What advanced technologies & treatments for diabetes are in development?

Recently, at the 9th International Advanced Technologies and Treatment for Diabetes conference (ATTD 2016) in Milan, the prospect of the much vaunted artificial pancreas appeared finally to be within reach. With numerous AP systems undergoing clinical trials, Medtronic seem to be ahead of the pack and referenced a pivotal study for their MiniMed system that should report out within weeks. Performance of the latest pump/sensor/algorithm combination appears to be good and regulatory submissions “will follow soon.”

But still there were mixed views in the hall as to whether this could mean a product to market in one, two or more years. And questions remain. Should a closed loop system be approved for night time use only (define ‘night time’…!) or 24 hours? What will reimbursement routes be? Should such systems be used to treat Type 1 sufferers only? What will the take-up and continuation rates be, and what level of education, training and ongoing support will be needed for patients and care givers?

The conference title refers to advanced technologies for good reason. On show, as well as all the latest pumps, were new sensing technologies based on 90 day implants, intelligent add-ons for pen injectors and – of course – increased use of connectivity, smart devices, and data. Very few pen injectors were on show – this technology is well established and essentially mature – and this all prompted me to ponder whether technology is effectively no longer the limiting factor for injection based diabetes treatment. From a device perspective at least, we will soon be able to design and engineer everything we need. From here on it will be largely about refinement and optimisation, including how to reduce the burden on diabetes sufferers.

There are of course huge areas of ongoing research and technical advance e.g. for new types of insulin, advanced surgical procedures, tissue engineering and even the pathogenesis of the disease itself. One of the many sobering facts that I was reminded of last week is, as one speaker bluntly put it, that “we still don’t know what causes diabetes.”

The fight against diabetes goes on, on many fronts, and the record number of delegates at the conference this year reflects the fact that, at a global level, the crisis is getting worse not better. But for Type 1 at least, the battle lines may be shifting.

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