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harma and tech giants are pouring hundreds of millions into diabetes technology, designing gadgets and developing software aimed at helping patients manage a burdensome disease.

They’re chasing what could be a blockbuster market: Close to 30 million Americans have diabetes and can face health problems including dangerously low blood sugar, vision loss, and kidney damage.

Among the tech on the way from companies large and small: Socks designed to monitor diabetics’ feet for signs of injury. A bandage-like sensor that continuously measures their glucose levels. An app meant to predict how the sandwich they had at lunch is likely to affect their blood sugar. And, of course, the first “artificial pancreas,” which was approved by the Food and Drug Administration late last month to monitor glucose and adjust insulin flow semi-automatically.

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The key question: How much of a difference will these products make?

Experts and patient advocates say there’s real reason to be optimistic. “It’s truly an exciting time,” said Dr. Lori Laffel, a Harvard Medical School professor who oversees the pediatric diabetes clinic at Boston’s Joslin Diabetes Center.

But there’s also reason for caution. Some of the new tech could carry high price tags, and even those that don’t will add expenses for patients already grappling with the soaring costs of insulin. Patients by and large haven’t embraced the most promising technologies already on the market. And devices that were touted as transformative in years past have fallen flat.

“There’s a lot of gee-whiz stuff that we diabetics have heard about for so long that never really comes to fruition,” said Michael Felts, a 51-year-old IT security professional from San Francisco who has type 1 diabetes.

A warning to accompany a tuna sandwich

The parade of new diabetes tech will likely be led by an arm patch, developed by Abbott and dubbed the FreeStyle Libre Pro system. It reads glucose levels every 15 minutes, though diabetics can’t see the data in real time and must rely on other methods to monitor their blood sugar. After two weeks, there’s enough data for clinicians to use to help guide the patient on medication and lifestyle decisions. It’s expected to become available in the coming weeks. The sensor will cost about $60 per patient, billable through insurance.

Also expected to hit the market before the end of this year: a new smartphone app, called “Sugar.IQ,” that draws on reams of anonymized data from diabetics — plus data that the patient transmits or inputs — to offer warnings about how food choices and certain activities might affect blood sugar.

“Be aware that you tend to go low when you eat this meal,” the app might say as a patient punches in his plans to eat a tuna sandwich for lunch. And early on a Saturday morning it might warn: “Planning your day? I see you tend to go low on Saturdays between 12 p.m. and 3 p.m.”

Developed by Medtronic and IBM Watson, it’s conceived as a “personal companion for people with diabetes,” said Huzefa Neemuchwala, who’s led Medtronic’s push to develop the app.

The app is now being tested in about 100 patients, and will initially be available for no extra cost for diabetics who buy certain Medtronic gadgets.

To promote its work in health, IBM Watson put out a glossy TV ad narrated by a disembodied voice who identifies himself as Watson. “I’m … working with Medtronic to predict the highs and lows of diabetes hours in advance,” Watson says, while a little boy on screen jogs towards a futuristic robot on the beach.

Yet another innovation expected this spring: “smart socks,” from San Francisco startup Siren Care. They’re lined with sensors designed to detect variations in foot temperature linked to inflammation, which can sometimes be caused by an unnoticed injury. (Neuropathy, or damage to the peripheral nerves, is common in diabetics, especially as they age.) The company plans to soon start testing the socks in about 30 diabetics.

Big investments from big players

There’s plenty more technology further up the pipeline — in many cases backed by big players in tech and pharma.

Sanofi and the Google life sciences spinout Verily last month poured $500 million into a joint venture called Onduo that aims to build devices and software to help with type 2 diabetes management, though the announcement was notably short on specifics.

Verily also has a partnership with a division of Novartis to develop contact lenses that would take glucose readings from tears rather than blood. It’s a steep challenge; independent experts told STAT it’s a scientifically dubious idea, given the weak correlation between glucose readings in tears and blood.

Also last month, Boston-based Intarcia Therapeutics raised $215 million in venture capital funding to boost its lead product, a drug-device combination that aims to continuously deliver medicine for type 2 diabetes using a pump that remains implanted under the skin for six months.

Another big player has invested in diabetes technology already on the market. Last year, the cable giant Cox Communications made an investment of undisclosed size in the Atlanta startup Rimidi, which at the time had recently launched diabetes management software for clinicians and patients.

A reluctance to adopt new tech

While companies see a tantalizingly big market, the reality is that diabetes patients have been slow to adopt the validated tech that’s long been on the market.

Only about 1 in 3 type 1 diabetics use the insulin pumps that have been available for decades to replace insulin shots. And only about 1 in 7 use the continuous glucose monitors that first hit the market in 1999, even though many private insurers cover them.

One big reason for the hesitation: cost. “Especially with high deductible health plans … it’s a big expense to use some of this technology right now,” said Adam Brown, head of technology at the diabetes advocacy group the diaTribe Foundation.

Security is another real concern. Johnson & Johnson last week warned patients about a vulnerability in one of its insulin pumps that could potentially be exploited by hackers to dose patients with dangerously high levels of insulin.

“Right now it’s hard to know if a company has adequate cybersecurity or not, because everyone says, ‘Yes, we’re good, trust me,'” said Dr. David Klonoff, a University of California, San Francisco, professor who treats diabetics at Mills-Peninsula Health Services in the Bay Area.

And for patients already burdened by the frequent demands of their disease, there’s limited appeal in new apps and software that can only be useful if they dutifully input information about their meals and other activities. “All that’s going to make me do is enter in data to one more place,” said Felts, the type 1 diabetes patient from San Francisco.

Laffel said it’s key that diabetics and families get the education they need to have “realistic expectations” about what new diabetes technologies can accomplish.

Yet even some people with measured expectations are still frustrated by just how much the new technologies can’t do.

Take James Wedding, a Dallas-area father of a 13-year-old girl with type 1 diabetes who sits on the board of a nonprofit working to promote open-source diabetes technology projects.

“More data points or more average historical information is great, but it still means I’ve got to make that decision” about what to eat or how much insulin to dose when manual intervention is needed, Wedding said. “And if I’m a 13-year-old that only does that course correction every three hours, that still means it’s a crappy course.”

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  • All of these devices are interesting, but the best potential is to develop a biological solution such as encapsulated cell line capable of producing insulin. it requires no pumps or devices of any kind and is totally self regulating. there are several companies working on this, but the best one I have found is Pharmacyte Biotech. Very interesting approach to cure type 1 diabeties.

  • What about the PredictBGL App, that predicts blood sugars hours ahead of time? So inexpensive, yet so good. No need to buy a $5000 device.

  • I’m a type 1 diabetic since over 20 years suffering from very unstable BCL. I’m on the road every week with changing schedules and unpredictable times for meals, exercise, sleep .. All technology out there never answered my most burning question – how much insulin would be best for this very moment.
    A German startup “diafyt” is working on my vision – a simple inexpensive smartphone app that can predict the right amount of insulin. So I keep hoping ..

  • Technology isGREAT but way to expensive. Also changing so quickly. Pharmaceutical seems only slightly more reasonable. But when you have $$ signs more important than clients needs … 🙁

  • Technology is good and it helps, but a simple life is also one of the best way to treat diabetes. In short, balance is the solution.

  • Grateful here too, for fast-acting insulins, pumps and continuous glucose monitors (so far). However, life is very difficult. Some are more brittle than others. This technology does not prevent alarms almost every night when sugar veers low or high, or the need to monitor 24/7 and make constant adjustments. Or the need to do math and strategize for every snack or meal, or bike ride. Where is the advocacy? If it is generally thought that these technologies are a cure (so many people think the pump manages things) then a cure will never happen.

    I am writing on behalf of a child, not myself.

  • The problem with “diabetes”, are in many respects, the sufferers themselves – 1 and 2. Their simply “too nice”. They let people pigeon hole them and tell them “this is good for you”, “yes, we’re the experts and we’re working hard to find a cure”.

    The so-called experts, have built generations of careers out of it and how many billions of dollars have disappeared…..again over generations.

    The truth is, there have now emerged a “nextgen” range of curative treatments….at long last….not “magical glucose readers” – who cares about them, people want to see the END of diabetes!

    So where, in almost now 2017, is the clear cut USFDA program, to get these treatments through human testing ASAP – send this disease into the history books and saving lives and billions from healthcare budgets every year?

    Where are the sufferers, taking to the streets – for example, look at Breast Cancer and HIV, [a disease that appeared “5mins ago” in medical terms], the HUGE “sharp political impact” these patient communities enjoy – demanding ACTION on curative treatments – no-one wants, artificial pumps or glucose monitors…with a buzzer!

    It’s “cure time” and keep the “expert associations” well away, or we’ll all be here in another generation!

    > Orgenesis
    > the Faustman Lab
    > Semma Therapeutics
    > Pharmacyte Biotech
    > Mesoblast

    Why are these types of technologies, examples above, not being fast-tracked NOW into streamlined independent clinical trials? Most are clinic ready or in early stage, ssssllllllloooowwww programs!

    Someone – somewhere, is asleep at the wheel!!!!

  • Type 1 is an autoimmune disorder by which the body attacks and destroys its own insulin-producing cells in the pancreas. It is not reversible. It is not caused by lifestyle factors . It requires attention 24/7 to deal with potentially dangerous lows and highs. Technology is great but companies make money on it. We need a real cute but there is no profit in that. Type I is an orphan disease. Only 5 per cent of those with diabetes are type 1. No one knows anything about it and the media never take the time to educate.

    • Orphan disease = fewer than 200,000 people. Over 1 million people have type 1. Not an orphan disease. Scientists have not to date cured any autoimmune diseases. So in the meantime, let the companies innovate and be incentivized by $$ to do so. We T1s reap the benefits. Case in point, continuous glucose monitors. IMO the most significant invention since home glucose testing. Who cares who makes money on it? Also note that medical innovation leads to cures. Starting with insulin. Would you turn down insulin because you were “waiting for a cure”? Embrace science in all its imperfect forms because it’s a series of small findings leading to big discoveries. And these finding come from advancements in how to manage the disease — not just some lightning bolt in a lab somewhere.

      Sincerely,
      A fellow T1 since 1982 and grateful to the companies that make my d-life a little easier

  • In July of 2015. it was discovered that I got type 2 diabetes, By the end of the July month. I was given a prescription for the Metformin, I stated with the ADA diet and followed it completely for several weeks but was unable to get my blood sugar below 140, Without results to how for my hard work. I really panicked and called my doctor. His response?? Deal with it yourself, I started to feel that something wasn’t right and do my own research, Then I found Lisa’s great blog (google ” HOW I FREED MYSELF FROM THE DIABETES ” ) .. I read it from cover to cover and I started with the diet and by the next morning. my blood sugar was 100, Since then. I get a fasting reading between the mid 70s and 80s, My doctor was very surprised at the results that. the next week. he took me off the Metformin drug, I lost 30 pounds in my first month and lost more than 6 inches off my waist and I’m able to work out twice a day while still having lots of energy. The truth is that we can get off the drugs and help myself by trying natural methods..

  • This article wastes an opportunity to explain the difference between type 1 and type 2 diabetes, an essential component of any article meant to educate. Also, the CGM only requires input of alarm settings, done once, and the pump requires input of basal rates, done as needed but certainly not burdensome. Why give readers the impression that these devices are hard to use? Both make life incredibly easier, and safer. Finally, please don’t use the term “diabetic”: “people with diabetes” is much better.

    • Agree with Pamela. T1D needs aggressive focus by FDA and medical device providers. T1D is often confused with T2D, and has no relation to lifestyle factors. Those with the T1D are insulin dependent and at risk of life threatening low (hypoglycemic) blood sugars, as well as damaging high (hyperglycemic) blood sugars which compromise body organs over long term.

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