Pharma 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.
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.”