2015: A year of improvements in diabetes management

Last year saw significant improvements in diabetes management. While diabetes, particularly type 2, remains an epidemic affecting more than 29 million people in the United States (or greater than 9% of the population, according to the Centers for Disease Control and Prevention), the number of new diagnoses has begun to slow. “This plateau may reflect slowing rates of obesity and is perhaps evidence that efforts to prevent the disease may be proving to be successful,” says Joshua D. Miller, MD, MPH, assistant professor of medicine, Endocrinology and Metabolism, Stony Brook University, Stony Brook, New York. “Most diabetes experts consider recent trends as a further call to action to double our efforts at preventing the disease.”

MillerThe American Diabetes Association (ADA) continues to emphasize the importance of individualized goal-setting for patients with diabetes in its annual treatment recommendations. As such, physicians continue to recognize patient-specific factors that influence glucose targets such as patient age, comorbidities, and diabetes type. “Just as patient goals are unique, so too are the newer pharmaceutical agents recently introduced to help manage diabetes,” Miller says.

Advances in medications

In the world of patient management and therapeutics, a number of new classes of diabetes medications have been recently brought to market. The newer sodium-glucose co-transporter (SGLT)-2 inhibitors are designed to help a patient’s kidneys excrete excess sugar from the body. The industry continues to offer new types of insulin (e.g., concentrated, longer-acting), which is greatly improving care for patients with insulin resistance.

In addition, newer formulations of previously available medications have proven to be more convenient for patients because they can take them less frequently than before. Examples include GLP1 agonists such as Victoza (liraglutide) and Bydureon (extended-release exenatide). An additional benefit is that they have been found to be very effective in helping patients with diabetes to lose weight. As a result, FDA approved their use to manage obesity.

Next: Technological improvements

Technological improvements

Technologies available to manage diabetes have also improved greatly in recent years. David Marrero, PhD, president of healthcare and education, ADA, Alexandria, Virginia, says continuous glucose monitors now have a sensor that can be inserted into the skin to measure glucose levels. This eliminates the need to prick your finger to get an insulin level snapshot and also helps patients and physicians recognize trends in blood sugars and responses to stress and physical activity.

MarreroMeanwhile, glucose pumps (continuous subcutaneous insulin infusion devices) now allow for a constant slow trickling of insulin and can be programmed to provide a higher amount of insulin while eating.

“The first device allows for constant monitoring of glucose and can provide warnings about the direction and impact of glucose before a patient actually experiences it, while the other device allows for good administration of insulin, much like the pancreas would do,” Dr. Marrero says. “If you combined these two devices, you would have an artificial pancreas-also called a closed loop system. In the last year, there have been experiments and trials to explore different ways to create an artificial pancreas. Although it is not yet perfected, if it was created it would help people with diabetes to more effectively control their blood glucose by automatically adjusting their glucose levels.”

Governmental efforts

On the legislative front, federal and state governments have recognized the burden of chronic disease on the healthcare system and have invested substantial resources in system overhaul and improvement. The Delivery System Reform Incentive Program (DSRIP) is a government-sponsored initiative aimed at redesigning delivery of care for patients enrolled in the Medicaid program.

New York State has allocated more than $6.4 billion to the program, and health systems throughout the state are developing new approaches to care management and delivery of chronic disease care that will greatly improve outcomes for our patients. “Programs such as these will redefine the way in which clinicians and healthcare systems provide care to patients as we move to a system of value-based purchasing,” Miller concludes.

These improvements in diabetes management are expected to continue to advance this year.