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These are exciting times in the diabetes world. The past year brought us new therapies, new technologies, and new ways of sharing and using information. Most importantly, brilliant researchers from around the world – and right here in Canada – continue to make great advances in the prevention and management of diabetes. Never has the future looked so bright for people living with diabetes.
Concentrated insulins, biosimilar insulins, and new longer-acting insulin and rapid meal-time insulins are allowing insulin therapy to mimic a functioning pancreas as closely as possible. The introductions of insulin glargine U300 (Toujeo®) in 2015 and insulin degludec (Tresiba®) in 2017 have provided longer, flatter and more stable basal (background) insulin control. The more recent introduction of faster-acting insulin aspart (Fiasp®) which is a slightly modified version of insulin aspart (NovoRapid®) has provided insulin with a faster onset at meal time – i.e. more like a functioning pancreas. These are important new tools in the insulin toolbox. We expect to see more faster-acting insulin and other biosimilar insulins introduced, perhaps in 2018.
For the management of type 2 diabetes with oral medications, we did not see any new medicines introduced in 2017, but we did see more combination therapies (two medicines in one pill). This is an important way to reduce pill burden (having to take so many pills) and to improve adherence to medicine. The biggest news in the non-insulin medicines to manage type 2 diabetes – and what we continue to learn more about – are the “non-glucose” benefits. Canagliflozin (Invokana®) demonstrated a reduction in heart disease in people with diabetes, similar to previous results with empagliflozin (Jardiance®). This class of medicines, called SGLT2 inhibitors, continues to demonstrate a reduction in many diabetes complications beyond heart attack and stroke, most significantly the prevention of kidney disease.
Understanding the importance of low blood sugars and their relationship to poor outcomes (including an increased risk of death) continues to be documented, but the most significant findings come from the DEVOTE study with insulin degludec. 2018 promises to bring us more results from large studies in heart disease and other complications of diabetes: we anxiously await the results of the DECLARE study (dapagliflozin/Forxiga®), the REWIND study (dulaglutide/Trulicity®) and the CAROLINA study (linagliptin/Trajenta® vs. glimepiride, a drug that is similar to glyburide). The CAROLINA study especially will help us further understand the safety of drugs such as glyburide in diabetes management.
Technology, so important in managing diabetes, also had new developments. 2017 brought us the flash glucose monitoring system, which helps us understand ambulatory glucose profiles, previously only available to people using continuous glucose monitoring systems. Starting to think about “time in range” vs. single number pre-meal and post-meal targets can be very helpful in achieving A1C targets and avoiding hypoglycemia.
Sharing information about glucose monitoring through cloud-based technology helps us to better utilize our time and improve communications between healthcare providers and their patients. We can expect more technologies to become integrated into the cloud for people with diabetes, incorporating food apps and activity monitors. This automation helps with the goal of putting all of the pieces of the puzzle together in the simplest way possible!
For insulin pump users, 2017 saw the end of an ‘old friend,’ with Animas pumps leaving the market. However, new advances in insulin delivery systems from Insulet and Medtronic will continue to improve to meet the needs of pump patients. We may even see a new player on the market in 2018: time will tell.
We do know, however, that ongoing research regarding the development of the artificial pancreas has brought us closer to seeing this very advanced technology become a reality. Will 2018 be the year in Canada? I wish I had a crystal ball!
We continue to learn more and more about diabetes and its related disorders. We have a greater understanding of the mechanisms of the disease and the numerous therapies available to treat diabetes; however, we need to help all healthcare professionals understand the diabetes “road map” while respecting that each person’s journey is unique.
Last, but not least, we look forward to the launch of revised clinical practice guidelines from Diabetes Canada in early 2018. A sneak peek at the association’s annual conference in November 2017 was like the introduction to what will be a great book: too little to get the complete story, but just enough to make us keen to read the whole novel. Stay tuned!
