Numeric health  

18/11/2016

Diabetes : a game-changing technology

Diabetes_LOcom.jpg

The discovery of purified animal-sourced insulin, followed by those of synthetic human analogue insulin and more recently insulin pumps, have all been major steps in the treatment of Type 1 diabetes. We believe Continuous Glucose Monitoring (CGM)1 is the next game-changer in the fight against this disease, potentially paving the way for the release of what would be the ‘holy grail’ for these patients: an artificial pancreas, writes Jérôme Berton, Healthcare Equity Analyst at Lombard Odier. 

According to the International Diabetes Federation (IDF), today in the world, diabetes affects 415 million people aged between 20 and 79.  This figure is expected to rise by 55% to 642 million people in 2040 and expand in every region of the world. Diabetes also has a substantial economic impact on countries and national health systems since for the majority of countries the disease represents 5-20% of their total health expenditures. In North America and Europe, diabetes costed USD 348 billion and USD 156 billion respectively in 2015 (including indirect costs). In other words, North America and Europe spent 14% and 9% of their total healthcare budgets on diabetes respectively.

Diabetes is a chronic, incurable and expanding disease with life-threatening complications, wherein the body does not make enough, or cannot properly use insulin2.
 

3 main types of diabetes

  • Type 1 (5-10% of the diabetes population): This is an auto-immune disease in which the body’s own immune system attacks the insulin-secreting beta cells in the pancreas, to the point that the pancreas stops producing insulin. Type 1 is usually diagnosed amongst children and young adults. Patients need insulin every day. Without insulin, a person with Type 1 diabetes will die. The reason is unclear why the number of people with Type 1 diabetes is increasing but it may be due to changes in environmental risk factors and/or viral infections.
  • Type 2 (90% of the diabetes population): This is the most common type and it usually occurs in adults but it is becoming increasingly present in children and teenagers. With Type 2, the body becomes resistant to insulin, rendering it ineffective. Over time, insulin levels become insufficient, the pancreas may become inefficient, and 15-20% of Type 2 patients require insulin injections. The cornerstone of the treatment is a healthy diet, increased physical activity, followed by oral drugs, and in some cases insulin injections. Exact causes are still unknown, but the most important risk factors are excess body weight, physical inactivity and poor nutrition.
  • Gestational (5% of the diabetes population): Hyperglycaemia3 is detected during pregnancy. Mothers’ gestational diabetes normally disappears after birth. However, these mothers are at higher risk of developing Type 2 later in life, as are their babies, especially in their teens or early adulthood.


    carte Diabete - source IDF.png

Uncontrolled diabetes can lead to life-threatening complications, which highlights the strong medical need due to:

  • Long-term complications: In case of hyperglycaemia, can result in shorter life expectancy (13-15 years less than a non-diabetic person), kidney failure, blindness, heart attack, nerve damage, and  lower-limb amputation.
  • Short-term complications: Severe hypoglycaemia can result in coma and death.

There is a strong medical need in diabetes as it is estimated that 50% of the patients are not well controlled due to an excess of blood glucose. Clinical trials have demonstrated that improving blood glucose control lowers the complications by up to 50%.

With that, we believe CGM is the next game-changer in fighting this disease. CGM is made of 1) a sensor attached to the body through a subcutaneous needle that needs to be changed every 7 days, 2) a transmitter, an electronic device that is attached to the sensor, to be changed every 3 months, that sends the data to 3) a receiver, a device – possibly an iPhone, used to read the data and to send alarms in case of hypoglycaemia/hyperglycaemia events. This is a huge advancement for patients, who otherwise must undergo 1,500 to 3,500 finger stick procedures per year.

CGMs helps patient to monitor their blood glucose without the need for finger sticks. This is a currently common procedure that involves patients having to use a small needle to prick their finger and collect blood on a lancet; it is then measured with a blood glucose meter. CGMs also provide a historical and dynamic picture of the evolution of the blood glucose, unlike traditional finger sticks with their static picture that risks missing hyperglycaemia and nocturnal hypoglycaemia events. Importantly, CGMs also sends alerts to the patients’ receiver in case of hypoglycaemia and hyperglycaemia. This is critical in the case of nocturnal hypoglycaemia as it wakes the patient or the parents of a child patient. CGMs’ utilisation results in fewer hospital emergency admissions and fewer deaths. Moreover, this technology also has the potential to decrease the level of stress inherent in Type 1 diabetes.

Currently, the CGM market is underpenetrated as only 10% of Type 1 diabetes patients use this technology in the US, and even fewer in Europe, but it is growing at a significant 40% annual rate, with a handful of players involved. Looking forward, we expect CGMs to increasingly trend towards better accuracy, lower outlier measures, longer utilisation, miniaturisation and connectivity. At some point, we believe CGMs could also help Type 2 diabetes patients to better control their disease, an untapped population that represents the vast majority of diabetes sufferers.

Although years away still, we believe the industry is approaching the ‘holy grail’ for Type 1 diabetes, i.e. an artificial pancreas – a closed-loop system able to automatically regulate the blood glucose, with no need for the patient to inform the pump of each meal or exercise; CGMs will play a significant role in this process.

We are convinced the CGM approach has the potential to transform the lives of many diabetes patients – adults and children – and their loved ones, helping them to better control this incurable and increasingly prevalent life-threatening disease.


*******

1 Device that continuously measures blood glucose.
2 Hormone produced by beta cells in the pancreas to regulate blood glucose levels.
3 Excess of glucose in the bloodstream

Source of all market data: International Diabetes Federation 




 

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