The pace of diabetes innovation is faster than ever. While a cure continues to remain out of reach, there are new medications, therapies, tools and technologies that can make living with diabetes a whole lot easier. Looking back over the past decade, it’s pretty amazing how far diabetes innovation has come. Let’s take a look at some of the headliners over the past 10 years.
CGM, or continuous glucose monitoring[1], is here to stay. Evidence shows that use of CGM helps to improve glycemic control[2] and reduce the risk of hypoglycemia (low blood sugar)[3] in both people with type 1[4] and type 2 diabetes[5]. And a study published in April 2018 in the journal Diabetes Care showed that use of CGM increased quality of life by extending the amount of time that users enjoy good health. The American Diabetes Association Standards of Medical Care[6] and the Endocrine Society now state that CGM use is part of the standard of care for those with type 1 diabetes. In fact, CGM use in those with type 1 has risen from just 6% in 2011 to 38% in 2018.
What’s the big deal about CGM? Well, for one thing, it can practically eliminate or at least drastically reduce the need for fingersticks. If you think about it, many people with type 1 diabetes check their blood sugars with a meter up to 10 times a day. That amounts to 70 fingersticks a week or 240 times a month or 2880 times a year. No wonder fingertips get sore! Currently, three CGM systems no longer require fingersticks: The FreeStyle Libre Flash Glucose Monitoring System, the Eversense CGM System and the Dexcom G6 System.
Speaking of the Eversense CGM System, this CGM has an advanced sensor that is implanted just under the skin of the upper arm and monitors glucose for up to 90 days. No more changing sensors every 7, 10 or 14 days.
Cost has always been a barrier to CGM adoption. While still not inexpensive, CGM is now more affordable for many people: Abbott’s FreeStyle Libre sensors cost between $75 to $150 per month, or $900 to $1800 per year, compared to the more typical $3000 to $5000 per year for other CGM systems, according to a March 2019 article in the American Journal of Managed Care[7]. And more health plans, including Medicare, are covering the cost of CGM for those using intensive insulin therapy[8]. Let’s hope the cost continues to come down and be more affordable for everyone with diabetes.
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The use of an insulin pen to deliver insulin has grown in popularity, making it easier and more convenient to inject insulin than using the more traditional insulin vial and syringe. Insulin pens have also proven their worth by increasing accuracy in dosing, adherence and quality of life.
Since its debut in the U.S. in 1985, the insulin pen has become “smart,”[10] literally. Eli Lilly, Novo Nordisk and Common Sensing have versions of smart pens — but what makes them so smart? These devices do more than just deliver insulin: they contain a memory that records the time, date and dose of insulin injected. One of these pens, called the InPen (which, by the way, allows for 1/2-unit dosing) contains a calculator that computes your insulin dose based on previous doses, current blood glucose level[11] and carbohydrate intake. To make this happen, you have to pair the InPen with the InPen Mobile app on your smartphone and enter a few settings provided by your healthcare provider. Smart pens can also transmit data, such as the dose of insulin injected, to the cloud, and this data can be shared with healthcare providers for more integrated diabetes management.
Insulin pen companies have partnered (or will be partnering) with companies that will integrate data into their apps or platforms to help with dosing decisions. With this level of sophistication, smart pens will be able to practically duplicate what insulin pumps do, but at a fraction of the cost.
One of the biggest recent advances in diabetes is the artificial pancreas, also known as the bionic pancreas[12] or a closed-loop system. This device closely mimics what a healthy, functioning pancreas does by a) monitoring blood glucose levels and b) delivering insulin, as needed, based on those levels. The artificial pancreas is an insulin pump integrated with a CGM and is connected to a receiver, such as a smartphone that uses algorithms. The user no longer needs to worry about doing fingersticks and complex calculations to determine how much insulin he or she needs. Some systems even incorporate glucagon[13] in the pump in case of hypoglycemia.
Numerous companies are involved in the development of the artificial pancreas, including Beta Bionics, Bigfoot Biomedical, Dexcom, DreaMed Diabetes, Lilly, Insulet Corp, Medtronic and Tandem Diabetes Care.
While the hope is that the artificial pancreas will come to market sometime between 2021 and 2022, some people in the diabetes community aren’t waiting for FDA approval — they’ve gone ahead and made the Artificial Pancreas System (APS) technology available to anyone with compatible medical devices to build their own system. For more information, check out the #WeAreNotWaiting or #OpenAPS hashtags or visit www.openaps.org[14].
You’re likely familiar with glucagon[15] (a hormone that works to raise blood glucose levels) and why you need it (to treat severe hypoglycemia). The question is: how many of you have a glucagon kit[16] in your medicine cabinet? And even if you do, how many of you have someone in your household that knows how to use it? The reality is that many people don’t use glucagon kits because it involves someone (not you) mixing a powder and a liquid and administering an injection to the person who is experiencing severe low blood glucose and is possibly unconscious. That’s pretty stressful, to say the least.
Baqsimi, which was approved by the FDA in July of 2019, is a needle-free nasal spray form of glucagon. No more mixing, no more injecting. Baqsimi doesn’t need to be inhaled, which means it can be used even if you’re congested or unconscious. Like injected glucagon, Baqsimi is meant to be used for severe hypoglycemia and when you need help from someone else to bring your glucose level back up to a safe level.
There’s a lot that’s happened with a class of drugs called GLP-1 agonists[17]. GLP-1 agonist drugs mimic the action of GLP-1, a hormone made in the small intestine that stimulates the release of insulin and inhibits glucagon secretion to help lower blood glucose. GLP-1 also delays stomach emptying and reduces appetite, which can help with weight loss. This class of drug has been revolutionary for those with type 2 diabetes, as it lowers A1C[18] by an average of 1% and helps with weight loss at the same time. It’s also versatile in that it can be combined with a number of diabetes pills as well as insulin.
In 2005, Byetta (exenatide) was the first GLP-1 agonist to be approved. The drug required two injections a day. Then, in 2012, the first long-acting form of GLP-1 was approved, Bydureon (exenatide ER)[19]. Bydureon is injected once weekly. Other once-weekly GLP-1 injections followed suit, including Trulicty[20] and Ozempic[21].
In September 2019, the FDA approved the first oral GLP-1 agonist, called Rybelsus (semaglutide)[22], giving those with type 2 diabetes a new treatment option that doesn’t require injections. Intarcia Therapeutics has resubmitted its new drug application for an implantable system that delivers GLP-1.
Saxenda (liraglutide)[23] is a once-daily injected GLP-1 agonist that’s approved as a treatment for weight management (along with lifestyle measures). Liraglutide is also available as Victoza[24], a daily injected GLP-1 agonist. The difference between Saxenda and Victoza is in the dosing: Saxenda’s maximum dose is 3 mg, whereas the maximum dose of Victoza is 1.8 mg.
GLP-1 agonists are now available as a combination with basal insulin. Soliqua[25] is a combination of insulin glargine and lixisenatide, and Xultophy[26] is a combination of insulin degludec and liraglutide. These are once-daily injections for those with type 2 diabetes who are inadequately controlled on a basal insulin or a GLP-1 agonist alone.
What about the use of GLP-1 agonists for type 1 diabetes? After all, GLP-1s have been a huge success in the type 2 population. Why not for those with type 1? Some research has indicated that GLP-1s could be helpful for A1C lowering in type 1 diabetes, but other research has shown that A1C lowering was insignificant, plus there was an increase in hypo- and hyperglycemia, DKA[27] and nausea. We’ll see what happens.
These days, everyone is busy. Whether it’s with work, school or family, making time for diabetes self-care, let alone taking time to go to an appointment with a diabetes educator[28] or to a class, can seem challenging if not next to impossible. A solution? How about a virtual diabetes coaching program? Lately, these programs have been springing up all over. Programs vary, but generally include tools, such as blood glucose meters and CGMs, combined with coaches (many of whom are certified diabetes educators), and in some instances, access to doctors who specialize in diabetes. Your coach has access to your glucose data, and through technology, you get alerts when your glucose is too high or too low, allowing you to make small, meaningful and actionable changes to help improve your diabetes management. You can talk to your coach over the phone, via email or even via text messaging. You might also have a video visit with your coach or doctor.
No more driving, paying for parking or wasting valuable time sitting in a crowded waiting room. And the coaching program is tailored to you and what you want to focus on, including healthy eating[29], becoming more active[30], getting more sleep[31], remembering to take your medications[32]…you get the idea.
Livongo[33], Onduo[34], Omada Health[35], Cecelia Health[36], Virta Health[37], Cornerstones4Care[38], and One Drop[39] are a few to look into. Some are for type 2 diabetes and some are for diabetes prevention. In addition, certain programs may be offered through employers or health plans. If you’re interested in a virtual (digital) program, check with your health plan to find out if one of these programs (or something similar) is an option for you.
Want to learn more about recent diabetes innovation? Read “CGM for Diabetes Management”[40] and “10 Diabetes Technologies to Watch in 2019,”[41] then watch our video on one version of the bionic pancreas[42] currently under development.
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