Diabetes is one of the world’s biggest healthcare challenges. 425 million people live with this chronic disease and it’s likely to rise to 629 million by 2045 according to the International Diabetes Federation. Diabetes caused 4 million deaths in 2017 and $727 billion was spent on healthcare, putting healthcare providers under enormous pressure.
These staggering numbers paint a gloomy picture, however there is one bright spot. Rapidly developing technology offers new ways to empower individuals, all with the same goal in mind: better management and control over their diabetes, a reduction in the risk of serious long-term complications and more freedom to get on and live their lives. With perhaps five different types of diabetes rather than the three commonly thought of, and with the condition found in all age ranges, from young children to the elderly, there is no one size fits all solution. Instead there are a number of different innovations for this huge and (unfortunately) growing market. Here are some of the latest developments.
Flash Glucose Monitoring
A flash glucose monitor is a small sensor worn on the skin that measures blood sugar in the interstitial fluid that surrounds body cells. The sensor is scanned with a small reader, indicating the current reading and also providing information showing glucose levels for the last eight hours. Software then analyses the results, so both the individual concerned and their healthcare provider has access to a wealth of information on their glucose patterns and is able to learn how well they’ve been able to manage their blood sugar over the period.
NHS England announced on World Diabetes Day, 14 November 2018, that the FreeStyle Libre flash monitoring system will now be available on prescription to all patients who qualify for it, whereas previously it was a postcode lottery. Diabetes UK campaigned for the technology to be made more readily available, saying it would help thousands of people safely manage their diabetes. Simon Stevens, Chief Executive of NHS England commented “Increasingly the NHS is going to be offering patients this sort of technology to help them more easily manage their own long term health problem. In the NHS of the future, for many conditions you’re going to get NHS support direct from your smartphone or wearable device rather than having to trek to regular hospital outpatient appointments. Supporting people with modern tools to manage conditions such as Type 1 diabetes is about to become much more widespread.”
Continuous Glucose Monitoring
The benefits of Flash Glucose Monitoring are clear but one thing these systems don’t do is provide warning if users are in danger of going especially ‘hypo’ (low) or ‘hyper’ (high) in terms of their blood sugar. Continuous Glucose Monitoring (CGM), like Roche and Senseonic’s Eversense XL, can. This system sends an alarm via the transmitter, so the user gets a vibrating warning if their blood sugar goes out of the normal range. Like a flash glucose monitor it also measures blood sugar in interstitial fluid, but the sensor sits just under the skin and the readings are continual, with access to data provided by a smartphone app so no other hardware is needed. Other systems on the market have sensors that need to be replaced by the user every seven to 14 days, but the Eversense XL has a sensor lasting 180 days. This means a user makes one quick visit to a medical professional every six months rather than having to insert a sensor themselves using an applicator several times a month.
Meanwhile in the UK Nemaura Systems are developing SugarBeat, a continuous glucose monitor that doesn’t need to be implanted under the skin. Instead it’s a patch that simply sticks on to the skin and is replaced daily. It works by passing an imperceptible electric current across the skin to draw glucose out of the interstitial fluid below. Designed for all types of diabetes, though Type 1 users need to combine it with finger prick tests, the device is set to launch this year in the UK, followed shortly after by other key European countries.
Closed loop systems
Closed loop, or automated insulin delivery systems, combine continuous glucose monitoring with insulin delivery systems, adjusting the rate of insulin in line with current and predicted blood sugar levels. The idea has been around since the early 2000s but only now are they entering the market, though apparently those with the necessary skills have in the past banded together to form DIY systems by hacking the devices and technology that were available.
The story of startup digital healthcare company Bigfoot Biomedical began with one of these hackers, Bryan Mazlish, a Wall Street trader whose son was diagnosed with Type 1 diabetes. Mazlish developed his own algorithm to create the original system for his son and wife, another Type 1 sufferer. In 2014 the company was formed to commercialise the system. The company have developed an insulin pump which they use with FreeStyle Libre and a smartphone app, hoping to have something in the market in 2020.
Medtronic were first to market with the MiniMed 670G in 2017. The system includes SmartGuard, ‘the only technology that mimics some of the functions of a healthy pancreas by providing two new levels of insulin delivery’. It automatically adjusts basal (background) insulin every five minutes based on CGM readings, and also stops insulin up to 30 minutes before reaching pre-set low limits, restarting again once levels recover. The user still needs to manage bolus doses of insulin to manage meals and spikes in blood sugar. It has now been approved in the US for children age 7-13. Francine Kaufman, MD, Chief Medical Officer of the Diabetes Group at Medtronic commented “This expanded age indication provides an important new treatment option for pediatric clinicians and parents of young children.
It’s clear that for the millions who need to cope with their diabetes every day, new technology offers a wealth of benefits. The advantages of having access to up-to-the-minute information allowing people to better manage the condition are huge. As new systems are enhanced and improved the ability to predict glucose levels will increase, and it will become easier to manage particular events that can alter blood sugar levels, for instance physical exercise or illness. The potential market is huge and competition will be strong as brands compete and new players enter the field. Those systems that lead the field will be the ones that can offer a winning combination of benefits: an easy-to-use interface, smart use of data that improves understanding and clinical care, an improved patient experience, a price that healthcare providers and insurers can accept, and better patient outcomes. Diabetes won’t stop being a daily battle for millions any time soon, but there’s hope at least that as new technology advances and prices come down, more and more people will be able to arm themselves with what they need to stay in control.