“In the old days, diabetologists prescribed therapy schemes for patients with diabetes based on one glucose measure, done during the inpatient visit in the doctor’s office. A lot of young, around 40-years old patients with diabetes type 1 were hospitalized, dying from kidney failure or infraction. Amputations were more common,” reflects the Slovenian diabetologist Draženka Pongrac Barlovič on how diabetes management used to look like. A lot has changed in diabetes therapy and management tools. Today, the industry is looking at novel therapies combined with technology, algorithms and support services to make the disease as invisible to the patient as possible and consequently better managed.

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Drugs

There are many types of drugs on the market for diabetes. Insulin is used only when the beta cells in the pancreas are not functioning anymore. Metformin is the first drug prescribed upon diagnosis of diabetes type 2, used to increase the sensitivity of body tissues to insulin and increase its absorption. There are drugs encouraging pancreas to secrete insulin and medicines decreasing levels of glucose in the body.

The latest new drugs in clinical practice are SGLT-2 inhibitors, preventing reabsorption of glucose in kidneys and causing the blood sugar to be secreted with urine. SGL-2 inhibitors seem to have important effects on cardiovascular outcomes and have created a hot debate in diabetology on should the specialty give more attention to cardiovascular complications associated with diabetes compared to the focus on glucose level management.

The next expected breakthrough are ingestible or implantable therapies which will react based on detected glucose in the body.

One such is ITCA 650, the subcutaneous infusion pump developed by Intarcia Therapeutics.

ITCA 650

Technology

On the technology side, the significant breakthroughs were the insulin pumps. Looking at apps, 1,800 were on the market in 2016. Then there’s continuous glucose monitoring sensors and ideas such as glucose-measuring contact lens. The idea is clear: the more automation, the better management.

For the last decade researchers from all around the globe have been working on an artificial pancreas and last year, the first closest example by Medtronic came to the market — MiniMed 670G.

Minimed 670G

The area is lively as the market is big.

430 million people are currently dealing with diabetes, with the incidence rising. Consequently, the market interest follows.

If there is someone you want to ask for an opinion on diabetes management challenges it’ David Kliff, editor of Diabetic Investor — THE source of information when it comes to business aspects of diabetes. He’s been following closely the area ever since he was diagnosed with diabetes type 1, 20 years ago.

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Behavioural change? Only works short time. Myths? That anyone cares about outcomes. Artificial pancreas to conquer type 1? Not really, since it applies to only a small number of patients and is currently still very complicated to use, with too many interdependent moving parts.

The problem in diabetes is not the know-how, it’s the “want to” desire that is hard to deliver to patients.

In this episode you will hear his Kliffs bold opinion on:

• - In what position are newly diagnosed patients today compared to the past?

• - Why does behavioral change not work? What about gamification?

• - What are the biggest myths in diabetes management?

• - How much can apps help?

• - Is diabetes ever going to be managed better or is the rising incidence only going increase the number of players in the market?