Roundup of advances made in diabetes care in 2017

The future looks bright for people living with type 1 diabetes as advances in diabetes research and care were rolled out around the world in the past year.


A recent article in HealthDay News listed the numerous advances in equipment and medications.


Strides have been made in:


Artificial pancreas technology


Probably the biggest and most anticipated news of 2017 was the rollout of the so-called artificial pancreas in the US. (It is not yet available in Australia).


Created by Medtronic, the MiniMed 670G combines an insulin pump, a continuous glucose monitor and a computer algorithm that measures blood glucose levels and then delivers insulin automatically when those levels rise. Insulin delivery is also temporarily suspended if blood glucose levels drop too low.


The device isn't completely automated yet. People with diabetes still need to know how to count the carbohydrates in their food and enter that information into their insulin pump.


The device still requires people with diabetes to check their blood glucose several times a day and enter that information into the machine, which is known as "calibrating." The hope is that future versions of the device won't require these steps.


Diabetes researchers believe that while the technology is not yet fully automatic, it has opened the door to further innovation.


It is also worth noting that a number of other insulin pump manufacturers and independent companies are working on their own artificial pancreas systems. Competition helps drive innovation and experts are expecting results on a fully automated artificial pancreas in the next few years.


Improving heart health


Heart disease is a significant concern for people with diabetes. New research has suggested that long-term use of metformin could reduce the risk of heart disease in people with type 1 diabetes.


Other medications have been linked to a reduced risk of heart disease in people with type 2 diabetes. These include Jardiance, Victoza and Invokana (note Invokana is not available on the Pharmaceutical Benefits Scheme in Australia since 2015).


"Cardiovascular disease is the most deadly and expensive complication of diabetes, and a number of recent studies have shown that certain medications also have a strong protective effect against cardiovascular disease in people at high risk for it," Dr Cefalu said.


Competition in continuous glucose monitor market


The artificial pancreas wasn't the only innovation in diabetes technology in 2017. Another glucose monitoring device was approved for use by many countries, including Australia.


Made by Abbott and called the Freestyle Libre Flash Glucose Monitoring System, this device has been in use in Europe for several years.


The major difference in the Libre compared with Continuous Glucose Monitoring (CGM) systems is that you have to request the blood glucose information. Other devices on the market, from Dexcom and Medtronic, send blood glucose information collected by a tiny sensor inserted under the skin to a receiver every five minutes or so.


The Libre also uses a tiny sensor inserted under the skin but the person with diabetes has to request the information be sent to the receiver. In addition, the Libre also doesn't require any fingerprick calibration as other devices on the market do.


Some people find the constant information provided by continuous glucose monitors to be stressful and confusing. With the Libre, you ask when you want the information. It's also cheaper and flatter than other CGMs.


Insulin speed


Novo Nordisk received FDA approval for a new insulin called Fiasp, which is currently under regulatory review in Australia. This insulin starts working in about 2.5 minutes.


Currently, Novolog, another product from Novo Nordisk, takes approximately five to 10 minutes to start working.


If people with type 1 diabetes inject insulin at least five to 10 minutes before eating, their blood glucose levels may spike too high after eating.


It's not always possible or even safe to pre-inject insulin. For example, in a restaurant, you have no way of knowing when your food might arrive, and if you pre-inject and your food is late, you can have a dangerously low blood glucose level.


The shorter time it takes Fiasp to work could help prevent spikes in blood glucose after eating, which ultimately leads to better diabetes management.


How do Australians fare?


Most Australians with diabetes are aware that although we have better access to cheaper insulin and top rate medical care compared with some other countries, there is an area where Australia is slipping behind.


Diabetes Queensland is lobbying the Federal Government to subsidise Abbott's FreeStyle Libre Flash Glucose Monitoring System under the National Diabetes Services Scheme in Australia.


In the past three months, both the UK and the US have approved covering the cost of FreeStyle Libre under their respective public health systems.

Abbott says that the FreeStyle Libre system is now being used by about 400,000 people across more than 40 countries, and notes that partial or full reimbursement for the system has been secured in 21 countries, including France and Japan.


Diabetes Queensland will report on the Australian Federal Government's decision in the coming months. 

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