Patients with Type 1 diabetes are unable to produce insulin in the pancreas due to an auto-immune disease. Patients with Type 2 diabetes have lost their ability to produce insulin, often in adulthood as a result of excessive body weight or insufficient exercise. Type 2 diabetes can be prevented and reversed through targeted lifestyle interventions. Rates of Type 2 diabetes have risen rapidly, driven largely by lifestyle factors. Estimates suggest that Type 2 diabetes accounts for 90-95% of cases worldwide.
Poorly managed diabetes can lead to serious complications for patients, including heart attack, stroke, blindness, amputation, kidney failure – and early death. By some estimates, only about six percent of patients
will live free of diabetes-related complications.
Diabetes also has a significant impact on national economies. The global economic burden of diabetes and its associated complications was estimated to be USD 1.3 trillion in 2015, or 1.8% of gross domestic product. With rising diabetes rates, the economic burden is expected to increase USD 2.2 trillion by the year 2030.
Diabetes is one of the only chronic diseases that continues to increase in prevalence. Rates of diabetes are growing in LMICs, with nearly 80% of people with diabetes living there.
50 years of innovation to improve disease management
The therapies that have been developed over the last couple of decades for the treatment of diabetes…the progress has been terrific. There have been major changes in the kinds of insulin that one can take, in terms of how quickly they may act or insulin that lasts for a whole day to give 24 hour coverage.
The quality of life of people with diabetes has changed considerably since 1968 thanks to evolution in types of insulin, mechanisms for delivering it, as well as tools to monitor and more accurately control blood glucose levels. Since the development of synthetic human insulin as the primary treatment for diabetes, innovation has made insulin easier to use, faster acting, and longer lasting. Side effects and long-term complications have been reduced, and the choice of treatments for patients expanded.
In addition to insulin, people with diabetes often rely on other drugs to control blood glucose. However, because diabetes is progressive, first-line treatments may eventually fail to control sugar levels, meaning second-line, and eventually third or fourth-line therapies may be required. Many new classes of OADs have been developed to meet this need, alongside advances in injectable drugs.
Approaches have evolved for earlier and more precise diagnosis for patients. The traditional diagnostic method of testing of blood glucose, is a relatively inexpensive ‘finger-prick’ for patients. However, this test fails to diagnose approximately 30% of previously undiagnosed diabetes. The oral glucose tolerance test is more sensitive and able to detect specific types of prediabetes. Some blood tests can look specifically for antibodies, which might be a sign of Type 1 diabetes. Many non-invasive tests have been developed which measure glucose without the need to draw blood, and recently, researchers have attempted to use patient saliva.
Collaborations target risk factors
Helping people lead healthy lifestyles is a means to reversing the rise in diabetes. Actions to prevent diabetes are most effective before birth and in early childhood.
Sanofi’s Diabetes in Schools partnership has enhanced early diagnosis of Type 1 diabetes in school age children and raised awareness of childhood obesity and the importance of healthy eating habits in preventing diabetes.
Astra Zeneca’s Young Health Programme has reached more than 2.25 million youth with health information on the importance of physical activity, healthy eating and avoiding tobacco use. IFPMA works with the International Federation of Red Cross and Red Crescent Societies to promote ‘4 Healthy Habits’: healthy eating, moderate consumption of alcohol, physical activity and not smoking. Technology can also promote healthy behaviors – IFPMA partner with International Telecommunications Union’s Be He@lthy Be Mobile initiative on the mDiabetes program which uses SMS technology to promote prevention and control of diabetes.
Prevention and early diagnosis in pregnancy is critical to reducing maternal, perinatal, and neonatal mortality. Novo Nordisk’s program Changing Diabetes® in Pregnancy focuses on the link between gestational diabetes and maternal and new-born health.
Urbanization has an important impact on diabetes. The Cities Changing Diabetes program launched by Steno Diabetes Centre Copenhagen, University College London, and Novo Nordisk tackles urban diabetes through local partnerships in 10 cities to address social factors that can increase vulnerability of Type 2 diabetes.
Better health systems key to improved diagnosis and care
Improved health infrastructure enables awareness raising, early diagnosis and a health workforce which can effectively care for patients with diabetes. The Capacity Advancement Programme, led by Merck KGaA in partnership with ministries of health, universities, and local diabetes associations across five African countries, strengthens health systems to enable prevention, diagnosis, and management of diabetes.
Context-specific interventions are needed to prevent the growth of Type 2 diabetes in LMICs. Eli Lilly and Company works with governments and local partners in Brazil, China, India, Mexico, and South Africa to tackle pain points in the cascade of care in order to increase early detection, intervention, and treatment.
Targeting serious and specific diabetes-related risks is also important. For instance, one frequently encountered complication is neuropathy, particularly affecting the feet. Sanofi works to prevent diabetes amputations through early intervention strategies as part of its Diabetes Africa Foot Initiative.
The lack of access to affordable insulin remains a challenge. Novo Nordisk’s Access to Insulin Commitment means the company supplies human insulin in low-income countries at a price that does not exceed 20% of the average realized price for Europe, the US, Canada, and Japan. Others, such as Novartis through Novartis Access – also commit to differential pricing in LMICs to widen the availability of treatments. Affordably priced insulin and generic treatment often does not reach patients in LMICs due to lack of healthcare financing, weak supply chains, and health care infrastructure. Ultimately, improving health systems and infrastructure is vital.
Future focus on disease management and tentative steps towards a cure
Despite huge strides in managing the disease and improving quality of life, WHO projects that diabetes will be the seventh leading cause of death in 2030.
There are hundreds of medicines being developed to improve insulin delivery. For instance, researchers are exploring a slow-dissolving molecule which could keep insulin in a patient’s body for over two weeks and could replace daily shots altogether. Similarly, a once-a-week natural hormone could effectively regulate blood sugar, as might modulating genes responsible for insulin sensitization. A cream has also been developed.
The University of Cambridge developed an artificial pancreas, described as ‘a bridge to a cure’, which delivers insulin and glucagon, connecting to a smartphone app to calculate the required doses needed.
Cell therapy, injecting or inserting living cells into a patient to take over the function of the faulty cells, brings the hope of restoring the normal function of the pancreas, reducing the need for insulin therapy. Preventing Type 1 diabetes is another area of interest, specifically immunotherapy. A patient’s own immune system can be re-educated not to attack beta cells, potentially delaying the clinical onset of the disease.