In the pipeline: diabetes care improvements

As the year 2016 gets underway, improvements in diabetes health management are expected to progress. Looking at the pharmaceutical aspect, David Marrero, PhD, president of healthcare and education, American Diabetes Association, Alexandria, Virginia, says companies are working to develop extremely fast-acting insulin that will be effective for a longer period of time. Current forms of insulin start to hit potency in 15 to 20 minutes, are effective for a few hours, and then diminish. New insulin formulas would start to act almost immediately upon injection. “This could impact how someone with diabetes eats,” he says. “Instead of planning in advance when you will eat and when to inject insulin, someone could eat something spontaneously, inject insulin, and not worry that their blood sugar levels will get too high.”

MarreroIn addition, some pharmaceutical companies are researching islet cell transplantation, which would produce insulin using innovative approaches. For example, one approach is to create a small, permeable device that contains islets and implant it inside the body. Typically, when foreign substances enter the body, the body works to get rid of it. But permeable devices would allow insulin to get out without allowing antibodies to get in.

Looking at the pharmaceutical industry itself, with a fairly small number of companies active in the diabetes market, the larger players provide product offerings across a range of drug classes. As a result, it is possible that these companies may attempt to partner with health plans and hospital systems to ensure that their products are the sole offering available within each class. “To date, little pricing competition has occurred among diabetes agents, but value-based programs may see some significant changes in the pricing structure in the type 2 diabetes market,” says Eamonn O’Connor, PhD, principal insights analyst, Decision Resources Group, Burlington, Massachusetts.

O’Connor also says that increasingly, more expensive branded therapies aim to distinguish themselves from generically available therapies (e.g., metformin [Glucophage], sulfonylureas [Amaryl, Glucotrol, Diabeta/Glynase], peroxisome proliferator-activated receptor-gamma agonists [Actos, Avandia]) on safety grounds, as these therapies offer little difference in efficacy despite their premium prices. “This strategy is proving effective, with the type 2 diabetes market expected to continue to grow through 2022,” he says. At that time, it is anticipated that the genericization of the dipeptidyl peptidase-IV (DPP-IV) inhibitor drug class (launched in 2006) will finally slow the rate of growth in diabetes therapy-related expenditures. “Until such time, type 2 diabetes will continue to exert an increasing burden on payer formularies.”

Next: Governmental efforts

Governmental efforts

MillerOn the governmental front, value-based purchasing will continue to develop as Medicaid-redesign programs are implemented. “Outcomes from these demonstration projects, many of which include development of accountable care organizations, will undoubtedly affect industry-wide reimbursement trends for diabetes-related services such as comprehensive diabetes education and robust prevention strategies,” says Joshua D. Miller, MD, MPH, assistant professor of medicine, Endocrinology and Metabolism, Stony Brook University, Stony Brook, New York. “I would expect the insulin pump and glucose sensor industry to continue to lobby for better coverage for these devices for patients with type 2 diabetes.” As of now, coverage is mostly limited to patients with type 1 diabetes.

Along these lines, Marrero expects to see more discussion about the availability of diabetes products for patients with different types of diabetes and patients with different secondary complications. “These discussions are starting to become aggressive and will continue,” he says.

In addition, the Centers for Medicare and Medicaid Services has been implementing competitive bidding into its systems to reduce costs associated with diabetes supplies and medications. “But this is a dual-edge sword, because it won’t necessarily mean that the patient will get a better product at a lower price,” Marrero says. “By introducing low-bid policies, it is possible for lower cost products to be accepted that may not have sufficient quality control standards applied in their manufacture. This could result, for example, in using less accurate glucose strips.”

Technological advances

In the coming years, Miller says the introduction of “cloud-based” initiatives will likely grow exponentially. For example, new companies that focus on engaging patients through app-based technology (e.g., Noom, Inc.) and mobile glucose monitoring (e.g., Livongo Health) to achieve better glycemic control have emerged.

Existing companies are enhancing current offerings to incorporate mobile and Bluetooth connectivity (e.g., Dexcom Inc., Medtronic, Animas, Omnipod) to various product lines. “These innovations have dramatically transformed the way in which patients and physicians evaluate and assess blood sugar control and overall diabetes management,” Miller says.

In addition, Marrero says there is an emphasis on making home glucose monitoring technologies more accurate, and a push to develop non-invasive monitoring. In fact, manufacturers are currently creating devices that won’t require someone with diabetes to prick themselves in order to obtain a blood glucose value.

Karen Appold is a medical writer in Pennsylvania.