Here’s What the Future of Diabetes Care Might Look Like, According to Experts
By Arvind Sommi
From continuous ketone monitoring to automatic insulin that only works when you need it, a panel of diabetes experts shares what they think diabetes therapy and care will look like in the next 5-10 years.
The treatment of diabetes has changed dramatically since the first successful administration of insulin more than a century ago.
In the decades since, countless therapies have become a reality for many people with diabetes, from small reliable insulin pumps to wearable glucose monitors and even pancreatic transplantation. But there’s still a long way to go to achieve better outcomes for people with diabetes and to reach the ultimate goal: a cure.
What new diabetes therapies and technologies are on the cusp of becoming reality? This was the topic of diaTribe’s recent Musings panel at ADA 2023 titled “The Future of Diabetes Care.” To an audience of almost 200 patient and non-profit advocates, healthcare professionals, and industry leaders, experts weighed in on what the future might look like for drug developments to better manage glucose and reduce complications, advances in insulins, wearable technology, immune therapies to delay and prevent type 1 diabetes, cell replacement therapies, and more.
The panel was moderated by Alan Moses, board chair of The diaTribe Foundation and past chief medical officer of the Joslin Diabetes Center and Novo Nordisk and included:
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Dr. Vanita Aroda, the director of diabetes clinical research at Brigham and Women’s Hospital and Harvard Medical School
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Dr. Scott Harper, division vice president of research and development for Abbott’s diabetes care business
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Dr. Luigi Meneghini, head of U.S. Diabetes Medical at Sanofi
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Girish Naganathan, executive vice president and chief technology officer at Dexcom
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Dr. Karen Boje Pedersen, Novo Nordisk’s global medical director of novel insulins
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Dr. Paul V. Tomasic, U.S. medical cardiovascular, renal, and metabolic senior field physician at AstraZeneca Pharmaceuticals
Advancements in glucose monitoring
The panel kicked off with a discussion on the future of continuous glucose monitoring (CGM) and diabetes technologies, from improving glucose measurement accuracy to extending sensor wear time. The group also spoke about the future of non-invasive sensors and ketone monitoring.
"CGM technology is clinically proven and accurate enough to be a part of algorithms in automated insulin delivery systems,” said Scott Harper from Abbott’s diabetes care business. “But we are always going to try to increase accuracy in the systems."
Harper pointed out another frontier in the field: continuous ketone monitoring. This has the potential to reduce the risk of diabetic ketoacidosis (DKA) in people with diabetes.
“One aspect we are really excited about is the dual glucose-ketone sensor we’re developing,” Harper said. “This could be the sensor of choice for all people with type 1 diabetes, especially those at risk for DKA."
Girish Naganathan from Dexcom emphasized the importance of sensor wear time and device footprint. He also highlighted the need for collaboration and innovation.
"We truly believe that at Dexcom, innovation cannot come from one company,” he said. “It needs to come from an ecosystem."
Naganathan emphasized that both device and software advancements in artificial intelligence and machine learning have made it possible for people with diabetes to gain highly personalized insights into things like 2 a.m. blood sugar spikes.
Once-weekly and glucose-responsive insulin
Dr. Alan Moses led the discussion on the potential consequences of the latest modifications to insulin. This includes ongoing efforts to develop once-weekly insulin (a potential advantage over once-daily insulin), faster-acting insulins for pump therapy, and insulin that responds to blood glucose (becomes active when glucose is high and inactive when glucose is normal or low).
Vanita Aroda from Brigham and Women’s Hospital and Harvard Medical School explained that there are three unique potential advantages to once-weekly insulin treatments:
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It can make insulin therapy more palatable for those not yet on insulin.
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It can help narrow the efficacy gap between clinical trials and the real world.
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It can be more broadly appealing to populations with less health literacy
“Insulin may be a more acceptable treatment option the moment there’s a switch from daily to weekly,” Aroda said.
The panel also discussed the concept of glucose-responsive insulin, or insulin that acts only when needed. Dr. Moses stated that this type of insulin, or “a beta cell in a bottle,” could be a huge advancement in the treatment of diabetes. That said, much more work is required before this concept makes it into everyday treatment.
Advances in therapies to prevent complications
Dr. Paul Tomasic from AstraZeneca spoke about therapies that are currently available and in clinical trials to treat complications.
“The phenomenal success of SGLT-2 inhibitors is wonderful,” he said. “We need to change to a mindset of making heart failure important because it’s one of the first cardiovascular complications for people with diabetes.”
Tomasic also discussed how administering SGLT-2 inhibitors in an inpatient setting is particularly powerful as the benefits can be seen in less than a month and as little as 13 days.
He also discussed the development of balcinrenone, a new combination medication that contains the SGLT-2 inhibitor Farxiga (dapagliflozin) and is currently in phase 2 clinical trials. Balcinrenone could be a treatment for both heart failure and chronic kidney disease, two of the most common diabetes complications.
Therapies that delay the onset of type 1 diabetes
Dr. Luigi Meneghini, from Sanofi, addressed the challenges of treating type 1 diabetes and the recent approval of Tzield (teplizumab), a medication that delays the onset of type 1 diabetes.
"With the approval of this disease-modifying drug, we are changing the way we look at type 1 diabetes. Teplizumab is a great first step in what we hope to be a series of combination therapies or interventions that delay beta cell deterioration," he said.
Meneghini contextualized the discussion of teplizumab by reminding the audience that more attention needs to be directed toward type 1 screening and staging. He highlighted the question of whether adult or pediatric endocrinologists should be responsible for screening, as primary care providers might not be as familiar with which autoantibodies to check for. New guidelines for teplizumab use were just released at ADA 2023.
Moses said he was hopeful about the future of diabetes care. “My vision of what could be the future is that a person gets diagnosed with diabetes and immediately gets attached with a sensor, enabling the iterative process of blood glucose management,” he said.
More details on diaTribe’s Musings discussion at the 2023 ADA conference are available here. For access to past Musings events, see our articles and video archive of panel discussions.
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