average Glucose 174 mg/dL Sensor Usage 7 of 7 Days Calibrations / day 2.3 Standard Deviation ± 69 mg/dL 53 % High

42 % Target

6 % Low Target Range 80 - 160 mg/dL Nighttime 10:00 PM - 6:00 AM

CGM DATA YEAR 2 CGM DATA YEAR 3

Statistics Average 128 mg/dL Glucose Sensor Usage 7 of 7 Days Calibrations / 2.1 day Standard ± 47 mg/dL Deviation 19 % High 77 % Target 4 % Low Target Range 70 - 160 mg/dL Nighttime 10:00 PM - 6:00 AM

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INPUTS VS OUTPUTS RACING IN OVER 35 COUNTRIES WORLDWIDE MATTERS OF DATA INTEGRATION 16 COUNTRIES REPRESENTED

NORTH AMERICA EUROPE Canada ASIA-PACIFIC Belgium United States Azerbaijan Croatia Mexico Czech Republic Dominican Republic Japan Denmark Kazakhstan Estonia MIDDLE EAST Phillipines France U.A.E. Turkey Taiwan Norway AFRICA Poland Rwanda Portugal Russia SOUTH AMERICA Spain Argentina OCEANIA Netherlands Brazil UK

HCP TESTIMONIALS

Amplification

DR. MICHIO HAYASHI FRANCESCA ANNAN TOKYO, JAPAN MD, DIABETOLOGIST, NTT CHILDREN’S DIABETES MEDICAL CENTER DIETICIAN. Many patients think they can do The work that Team Novo nothing because of diabetes, Nordisk do promotes but that’s not true. So I tell diabetes in an amazingly those patients, look at Team positive light, and it’s Novo Nordisk. enabling people to see what can be achieved despite the hurdles.

PATIENT TESTIMONIALS SHARE THE EMPOWERMENT

teamnovonordisk

@teamnovonordisk

CIARAN DIXON KAROLINA WITEK JIM KISHEL ZANDER MORTENSEN AGE OF DIAGNOSIS / 13 AGE OF DIAGNOSIS / 13 AGE OF DIAGNOSIS / 13.

Team Novo Nordisk inspires me Thanks to TNN I feel that I’m I am a type 2 diabetic. I would After my diagnosis, I was really to do my best on and off the not alone, and I do the like to say thank you for angry about my diabetes, but @teamnovonordisk bike every day, and to manage things I love. Nothing limits encouraging me to get on my Team Novo Nordisk showed me my diabetes the best I can! me. bike and to keep riding. a new perspective on diabetes and how to manage it

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CONSIDER WHAT’S POSSIBLE THANK YOU

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