Diabetes is one of this century’s most prominent and growing public health threats, affecting almost 26 million Americans – including 7 million people who are not even aware they have the disease.
The latest Medicines in Development report addresses the grim realities we face as a society should diabetes go untreated and highlights the incredible innovation that we hope will turn the tide on this disease. America’s biopharmaceutical research companies are currently developing 180 new medicines for type 1 and type 2 diabetes and diabetes-related complications, such as chronic kidney failure due to diabetes and painful diabetic neuropathy. Additionally, there are 200 active diabetes clinical trials in the United States.
Though we continue to make great strides, industry innovation and novel therapies are only part of the multi-faceted approach we must take in managing diabetes. All members of society - citizens, industry, academia, science and government - must work together to meet the broad challenges of this disease.
As citizens, caregivers, and people living with diabetes, we must be aware of the warning signs of diabetes and be prepared to undertake disease management responsibly. This includes adherence, something that recent research shows to be a key in successful diabetes management.
Diabetes patients who do not consistently take their medicines as prescribed are 2.5 times more likely to be hospitalized than those who follow their prescribed treatment regimens more than 80 percent of the time. In addition, a recent study in Health Affairs projected that improved adherence to diabetes medications could avert more than 1 million emergency room visits and close to 620,000 hospitalizations annually, for a total potential savings of $8.3 billion annually.
This is an enormous opportunity for patients and healthcare professionals to improve outcomes and reduce costs. As an industry, we must also be willing to broaden our approach to finding solutions. We must work hand-in-hand with non-profit patient-focused groups, government, fellow industry members and academia to bring together the brightest minds and scientific discoveries to produce therapies that can’t be created in a traditional ‘silo’ approach.
Last week’s Accelerating Medicines Partnership (AMP) announcement is a prime example of how collaboration across stakeholders can produce an integrated approach to treatment discovery.
AMP is comprised of The National Institutes of Health (NIH), several non-profit disease foundations, 10 biopharmaceutical companies and PhRMA. The partnership aims to transform the current model for developing new diagnostics and treatments by jointly identifying and validating promising biological targets of disease starting with three five-year pilot projects focused on Alzheimer’s, type 2 diabetes and autoimmune disorders, including rheumatoid arthritis and systemic lupus erythematosus (lupus).
Chronic disease management presents formidable challenges. However, through collaboration and innovation, we can provide a platform of shared expertise and vision to tackle the nation’s greatest public health challenges, one at a time.
Dr. Bill Chin leads PhRMA’s Scientific & Regulatory Affairs department. A physican, an endocrinologist and an academic at heart, Dr. Chin envisions establishing PhRMA as the premiere convener in advancing drug discovery and development, regulatory sciences and collaborative partnerships.
Despite many attempts by prominent researchers utilizing different approaches, there is no cure for diabetes. While continuing extensive research looking into “the cure”, much work is being conducted in the day –to- day management of diabetes. As such, it is essential to develop treatments that not only help measure and adjust blood glucose levels- thus preventing hyper and hypoglycemia, but also to improve the quality of life in our patients with diabetes. The amount of self care skills required to manage diabetes is extensive, requiring blood glucose monitoring, insulin injection and planning around all activities. The underlying challenge is to incorporate and embed the treatment that enables people with chronic diseases such as diabetes to live productively, happily and hopefully.
Clearly, looking at the big picture, by achieving improved care of our population with diabetes, we will be able to decrease complications associated with diabetes and thus decrease healthcare costs that constitute a major burden for both society and individuals. However, asking patients to attend to all aspects of diabetes care 24 hours/day/365 days/year requires a great deal of psychic energy which in many situations leads to “burnout” and despair. Hence, a major challenge in the management of diabetes and chronic illness is the adaption and incorporation of the latest, most efficacious treatment. If suggested therapies are not applied, appropriate care is not delivered. Therefore, support by a multidisciplinary healthcare team including a psychologist and social worker is paramount in assisting patients with chronic illness. Thus, in addition to basic science and clinical research in the treatment of diabetes, adherence research is also essential to enable our patients with diabetes to achieve appropriate glycemic control, avoid complications and live well. In summary, until there is a cure for chronic diseases such as diabetes, the mainstay will be treatment that is successfully integrated into the day-to-day activities of our patients.
Fran R. Cogen, MD, CDE, is the director of the Childhood and Adolescent Diabetes Program at Children’s National. Her clinical interest includes intensive insulin therapy and its effect on quality of life. She is dedicated to advocating for the needs of patients and their families in managing diabetes, and in 2014 was named a “Top Doctor” in endocrinology by Washingtonian Magazine. Originally from New York, she has lived in the Washington, DC, area since 1996.
Dr. Cogen served on the American Diabetes Association National Diabetes Education Recognition Committee and is the Chairman of the Examination Committee of The National Certification Board for Diabetes Educators.
Through Dr. Cogen’s perseverance, The Washington Nationals Baseball Club chose diabetes education and care as one of its three signature causes. The commitment was solidified by a $2 million lead gift from the National’s Dream Foundation to secure space in Children’s master facility plan for the building of a 6,500 sq. ft. Diabetes Care Complex. The Washington National’s Diabetes Care Complex celebrated its opening in June 2013.
The discovery of insulin nearly 100 years ago, created a lifeline for every person diagnosed with T1D. But the individualized use of this sole therapy for managing T1D is an enormous daily burden that leaves many with suboptimal glucose control, despite their heroic efforts. Poor glucose control is directly related to the many serious complications of the disease that result in significant burdens on individuals with T1D and their families and on society due to their huge economic impact. Automating the cycle of testing and injecting by using artificial pancreas systems is a near-term prospect given the state of today’s devices and insulin products. Improved glucose monitors, pumps, and insulin formulations are needed to deliver more sophisticated artificial pancreas systems that fully automate insulin delivery, further reduce the burden of daily T1D management, and improve long-term outcomes. Furthermore, new therapies are needed that can be used in addition to insulin to improve the management of T1D and move us beyond the era of insulin as a sole therapy. The growing treatment options being approved for type 2 diabetes represent “low hanging fruit” in the quest for testing and developing adjunctive therapies for T1D since early research suggests their utility in both diseases.
Richard A. Insel, M.D., oversees the research strategy of JDRF, the world’s largest funder of type 1 diabetes (T1D) research. Prior to joining JDRF in 2003, Dr. Insel was the founding director of the Center for Human Genetics and Molecular Pediatric Disease and professor of pediatrics and microbiology and immunology at the University of Rochester Medical Center. During his 26-year affiliation with the university’s medical center, he served as the acting chair of pediatrics, director of the Strong Children’s Research Center, and chief of the division of pediatric immunology, allergy, and rheumatology. His research program at the university focused on immune responses to bacterial vaccines and B cell immunity. Dr. Insel was a co-founder and board member of Praxis Biologics, a biotechnology company that developed a vaccine that protects against Haemophilus influenzae type b, the cause of bacterial meningitis. This vaccine was the first to be licensed in the United States in a decade. A second, a conjugate vaccine, was the first to be licensed for universal use with infants since the vaccine for measles and mumps. Today, the Hib vaccine is regarded as one of the medical success stories of the 20th century, responsible for reducing the incidence of bacterial meningitis in children by 98 percent in the United States. Dr. Insel currently serves on the board of the Alliance for Regenerative Medicine and on the Steering Committee of Type 1 Diabetes TrialNet, an international network of researchers who are exploring ways to prevent, delay, and reverse the progression of T1D, and served on the National Advisory Allergy and Infectious Diseases Council of the National Institutes of Health. Dr. Insel completed his pediatric and immunology training at Boston Children’s Hospital and Harvard Medical School.