As technology becomes more integrated and personalized, experts say the biggest opportunity in diabetes management is reducing everyday burdens.
The pace of diabetes technology innovation continues to accelerate, from smarter algorithms and longer-wear sensors to smaller pumps.
Major advancements that have developed for diabetes management include automated insulin delivery, new patch-pump concepts and broader sensor integration. Scaled-down pumps, larger insulin reservoirs and extended wear options offer “smarter, more flexible tech ecosystems that give people choice.”
The drive for innovation makes sense considering how the U.S. diabetes burden has been increasing steadily, said Dr. Wendy S. Lane, clinical endocrinologist & director of Clinical Research at the Mountain Diabetes and Endocrine Center in Asheville, North Carolina. Diabetes prevalence in the U.S. has climbed from roughly one in 10 adults to more than one in eight, while the disease is also affecting younger patients.
Current Treatment Landscape
The innovations cited have tremendously benefited patients, said Sarah Howell, CEO of Arecor Therapeutics, which is developing the only ultra-concentrated (500U/mL) ultra-rapid acting insulin.
Continuous glucose monitors measure a person’s blood glucose in real-time and this information feeds into algorithms that can calculate how much insulin is needed to keep patients inside a target blood glucose range. That insulin is automatically delivered by the pumps, called automated insulin delivery systems (AIDs). There is also now faster-acting insulin that simulates the pancreas’ action, Howell said.
But despite these “fantastic” advancements, there is still room to make improvements in care for this disease with such a high, 24/7 patient burden, Howell said. Lane agreed, although diabetes has gone from being a fatal condition to one where a patient can live a long life.
Patients are still far from a “carefree” experience because they must manage timing, dosing, food and device function constantly, Lane added.
“It’s not just, ‘I put on my pump and away we go’,” Lane said, “I have to think about, ‘What time did I take my insulin? How much insulin do I take to match the carbohydrates in my food? Is my pump working properly? Do I have a blockage? Is that why my sugar is high? Is my sensor accurate? And maybe I need to do a finger stick to confirm that. Did I lay on my sensor and that’s why it’s reading low?’”
In terms of therapeutics, while GLP1-s can complement tech advancements, they do not replace insulin, especially in type 1 diabetes. Many patients still need substantial insulin even when GLP-1s reduce requirements, Lane said. In addition, as the side-effect profile of this drug class can be disagreeable, many patients with diabetes would not be eligible.
Obstacles to Pump Adoption
Despite better health outcomes for patients on continuous insulin pumps than those that administer daily insulin injections, only 40% of U.S. patients with type 1 diabetes and 5% of patients with type 2 diabetes use them, Howell said.
For type 1 diabetes, it’s difficult for such patients to reach the seven-day wear time of pumps due to high insulin requirements, Howell said.
Those with type 2 diabetes often need more than 100 units of insulin a day. That means with current insulin dose availability and patch pump application, they can’t be used for the standard wear time of three days. Thus, another patch pump must be applied, used and discarded or insulin cartridge used. Not only is this burdensome, but there’s much consumer waste, Howell and Lane agreed.
A very overweight, obese person with diabetes, either type 1 or type 2, might need 400 or 500 units a day, Lane said. In addition, due to the heavily processed American diet, the need for additional insulin requirements is increasingly seen for obese teenagers, and older, pregnant women.
“My typical day is trying to figure out how to get enough insulin into people,” she said.
The pump sizes also are discomfiting, Howell and Lane agreed, and obvious reminders to patients of their chronic condition. A pump or wearable on an arm for example, can snag on something. For those in physically demanding jobs, or active in sports or in play, this can draw unwanted attention if not pain.
Payers also are reluctant to cover the costs of these additional insulin cartridges or pods, Howell and Lane agreed. Ultimately, patients want to “fit and forget” about their pumps, Howell said.
Holy Grail of Diabetes Tech
Despite the challenges, both Howell and Lane noted the future is bright for further innovation, especially in the next decade.
The “Holy Grail” for patients would be an integrated, smaller, concentrated insulin pump with a smart algorithm and continuous glucose monitoring, to be worn as long as possible, Howell said. The advancement would mean patients no longer need to update the system at mealtimes or count carbs as the insulin would be fast enough to deal with glucose fluctuations, Howell and Lane agreed.
A small, unobtrusive system, such as U.S. quarter size, that can provide regular insulin requirements with very precise microdosing of both the basal and the bolus insulin would be ideal, Lane said. For patients with larger insulin requirements, an ultra-rapid insulin in a pump that can hold a week’s worth of insulin, like 500 or even 1,000 insulin units, combined with a glucose sensor and an algorithm, is desirable.
You can hear more on this week’s Denatured podcast episode.
