APRIL 10, 2017
Advancements in Diabetes Treatment to Watch
The healthcare industry continues to focus efforts on treatments that work better, and ideally are less expensive and less invasive for patients.
Nearly 86 million Americans have pre-diabetes and another 30 million have diabetes; roughly 1 million individuals are added to these figures each year, according to the American Diabetes Association (ADA). The overall cost annually to treat pre-diabetes and diabetes in the United States has escalated to $322 billion. In fact, one-third of all Medicare dollars are spent caring for people with diabetes and overall, 20% of all healthcare dollars are spent caring for people with this disease.
Just like the number of diabetes cases continues to increase, the cost of diabetes treatment and medications is rising. Many people with diabetes have multiple complex comorbidities (e.g., heart disease, high blood pressure, high cholesterol, and obesity), which also require intensive management. Diabetes patients incur medical expenses that are 2.3 times higher than those without diabetes and their average medical expenditures are about $13,700 per year, of which some $7,900 are attributed directly to diabetes, according to the ADA.
In addition, many of these patients require newer and/or more expensive therapies, such as insulin. “A significant increase in the cost of vital diabetes medications has occurred over the past few decades, particularly with insulin therapy,” says Kevin M. Pantalone, DO, staff endocrinologist and director of clinical research, Department of Endocrinology, Cleveland Clinic, Cleveland, Ohio. “This has caused significant difficulty in getting patients the medications they need, especially those who are on a fixed income and Medicare patients who lose drug coverage when they hit their insurance coverage gap (i.e., the ‘donut hole’).”
Depending on their type of insurance coverage – such as those with high-deductible plans – many patients with diabetes cannot afford some of the newer therapies that may provide numerous benefits over older medications such as sulfonylureas, Pantalone continues. Newer medications (dipeptidyl peptidase 4 [DPP-4] inhibitors, glucagon-like peptide 1 receptor agonists [GLP-1RA], and sodium-glucose co-transporter 2 [SGLT-2] inhibitors) are not associated with an increased risk of hypoglycemia (low sugar levels) and are either associated with weight loss or are weight neutral.
The healthcare industry continues to focus efforts on treatments that work better, and ideally are less expensive and less invasive for patients.
Continuous glucose monitoring (CGM) and connected blood glucose monitoring (cBGM) devices provide actionable data to guide people with diabetes and their providers. “As a technology, CGM provides nearly continuous glucose measurements in real time, which translates to almost 300 readings a day for providers to review and respond [to] with therapeutic adjustments,” says Andrew S. Rhinehart, MD, chief medical officer, Glytec. “Presently, CGM is mainly used for individuals with type 1 diabetes, but that may change over time depending upon reimbursement and outcomes data for people with type 2 diabetes.”
New CGM systems, such as the Dexcom G5 Mobile CGM system and Abbott’s FreeStyle Libre, consist of a small disposable sensor that is inserted into the skin. A transmitter connected to the sensor wirelessly sends results to a receiver that displays real-time glucose information, explains Stephenie Lucas, MD, medical director of the diabetes treatment center at Beaumont Health, Grosse Pointe, Michigan. These devices require fingersticks as infrequently as twice a day for calibration and users can safely and conveniently access and share their dynamic glucose data anywhere and anytime.
FreeStyle Libre is now available across 32 countries around the world, although still under FDA review in the U.S. The professional version of the system, FreeStyle Libre Pro, is approved in the U.S. and was launched toward the end of 2016.
cBGMs include meters with cellular or Bluetooth capabilities that allow blood glucose data to be transmitted to the cloud, making it easily accessible to providers. “This allows for better patient engagement, and if acted upon properly, better patient outcomes,” Rhinehart says. The first cellular meter was launched by Telcare in 2010.
Diabetes therapy management software with decision support for dosing and titration is the final piece of the therapeutic puzzle. In concert with data made available through CGM and cBGM, this software can help providers properly dose and titrate diabetes medications, especially insulin, and choose which diabetes medications may work best for each patient. Diabetes therapy management software, in its earliest form, was launched by Glytec in 2006.
“For most providers, this is the most challenging aspect of diabetes management, but also the most important,” Rhinehart says. “Having providers choose the right medications and making the necessary dosing adjustments in a timely manner is critical to achieving and maintaining acceptable A1c levels. The combination of connected devices and this type of therapy management software may be the holy grail of personalized diabetes management.”
