Article
Diabetes management made easier
Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces.
March 14, 2019
Insulin is a hormone that regulates blood sugar. Hyperglycemia, or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body's systems, especially the nerves and blood vessels. In 2014, 8.5% of adults aged 18 years and older had diabetes. In 2016, diabetes was the direct cause of 1.6 million deaths and in 2012 high blood glucose was the cause of another 2.2 million deaths.1
There are mainly 2 types of diabetes.
- Type 1 diabetes (previously known as insulin-dependent, juvenile or childhood-onset) is characterized by deficient insulin production and requires daily administration of insulin. The cause of type 1 diabetes is not known and it is not preventable with current knowledge. Symptoms include excessive excretion of urine (polyuria), thirst (polydipsia), constant hunger, weight loss, vision changes, and fatigue. These symptoms may occur suddenly.
- Type 2 diabetes (formerly called non-insulin-dependent, or adult-onset) results from the body’s ineffective use of insulin. Type 2 diabetes comprises the majority of people with diabetes around the world, and is largely the result of excess body weight and physical inactivity. Symptoms may be similar to those of type 1 diabetes, but are often less marked. As a result, the disease may be diagnosed several years after onset, once complications have already arisen. Until recently, this type of diabetes was seen only in adults but it is now also occurring increasingly frequently in children.2
Diabetes: A massively growing chronic condition
Due to a host of factors, the number of people living with diabetes is projected to rise sharply. An unhealthy diet coupled with a lack of physical activity is the most important driver. In many countries around the world, recent changes in lifestyle have led to a significant increase in the prevalence of diabetes.
Figure 1: The Prevalence of Diabetes worldwide
Diabetes is also, very markedly, an age related disease. Although diet and exercise – and as a resulting factor weight – play an important role, demographic aging will lead to a much larger diabetes population in the future. Some areas around the world will be hit simultaneously by both factors: Their population has adopted a lifestyle that leads to a higher prevalence of diabetes, and this is exacerbated by a faster demographic transformation process.
Figure 2: The Relationship between Age and Diabetes Prevalence
Insulin management yes – but….
For all type 1 diabetic patients, blood sugar level control through insulin management is a necessity. For type 2 patients, there is usually a host of measures that can be used to control blood sugar. It starts with diet and exercise and involves different oral medications (Metformin, DPP4-inhibitors, SGLT2 inhibitors). However, at some point adequate blood sugar control can only be obtained by regular insulin administration.
Without the help of technology, insulin management can be complicated: It involves several finger pricks per day, calculation of the optimal combination of long- and short-acting insulin, and finally insulin administration by syringe or pen. Given the fact diabetes is a chronic condition, and patient compliance for chronic conditions is generally not perfect (understandably so because of the high prevalence at a later age), there is a growing number of patients who need insulin administration but are looking for easier solutions that help them keep their blood sugar level within an acceptable range. Not too high – which causes all types of follow-on diseases (eye diseases, diabetic foot etc.), but also not too low (which causes a hypoglycemic event where the patient loses consciousness and often qualifies as a medical emergency).
A technology that simplifies the whole process of blood sugar measurement, insulin calculation, and insulin administration (in other words diabetes management) can be a very effective tool to prevent these blood sugar excursions – which will greatly diminish follow on costs for the healthcare system as these patients have less diseases caused by a poor blood sugar control, and less hospitalizations due to hypoglycemic emergencies are necessary.
How can technology help with the management of the chronic diabetes condition?
It has been a long lasting medical dream to establish a closed loop system that would perfectly mirror the way the natural pancreas works. Although today, such a system is not fully autonomous yet, a lot of progress in this direction has been made over the past couple of years. Often, already nowadays such a system is referred to as an “artificial pancreas”.
The different elements of the “artificial pancreas” are all critical, and for all the elements significant progress has been made. Starting with the continuous glucose monitoring sensor, its accuracy is crucial as the cascade of algorithms and resulting actions (insulin administration, alarm functions) is based on its readings.
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The devices have to have a reliable interconnection. Algorithms themselves are hard to develop as they have to adjust to many situations and should be learning from the behavioral pattern of the patient to come up with better predictions. Finally, the insulin pump should be very small and extremely resistant (water, shock, etc.).
Over time, each system generation will have incremental benefits: More accurate blood glucose measurement, better trend prediction, less false alarms, insulin switch-off function to prevent a dangerous hypoglycemic event, more data capture capabilities, and the possibility to send alarms elsewhere (to caregivers, parents, etc.).
A lot to gain – a better insulin management can save a lot of tears and money
The cost implications of diabetes are huge. Over the long term, a very good insulin management can cut those costs dramatically and has the potential to lower the overall costs. In the US, about 15% of the healthcare spending is tied to the treatment of diabetes. Of course, a mere focus on the cost side would not take into account the many losses and lives changed due to the dire consequences of an inadequate blood sugar control: In the US alone, on an average day, 295 Americans have to undergo an amputation!
Conclusion
20 years ago, the dream of creating a fully closed loop for the treatment of diabetes was already alive but a futuristic idea. It is only with recent technological advances that such a system could make meaningful progress. However, it is only a step in the right direction and more work is needed to create a fully automated solution.
A more and more accurate constant glucose monitoring sensor, sophisticated algorithms in conjunction with the ability to capture data and send out alarms was a pre-condition for such an integrated system. Not to forget the insulin pumps which used to be bulky devices that had to be manually told how much insulin to administer.
The progress already made can in many cases greatly benefit the patient and increase the quality of life. Also, by avoiding a lot of follow on costs and hospitalizations, the healthcare system can even save money despite the additional cost of the tool.
At Credit Suisse, we believe in this long-term opportunity. We have therefore designed a strategy to give investors exposure to the theme of technology revolutionizing diabetes management, within the broader context of digital health.
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Sources
1 World Health Organization, www.who.int/news-room/fact-sheets/detail/diabetes
2 World Health Organization, www.who.int/news-room/fact-sheets/detail/diabetes
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