|Jen M. Block, FNP, NP-C, RN, CDE
Department of Pediatric Endocrinology, Stanford University
President, ARKRAY USA, Inc.
Executive Director and Co-Founder, T1D Exchange; CEO, Unitio
Dr. Eliaz Babaev, Ph.D., D. Sc.
Pharmacist, CEO of Diabetes Sentry Products Inc.
Mediaplanet: What are some of the newest tools that you see becoming available for those trying to manage diabetes and symptoms of diabetes?
Jen Block: Hypoglycemia and the fear of hypoglycemia is a major barrier to reaching glycemic control in many people with diabetes. Any technology that has the potential to reduce hypoglycemia without significantly increasing blood glucose and A1c levels is a definite win. The advent of continuous glucose monitoring (CGM) has been, and continues to be, key to this.
Jonathan Chapman: While simplicity is still something to be valued in today’s market, the changing needs of people with diabetes are as evident as the change in the demographic itself. Now you are seeing Bluetooth meters — meters that sync directly with a management program and online interactive wellness programs.
Dana Ball: There are many tools on the market and in development that will help monitor blood glucose, deliver insulin and make tracking diabetes data easier. A device was recently launched, which is the first to automatically stop insulin delivery when glucose reaches a set low threshold — a great step toward automating insulin delivery.
Eliaz Babaev: Newly diagnosed and veteran diabetic patients face a serious disease with a variety of complications, including amputation. With 40+ years in wound healing, one effective technology, low frequency ultrasound (LFU), delivers both debridement and therapy modalities for treating diabetic-related wounds and produces clinical results far superior to other therapy modalities.
Tim Hayes: A constant flow of new, more affective pharmaceutical drugs, mobile applications to help manage and track daily activities, diets and blood glucose levels. Web sites that provide current and relevant information and support groups.
MP: What is the number one tip for a recently diagnosed person with diabetes?
JB: Be honest. Share your concerns, your fears and your aspirations for diabetes management with your diabetes care team. We need to understand your needs in order to ensure you get the education and a personalized diabetes management plan that is both realistic and safe for you.
JC: The number one tip for a recently diagnosed diabetic is that you are not alone! Diabetes shouldn’t just be monitored, it should be managed, and there are a variety of resources and groups that can work alongside you as you move toward smarter, healthier lifestyle choices.
DB: You’re not alone. There is a community waiting to help you. Our Glu online community is filled with people who know firsthand about the challenges of learning to manage type-1 diabetes. You can find support, empowerment and education while sharing your own valuable lessons learned.
EB: In my opinion, the best tip is to become well-informed through diabetic education on living with diabetes and minimizing the consequent complications associated with unmanaged diabetes. One should not be overwhelmed by all the changes, but instead should focus on each area that will have the most impact.
TH: Take the diagnosis seriously. Make the appropriate lifestyle changes and be very diligent about managing and protecting yourself from the serious complications of the disease.
MP: What advice do you have for the families of people with diabetes?
JB: Be supportive and realistic. Diabetes management is very challenging. As healthcare providers, we have a team of experts to care for each individual patient, to expect an individual of any age to manage diabetes without support is asking for too much in my opinion. Go to appointments, ask how you can help, and whenever you see a personal success in diabetes, acknowledge and celebrate it.
JC: I would advise the family members of a person with diabetes to look into an online diabetes management system. This allows them to look at their loved one’s glucose readings and take an active role in helping monitor and understand how glucose levels are affected.
DB: It’s important to become educated about diabetes so you can understand how to support someone in healthy ways by listening to their needs. People with type-1 diabetes don’t define themselves by their disease and it’s really important to not lose the person in the process. Let them be heard.
EB: As with any disease, the support network around the patient is the key to success. Families show their support by educating themselves to make sensible dietary choices, pursue physical activities, participate in charitable events promoting diabetes research and provide support in patient compliance.
TH: Make it a family affair. Don’t force the individuals to deal with the condition on their own. Make family changes to lifestyle that are necessary for a diabetic to live a long, productive life. All family members will benefit from these changes.
MP: What do you see as some of the biggest hurdles that companies trying to advance diabetes research are faced with?
JB: I am afraid I can’t even come close to addressing all of the challenges that companies are facing; there are many. Among the biggest that I see is the ever increasing costs incurred in both the development of novel drugs, devices or products coupled with the expense of conducting adequate testing, research and clinical trials to bring them to market. These costs and potential financial incentives to innovate in diabetes are also challenges by the changing regulatory environment, and if approved, the uncertainty of an evolving reimbursement landscape.
JC: With current reimbursement rates at an all-time low, companies are having a hard time developing new products for consumers that are both innovative and cost effective. If independent pharmacies are unable to make a profit, they go out of business – leaving their patients with limited outlets to choose from.
DB: Companies are struggling with the high cost of developing and delivering new therapies. Drug discovery has become more challenging, and regulatory demands to ensure safety and efficacy have increased the cost of studies and clinical trials. These issues are complicated by changes in healthcare—both delivery and reimbursement.
EB: Research and development is fueled by funding, and the largest hurdle remains obtaining adequate backing to bring new therapies and technologies to fruition. There’s still a social stigma associated with diabetes, which translates into a dearth of funding, whether grants, venture capital, angel investors, strategic alliances, mergers & acquisitions, IPOs, etc.
TH: Necessary funding to accelerate the process and development of new products and services to manage diabetes. Diabetes is a self-managed disease, and cannot be solved by simply taking a pill. This complicates finding solutions that will work for the masses.
MP: How do you think these hurdles can be overcome?
JB: I think it will take creative ventures like T1D Innovations coupled with an emphasis on the importance of coverage and reimbursement. Coverage and reimbursement will need to be adequate for the drugs, devices and therapies themselves, as well as the time it takes providers to introduce and support their use in clinical care.
JC: There needs to be more support for reimbursement beyond what is currently available. This will incentivize manufacturers and providers to push for new and innovative advancements in the testing and monitoring of diabetes, as well as the collaboration for new partnerships to better assist people with diabetes.
DB: At T1D Exchange, we believe partnerships between nonprofit disease organizations and industry optimize the use of capital and human resources, which then accelerate clinical translation and advance treatments. Nonprofit disease organizations are uniquely positioned to represent the patients’ best interest and facilitate interaction by acting as the prudent custodian.
EB: These hurdles will be overcome in the private sector. While the economy and investing thereof has been slowly and steadily improving, more creative ways of financing are emerging as a result of social media and the democratizing of funding, which predicate a shift in realizing these future therapies and technologies.
TH: Solutions need to be simple and easy to understand for individuals to use and take full advantage of. The simpler the solutions the more likely an individual is to adhere to the proper use of the specific solution.
MP: In your opinion, what are the most promising new drugs/devices in the pipeline?
JB: For me, and I confess I am very biased as I have the pleasure of working with some of the world leaders in this area — including Dr. Buckingham and Dr. Ly at Stanford — is the artificial pancreas. I believe this system, which takes glucose data from a continuous glucose monitor through an algorithm that uses the data to calculate insulin needs and then programs an insulin pump to administer the recommended insulin (and possibly other medications) to regulate glucose control, is extremely exciting. I believe that in my lifetime systems like this will be part of my daily life as a person living with type-1 diabetes and I for one look forward to the day when I can turn all, or at least part of my daily diabetes management, over to a more automated system.
JC: Bluetooth glucose meters are very hot right now – and rightfully so. These meters allow users to wirelessly upload their glucose readings to apps and management programs that can help them better understand and manage their glucose levels, which is a major component of lifestyle modifications.
DB: Several new insulin and glucagon formulations in trials now will broaden therapy options. New type-2 drugs that stimulate insulin production and regulate glucose production may also help with type-1 diabetes. Improvements in continuous glucose monitoring technologies could give way to automated insulin delivery devices, revolutionizing diabetes management.
EB: Beyond the so-called artificial pancreas and coming with a speed akin to Moore’s Law, new drugs, pica-sized devices and active biologics (like stem cells, tissue cloning, etc.) are leveraging our genealogical understanding of diseases or targeting activation of key genes. Why have an artificial pancreas if you can repair yours?
TH: In 2010, more than 252 drugs were in development specifically targeting diabetes care. The focus of these drugs is to help diabetics maintain very tight glucose levels. This has created an unintended consequence, the dramatic increase in low blood sugar events or hypoglycemia. A number of solutions have been developed to help diabetics manage this condition.
Companies that develop continuous glucose monitors have developed optional modules to their CGMs that assist individuals with managing low blood sugars, but in order to take advantage of this option you need to purchase and use a CGM.
If an individual is tightly managing the condition and is following the recommended blood testing regiment of eight times per day, a CGM may be an unnecessary expense if the purpose of the CGM is to prevent low blood sugar emergencies. A new non-invasive device has been introduced to the market that is simple to use, costs significantly less than a CGM and potentially can save the healthcare industry significant costs.