Products and Partnerships in the Diabetes Pipeline
An extended-wear version of Senseonics’ implantable Eversense continuous glucose monitor (CGM) is headed your way, likely at the end of 2020. While its current model operates for 90 days, the new one will last twice as long—a full six months. Inserted by your health care provider, the sensor takes glucose readings every five minutes and transmits data to your Apple or Android phone or watch. Senseonics aims to reduce the number of required calibrations for the upcoming extended-wear Eversense (the current version requires calibration every 12 hours), but the exact number won’t be known until it has been approved by the Food and Drug Administration (FDA). Further into the future: a 365-day version of the Eversense.
Dexcom, but Cheaper
Expected late this year: a limited release of Dexcom’s real-time G7 CGM, with a full rollout planned for 2021. It’s a mix of things you love about the G6 CGM—no need for finger sticks for calibration or when making treatment decisions, for instance—and modifications such as a smaller transmitter that’s disposed of with each use. Another plus: The G7 will extend sensor wear to 14 to 15 days, up from the G6’s 10-day limit. But arguably the G7’s most welcome new feature is its price tag, touted as significantly lower, though Dexcom is mum on exactly how much it’ll cost.
A drug that delays the onset of type 1 diabetes may be a reality within the next few years. A study published in 2019 in The New England Journal of Medicine showed that Provention Bio’s experimental medication teplizumab kept the disease at bay for an average of two years in both children and adults at high risk for type 1 diabetes, such as those with a family history of the disease. Teplizumab works by slowing down the loss of beta cells, which produce insulin, while helping to maintain those cells’ ability to function. If the drug receives FDA approval, it will be the first of its kind.
Abbott’s FreeStyle Libre 2—currently available in Europe but not yet in the United States—boasts a major new feature: alarms. That’s significant because the current Libre must be scanned to get glucose readings, with no option to set alerts that notify users when their glucose rises too high or dips too low. This new Bluetooth-based feature is a welcome improvement, as it will allow users to sleep without worrying about missing an overnight low or waking up to scan during the night. The company is seeking FDA approval for the Libre 2 to be designated an interoperable CGM (or iCGM), meaning it will work with compatible insulin pumps and other devices. Despite the upgrades, this second-generation device isn’t expected to cost more than the current FreeStyle Libre.
Smaller, Thinner CGM
The future of continuous glucose monitoring may bring tinier devices. Biolinq’s nickel-size sensor promises to be among the smallest available. With a quick press, the sensor will attach to the skin. The company is aiming for a design that will allow users more choice regarding where on the body to place it. This will be an all-in-one device—no separate transmitter or receiver required. Instead, a microchip will send data to a smartphone app via Bluetooth. All of this will take time to develop, but the company expects it to be available within the next few years.
Automatic Insulin Adjustments
Medtronic’s MiniMed 780G, an advanced hybrid closed-loop system, promises to improve upon the current model in several ways. Like the MiniMed 670G, the new device is a combination insulin pump and CGM that automatically adjusts basal insulin delivery. But the 780G, launching as early as this spring, will also provide automatic correction boluses—a burst of insulin—when it senses prolonged high glucose levels. Medtronic aims for the 780G to boost time in the glucose target range of 70 to 180 mg/dl to over 80 percent compared with the 670G’s 72 percent, with significantly lower average glucose readings. (More on time in range at diabetesforecast.org/timeinrange.) Big bonus: Like Tandem’s T:slim pump, Medtronic’s 780G is designed to receive updates via wireless software, so you won’t have to physically replace the pump when new features or algorithms become available.
Last summer, drug maker Eli Lilly and Co. announced encouraging results from two studies of its ultra-rapid mealtime insulin currently in development. In the studies—one included people with type 1 diabetes; the other included those with type 2—participants took the experimental insulin or Lilly’s rapid-acting insulin lispro (Humalog) for 26 weeks. Both drugs did an equally good job of lowering A1C. However, the ultra-rapid-acting insulin, which Lilly has submitted to the FDA for review, proved better able to lower blood glucose one to two hours following a meal. The company’s goal: to make an injected insulin that acts as quickly as insulin from the pancreas does in people without diabetes.
Tubeless Combo System
Expected in the second half of this year: Insulet’s Omnipod Horizon, a tubing-free hybrid closed-loop insulin pump system that, using readings from a paired Dexcom G6 CGM, automatically adjusts basal insulin and delivers correction boluses if your glucose rises too high. Users can customize their insulin delivery throughout the day by setting multiple glucose targets. The system still requires users to manually deliver mealtime boluses via a handheld controller or Android smartphone app. The device can be used for up to three days. In a small study conducted by Insulet, children as young as 2 years old spent significantly more time in their target glucose range compared with their usual therapy.
EOFlow’s tubeless EOPatch insulin pump, about the size of the Omnipod pump, is both disposable and waterproof. It holds up to 200 units of insulin, which it delivers over 3½ days before you replace it. The device—already available in South Korea, where the company is based—pairs with a handheld controller, as the patch itself has no integrated controls (similar to the Omnipod). The first version will work like a traditional insulin pump, automatically delivering basal insulin throughout the day and allowing users to deliver bolus doses. Eventually, the company hopes to integrate the pump and a CGM sensor into a wearable system it has dubbed the EOPancreas. The FDA has fast-tracked that system’s review process.
Collaboration Drives Improvement
The future of tech that’s designed to ease the daily management of diabetes won’t simply revolve around the latest device from one company or another. Instead, signs indicate that technology will be driven, at least in part, by collaborations between companies to provide new solutions.
Think about it this way: If your insulin pen and continuous glucose monitor (CGM) linked the way many CGMs and insulin pumps do, you could see all of your data—when you last injected insulin, how much you dosed, and your glucose response—in a single place. It might ease some of the burden of diabetes management and make it easier to discuss your glucose trends with your doctor.
Medtronic and Novo Nordisk have established a partnership that will enable users to integrate the insulin-dosing data collected by select Novo Nordisk pens into CGMs produced by Medtronic, such as the Guardian Connect. The Android- and Apple-compatible insulin pens, the NovoPen 6 and the NovoPen Echo Plus, are expected to launch later this year. The Guardian Connect system will be updated so that it can pair with both of these smart pens.
Sanofi and Abbott, meanwhile, are joining forces to integrate Abbott’s FreeStyle Libre CGM and mobile app with diabetes management tech currently in development at Sanofi, including smart pens, insulin titration apps, and Internet-based data-management tools. The companies expect the partnership, which aims to simplify the day-to-day management of diabetes, to become a force within the next few years, pending regulatory approvals.
Not to be outdone, Abbott and Tandem, maker of the T:slim X2 insulin pump, are mapping out a way to bring together each other’s tech. It’s too soon to say when they’ll reach a final agreement or which generations of their respective devices will be paired, but like other collaborations, the goal is to lessen the burden of diabetes management.