The evolution of care for different types of diabetes

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© iStock / spukkato

Gerard Sola, founder and CEO of biotechnology company, Adocia, discusses the challenges of diagnosing, treating and managing different types of diabetes.

Diabetes is a global public health concern, affecting 9.3% of adults between the ages of 20 and 79. With the number of adults with diabetes expected to reach 700 million by 2045, meeting challenges related to diagnostic procedures, access to treatment and the comprehensive management of the disease has never been more important. Type 1 diabetes, which requires multiple daily insulin injections to control blood sugar levels, accounts for 5-10% of all diabetes cases. The most common type 2 diabetes requires oral medications and insulin injections in 20% of cases.

Type 2 diabetes is increasingly attributed to high levels of obesity, lack of physical activity and poor nutrition. Large disparities in access to treatment and services worldwide have made it difficult for many to struggle to manage their condition, while others may remain undiagnosed for years. To discuss some of the major challenges associated with the disease, as well as the revolutionary innovations that could represent a new wave of diabetes treatment, Health Europa Talk to Gerard Sola, founder and CEO of biotech company Adocia.

What are the main challenges currently facing the management and treatment of diabetes?

There are many factors to take into consideration. The first challenge is to identify people with diabetes because many people are undiagnosed, currently about one in two. The lack of diagnostic and screening services for diabetes is a real problem, especially in remote or less affluent areas of the world.

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Moreover, symptoms of type 2 diabetes may not appear for many years, which can often mean that a person’s condition becomes complicated before they receive any type of treatment. The second challenge relates to providing affordable diabetes treatments that can support the specific needs of the patient. There are great disparities regarding affordable diabetes treatments around the world, and some of them are actually quite expensive. It is important to have the necessary products and medicines within reach of every type of diabetes patient, regardless of the stage of the disease.

Third, we need to think about how to enable patients to live their lives to the fullest. This means we need to enable them to manage their condition throughout their lives with minimal impact and complications. There is currently no cure for diabetes, so it is important to adopt a patient-centered approach and provide a comprehensive model of care. For me, these are the three pillars that we need to take into account in order to improve the situation of people with diabetes.

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It is estimated that 463 million adults had diabetes in 2019, and this number is expected to rise to 700 million by 2045, so what do you attribute to this rise?

This is the progression of the disease. To be sure, the increase in obesity, malnutrition and lack of physical activity have a role to play. Stress is also a critical factor. What is surprising is how quickly cases of diabetes are increasing, it is hard to imagine a way we can slow this down, we need political and social intervention. When we consider the numbers for new diabetic patients, 85% of type 2 diabetics in the United States are obese and the process that leads to the condition is clearly visible; Typically, people start to gain weight, which can lead to obesity, and then can become pre-diabetes before developing type 2 or even type 1 diabetes. Today, we’ve identified 1.9 billion adults who are overweight or obese, so we can To expect an increase in diabetes in the future.

Type 1 diabetes is more complex because, for the most part, this type of diabetes is not the result of being overweight or poor lifestyle. However, what we see today, in the United States for example, is a high percentage of type 1 diabetics who are overweight or obese due to the switch to a more sedentary lifestyle.

A large proportion of adults with diabetes go undiagnosed – why do you think so, and how can early diagnosis and better access to diabetes treatment be supported?

This has a lot to do with the health care services that are available for testing and diagnostic procedures. There is great disparity in the number of medical professionals available to perform these tests, with those in low-income countries or remote areas having poor access to health care services. The other problem is that while only 50% of people are diagnosed, fewer are receiving the necessary treatments.

We need innovation for everyone, everywhere, not just to reduce the risk of comorbidities and improve life expectancy but to improve the quality of life for those living with diabetes © iStock / dzika_mrowk

Diabetes education may also be unavailable, not only to patients but also to medical professionals. In low- and middle-income countries, there are fewer educators and doctors trained in diabetes as well as clinics where people can learn about how to manage their condition. Sharing knowledge is very important, and information needs to be made more widely available so that we can change the level of treatment in areas where patients need it most.

Are there notable developments in treatment that you would like to highlight?

You mentioned one of the main challenges at the top of the interview which has to do with making medicines affordable, and that’s something my organization has been working on. Making medicines affordable for a large population is one thing, improving the quality of treatment and ensuring patient adherence is another. For many type 2 patients, the oral medications available to them today work well because they are early in the disease, however, as the disease progresses, patients require more intensive treatments in the form of injections. Insulin dependence can be very challenging, affecting not only physical health but mental health as well.

Type 1 and type 2 patients can have other long-term health complications including foot ulcers, which can lead to amputations and kidney and cardiovascular disease. We need innovation for everyone, everywhere, not just to reduce the risk of comorbidities and improve life expectancy but to improve the quality of life for those living with diabetes. The majority of innovations today are directed at patients who take insulin, and we as an organization try to improve treatment by switching or combining different types of insulin to achieve better results. Another way we are focusing is to develop treatment adapted to modern technology such as smart pens or insulin pumps (patch pumps, closed-loop system or bi-hormonal artificial pancreas).

If we go back to the idea of ​​a holistic approach, we know that the general well-being of a diabetic patient is not simply due to pharmaceutical or chemical ingredients and algorithms, there are many elements of care to consider, and the patient must be a part of this process. A device that can be paired with a continuous glucose monitor (CGM) to help a patient measure their blood sugar can, in the long run, enable them to lower their risk of complications and comorbidities and give them a greater sense of control. The pharmaceutical part is also important, we know that without insulin it is impossible for people with type 1 diabetes to survive, but there are also other hormones that are important for glucose regulation in the body. At Adocia, we are working on a formulation that includes insulin as well as amylin analogues and have seen promising results from clinical trials thus far. We hope to offer patients the possibility to use these two hormones and combine them as one treatment. These formulations are currently incompatible, which means that if you wish to use these hormones as part of your treatment, it may require four injections of insulin and three injections of amylin daily. In addition to improving a patient’s quality of life, our combination formula can make treatment more effective and affordable. Our vision is not only to control hyperglycemia, but also to prevent hypoglycemia with glucagon, which remains one of the main concerns of the patient.

In addition to this approach, there is another so-called “cup” that can be accessed. Today, 25 million type 1 diabetics live without beta cells, which have been destroyed by their immune system. There is a lot of work going on around the world looking at how to convert stem cells into functional cells, including beta cells, which can then produce insulin and amylin within the body. The challenge is how to transplant these cells into the body without destroying their immune system, or the patient’s need to take immunosuppressants. Because immunosuppressants can leave the body vulnerable to infection and disease, cell transplantation should be avoided while using immunosuppressants. So we’re in the process of developing a cell cage to protect cells from the body’s immune system, and hopefully one day we’ll be able to make this treatment accessible, effective, and most importantly, a comforting type 1 treatment. Diabetics.

Gérard Sola Ph.D., MBA
President and CEO

This article is taken from issue 19 of Health Europe Quarterly. click Here Get your free subscription today.

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