Roughly 30 million Americans — close to 10% of the population — have diabetes, and 75,578 people died from the disease in 2013, making it the seventh leading cause of death in the U.S., according to the Centers for Disease Control and Prevention (CDC). And the problem is getting worse, with 1.4 million new cases diagnosed each year. At the current rate, the CDC predicts one in three U.S. adults could have diabetes by 2050.
That’s alarming not just in terms of public health, but also because of the high costs of treating diabetes. In 2012, spending on people with diabetes totaled $245 billion, or about 20% of all healthcare spending in the country. And diabetes-related spending is going up at a startling rate. In 2014, spending on diabetics who were covered by employer-sponsored health plans grew nearly twice as fast as spending on nondiabetics, totaling $16,021 per capita, according to a June 2016 study by the Health Care Cost Institute.
From routine blood glucose testing to nutrition and healthy lifestyle training, the challenge of coping with this epidemic has spawned a growing interest among both new companies and tech giants in diabetes management.
Startups tackle behavior change
Innovations in the diabetes management space have been focused on both hardware (e.g. glucose monitoring and pumping) and on software (e.g. digital monitoring of blood sugar levels and predictive analytics).
In addition, the global needle-free diabetes management market is expected to grow 17.8% year over year, reaching $16.8 million by 2025, according to a recent report by P&S Market Research. Included in the space are glucose monitors, advanced insulin jet injectors and artificial pancreases — the latter projected to see the fastest growth. Major players include Medtronic, Pharmajet and Zogenix, among others.
“Companies focused on delivering behavior change are the ones to watch in this industry,” Troy Bannister, lead academy analyst with StartUp Health, told Healthcare Dive. Bannister argues behavior change is the most challenging part of diabetes management.
“It is incredibly hard to try and encourage behavior change like exercise, diet and medication adherence,” he said. And the problem is only getting worse with the clinician shortage, he added.
"We will need to find ways to incentivize people to change their behaviors.”
Lead academy analyst, StartUp Health
One company focused on making strides in that area is Omada Health. The online and mobile phone-based program offers lifestyle education, small group support and individual coaching along with a wireless scale and other digital tracking tools to gauge patients’ progress. In a recent study in a Medicare population, participants using Omada experienced 7.5% weight loss and saw improvements in both glucose control and cholesterol levels.
Taking a slightly different tack on diabetes management is Virta Health, an online specialty medical clinic that aims to not just manage type 2 diabetes but also to reverse it. The company operates as a licensed provider in states across the U.S., delivering telemedicine and support on a 24/7 basis.
“What we wanted to do and have now demonstrated can be done is to fundamentally reverse the disease and get patients off of medications and get their blood sugars into a healthy range,” Sami Inkinen, founder and CEO of the San Francisco-based startup, told Healthcare Dive.
In a clinical study, more than half of patients using Virta’s virtual support reversed their type 2 diabetes in under three months, meaning their blood sugar dropped below 6.5 A1C, according to Inkinen. In addition, more than 90% of patients who started the trial with insulin were able to reduce or stop using it altogether and more than 90% complied with the program and stayed on as patients, he added.
Advances in blood glucose monitoring are also improving diabetes management. In December, One Drop announced regulatory approvals in the U.S. and European Union for its subscription-based One Drop|Chrome mobile blood glucose monitoring system. The tool includes a lancing device, unlimited test strips and an app that wirelessly transmits glucose data to the cloud. The device is available on both iOS and Android.
Tech giants in the mix
It isn't just startups that are biting into diabetes. Several tech giants have big plans for diabetes too.
Verily, Alphabet’s life sciences unit, and French drugmaker Sanofi launched a joint venture last September called Onduo to create tools for diabetes management. The aim is to combine devices, software, medicine and professional care to create digital solutions to help diabetics manage their disease. The effort, which recently raised $500 million, is focused on type 2 diabetes, but plans to expand over time to include type 1 diabetes and people at risk of developing the condition.
Samsung and WellDoc recently teamed up to offer WellDoc’s BlueStar mobile diabetes management tool directly to consumers. The app, which received FDA clearance in January, uses clinical and behavioral algorithms to drive individualized, real-time coaching, according to WellDoc’s website. In two clinical trials, BlueStar reduced blood glucose A1C by an average of 1.9%.
In the area of cognitive computing, IBM Watson is using deep learning to look for genetic variants and molecular indicators of diabetes, Bannister noted. The Sugar.IQ combines IBM Watson’s artificial intelligence prowess with Medtronic’s diabetes expertise to identify patterns in diabetes data that can inform real-time insights into a diabetic’s health status and actionable steps.
Apple also has plans to enter the space. In April, reports surfaced that the tech giant had hired a team of biomedical engineers to develop noninvasive sensors that can monitor blood sugar and help diabetics manage their disease. If successful, this could open a whole new market for Apple Watch. Word of the top-secret team follows discussions between the tech giant and Food and Drug Administration officials on a range of issues including the 510(k) clearance process.
Bannister expects the trend toward life sciences and technology in diabetes management to continue. “The line between life sciences and technology is continuing to dissolve as we quantify our medical statuses,” he said. “Life science companies want data to understand disease; tech companies are getting really good at building products that not only fit seamlessly into our lives but are also exciting and fun for us to use. They make our lives better.”