Revolutionary weight loss drugs, over-the-counter continuous glucose monitors, and insulin pumps small enough to fit in a coin pocket are just a few examples of the incredible advancements seen in diabetes technology and treatments over the last few years.
These advancements are transforming diabetes management and accelerating the development of even more innovative tools to optimize care. However, despite the life-changing benefits of such devices and drug therapies, they often aren’t reaching the people who need them most.
These issues were hot discussion topics at a recent diaTribe Musings panel just before the 2024 ADA Scientific Sessions in Orlando, Florida. The panel, moderated by Dr. Alan Moses, board chair of The diaTribe Foundation and past chief medical officer at the Joslin Diabetes Center and Novo Nordisk, included the following diabetes experts:
- Dr. Alice Cheng, endocrinologist at Trillium Health Partners and associate professor at the University of Toronto
- Dr. Anila Bindal, associate medical director at Abbott’s diabetes care business and an endocrinologist
- Dr. Thomas Grace, head of advocacy and clinical outcomes at Dexcom and a diabetologist
- Dr. Jennifer McVean, senior director of global medical affairs at Medtronic and a pediatric endocrinologist
- Dr. Laurel Messer, senior director of medical affairs at Tandem Diabetes Care and certified diabetes care and education specialist
CGM: The Gold Standard for Glucose Monitoring
The panel opened with a conversation about how continuous glucose monitoring (CGM) has radically changed care for both physicians and people with diabetes. CGM has been shown to improve glucose management, reduce hypoglycemia, and lower the risk of diabetes complications. With each new model, CGMs continue to get more accurate. However, technology alone is not enough as diabetes education, including how to gain the greatest benefit from new devices, is critical.
“I have 99.5% of the patients in my clinic using CGM. I don’t know anything different and I couldn’t imagine going the other way,” said Grace, who lives with type 1 diabetes.
Not only are the people Grace sees learning much more about blood sugar with a CGM, but the technology also benefits clinicians, allowing them to individualize and better administer care.
“Every single one of us has fluctuating glucose every moment we’re alive, and we need to have metrics that reflect these parameters,” Bindal said. “Using a CGM gives a more complete glycemic profile, which allows us to see where we can intervene and make more specific recommendations to really personalize care.”
Panelists also spoke about the wider adoption of CGM as the next big goal for improved diabetes management, especially in the type 2 community.
The Next Frontier: Ketone Monitoring
A key topic that surfaced in many ADA sessions was the potential of adjunctive therapies for type 1 diabetes. Many people with type 1 diabetes take GLP-1 agonists or SGLT-2 inhibitors like Ozempic (semaglutide) and Farxiga (dapagliflozin) off-label to help with blood sugar, weight management, and possibly kidney and heart complications. Despite the potential benefits, these drugs aren’t approved for the type 1 population because proper clinical trials have not yet been conducted to address safety concerns including hypoglycemia and diabetic ketoacidosis (DKA). This is where ketone monitoring may be helpful.
“Data now shows that ketone levels start to rise even before glucose levels do,” said Bindal. “If we can detect those ketone levels early, people can intervene earlier, potentially reducing the risk of DKA.”
Because ketone monitoring helps prevent DKA, it could be an immensely powerful tool to protect those using off-label medications while we wait for more clinical trials to test the safety and efficacy of these therapies in people with type 1.
Talking About Time in Range
While A1C was once the gold standard for diabetes care, time in range – the percentage of time spent between 70-180 mg/dL – is quickly taking over as an increasingly important parameter for glucose management. Time in range offers a more complete glycemic profile compared to A1C, enabling physicians to make specific recommendations for diabetes care.
“I think regulatory bodies are becoming more in tune with the concept and are starting to accept time in range as an outcome, not just A1C,” Cheng said.
Automated Insulin Delivery: Revolutionizing Diabetes Care
With the advent of automated insulin delivery (AID) systems, people with diabetes have experienced streamlined insulin dosing.
“Living with type 1 diabetes in the 1980s and being in the nurse’s office all the time or waking up in the middle of the night with low blood sugar…when I think about where we are now with automated insulin delivery and how a person with diabetes can live a pretty normal life, it’s just amazing,” said McVean.
AID systems have proven to be life-changing, and companies like Medtronic and Tandem are finding solutions to many ongoing challenges of diabetes management. One is the continued burden around meals and the goal of fully automated meal handling. Another advancement has been extending the life of infusion sets.
“Some people are very self-conscious about wearing insulin pump systems,” Messer said. “I think one way we can increase the prevalence of AID system use is by offering people choices.”
Access to Care: An Ongoing Challenge
While there are many great options to tailor therapy for people living with diabetes, a huge problem is access.
“If people don’t have access to the technology, then what good is the technology?” McVean said.
Access issues can arise from geographical limitations, cost, insurance coverage, and physician knowledge. Educating healthcare providers and patients is crucial for improving access to and effective use of diabetes technology.
“Innovation without access is truly meaningless,” Bindal said.
Looking Forward
Experts agree that access to cutting-edge diabetes technology and medications continues to be a major issue, but it is an exciting time to be working in the field of diabetes care, holding promise for the future.
“I’m approaching four decades of living with type 1 diabetes. I think about how hard I had to work back then and with outcomes that weren’t nearly as good as they are now,” said McVean.
As a doctor and person with type 1 diabetes, Grace added: “Looking back to where we were, we’ve moved mountains. We still have a few more mountains to move and I’m hopeful that we’re getting closer and closer every day.”
In closing, Cheng looked to a future where misconceptions and stigma around diabetes no longer make the challenges of living with the disease even greater than they are.
“I’m excited about a future where diabetes stigma is not as rampant as it is now, and looking at the companies that are up here, I think all of us in this room have a very critical role in allowing that to happen,” she said.
