The evolution of diabetes management

September 1, 2022 - 6 minutes

Diabetes management has progressed leaps and bounds in the last 100 years. Francine Kaufman, Chief Medical Officer of Senseonics, outlines how far the field has progressed and what is on the horizon for diabetes patients.

This year marks 100 years since insulin was first available to treat diabetes – an incredible milestone. One of the most important discoveries in the history of medicine, insulin completely transformed diabetes care, saving millions of lives. In celebration, here is a whistle-stop tour through the evolution of diabetes management and discuss what we can look forward to.     

The history of diabetes treatment          

Diabetes and its symptoms have been recognized for thousands of years. In fact, the modern term ‘diabetes’ can be traced back to Ancient Greece. The discovery of the role of the pancreas in insulin production, however, was not until the late 19th century, when scientists discovered that removing a dog’s pancreas would rapidly result in the development of severe diabetes. 

This sparked a real shift in diabetes research and led to the first injections of animal-derived insulin into a human in 1922. The first patient continued to take doses of insulin and went on to live for 13 years – which was previously unheard of. The findings were presented to the Association of American Physicians and met with unparalleled interest and praise. 

The discovery of insulin was the beginning of a journey of research and development with the goal of more effectively monitoring and managing diabetes. It led to a wave of discovery throughout the century, particularly concerning how to monitor glucose levels at home, first with testing intermittently in urine and then blood samples, and finally testing continuously in the interstitial fluid. This has allowed people with diabetes to better understand their glucose levels so they may make informed insulin-dosing and life-style decisions.      

Diabetes in the present day     

Although a cure has not yet been found and the number of people with diabetes is rising, technology has enabled people with diabetes to significantly improve their health outcomes. 

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Today around 537 million adults across the world are living with either type 1 or type 2 diabetes and in Europe, 1 in 11 adults live with the condition. Once diabetes is diagnosed, it is imperative that the patient, as well as their support team of family and friends, learn the complexities of diabetes management. It requires balancing many factors including medications, food intake, activity and stress to maintain glucose levels as near to normal as possible to avoid the long- and short-term complications. 

There have been remarkable advances in the development of glucose-lowering medications, including a now expansive list of insulin preparations that more effectively manage both type 1 and type 2 diabetes. Coupled with this expansive list of effective glucose-lowering agents, remarkable progress has also been made in the field of diabetes technology.

People with diabetes can now track their glucose levels throughout the day and night using Continuous Glucose Monitoring (CGM) systems, which I believe are a huge leap forward and one of the most significant advances I have seen in over the 40 years I have been an endocrinologist. 

In fact, insulin pumps and CGMs are constantly evolving and providing people with new options. At Senseonics, our unique fully implantable Eversense E3 CGM System, that can be used for up to 6 months and is brought to patients by Ascensia Diabetes Care, has just hit the market, as has Insulet’s Omnipod 5. Encouragingly, we are seeing healthy competition spurring innovation across the board, and this certainly benefits the diabetes community. 

Everyone’s experience with diabetes is different and it is crucial that medical technology companies deliver both optionality and interoperability, so that people can best manage their own condition, the way they desire. 

In lieu of a cure, treatments and the necessary technologies aim to make the lives of people with diabetes as easy, flexible and free from burden as possible. 

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Looking forward     

It is thought that, by 2040, there will be 642 million people aged 20-79 living with diabetes across the globe – a staggering statistic that will impact clinicians, researchers and those in the biotech and medtech fields. With type 2 diabetes, lifestyle improvements can go a long way in prevention, management and even in allowing for remission. Digital solutions which help track the impact of diet and exercise are proving to be key in supporting people with their treatment choices. Along with hallmark new medication classes, such as the glucagon-like peptide-1 receptor agonists, the dual agonists and the SGLT-2 inhibitors, healthcare providers have the opportunity to guide their patients to significantly better outcomes. 

The cure for type 1 diabetes has continued to be elusive. Many biotechnology companies are looking to develop ground-breaking therapies in pursuit of the prevention and cure. In particular, there is a lot to be excited about with immunotherapy and cell therapy. Immunotherapeutic approaches hope to stop the progression of diabetes by blocking immunologic-mediated damage to beta-cells, whilst cell therapies hope to replace insulin-producing cells that have already been rendered ineffective. While the science continues to evolve, there have been recent developments that appear to be very promising. 

From a medtech perspective, combining an insulin pump, a CGM and an insulin dosing algorithm to automatically deliver some insulin doses, has already proven to improve glucose management and reduce hypoglycemia.  These systems that automate insulin delivery (AID systems) shift some of the burden of diabetes management away from the patient and provider to the technology itself. With multiple systems commercially available across the globe, it has already become evident that they can make a positive difference to the lives of people with diabetes who require intensive insulin regimens. 

Advanced pharmacotherapies and technologies have continued to improve patients’ lives every day, and each advancement allows people with diabetes to live a little more freely. In a world where the number of people with diabetes is rising, continued research and development is imperative. At the 100-year anniversary of the discovery of insulin, we should celebrate how far we have come and continue working towards the eventual finish line for both type 1 and type 2 diabetes.

Francine Kaufman is a world-renowned endocrinologist who has served as president of the American Diabetes Association and chaired the National Diabetes Education Program. Alongside her position as Distinguished Professor Emerita of Paediatrics and Communications at the University of Southern California, she has been a practising physician for almost 45 years. She joined the team at Senseonics in 2019 as the Chief Medical Officer.

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