Gérard Soula, founder and CEO of biotech company, Adocia, discusses the challenges facing the diagnosis, treatment, and management of various types of diabetes.
Diabetes is a global public health concern which affects 9.3% of adults aged 20-79. With the number of adults living with diabetes expected to reach 700 million by 2045, addressing the challenges around diagnostic procedures, treatment accessibility and the overall management of the disease has never been more vital. Type 1 diabetes, which necessitates multiple daily insulin injections to control blood sugar levels, accounts for 5-10% of total diabetes cases. The more common type 2 diabetes requires oral medication and insulin injections for 20% of the cases.
Type 2 diabetes is increasingly attributed to rising levels of obesity, physical inactivity, and poor diet. Great disparities in access to treatment and services around the world has left many struggling to manage their condition, while others can remain undiagnosed for years. To discuss some of the key challenges associated with the disease, as well as revolutionary innovations that could mark a new wave of diabetes treatment, Health Europa spoke to Gérard Soula, founder and CEO of biotech company, Adocia.
What are the key challenges currently facing the management and treatment of diabetes?
There are many factors to consider. The first challenge is the identification of diabetic patients as many people are undiagnosed, currently around one in two. A lack of diagnostic services and screening for diabetes is a real issue, particularly in more remote or less affluent parts of the world.
Furthermore, symptoms for type 2 diabetes may not present themselves for many years, which can often mean a person’s condition becomes complicated before they receive any kind of treatment. The second challenge relates to the provision of affordable diabetes treatments that can support a patient’s specific needs. There are great disparities with regard to affordable diabetes treatments around the world, some are indeed very expensive. It is important that the necessary products and medications are accessible for every type of diabetic person, no matter what stage of the disease.
Thirdly, we need to consider how we can enable patients to live their fullest life. This means we need to enable them to manage their condition throughout their lifetime with minimal impact and complications. There is currently no cure for diabetes so adopting a patient-centred approach and providing a holistic model of care is important. For me, these are the three pillars we need to consider in order to improve the situation for those living with diabetes.
An estimated 463 million adults were living with diabetes in 2019 and this number is expected to rise to 700 million by 2045, what would you attribute this rise to?
This is the evolution of the disease. An increase in obesity, poor diet and lack of physical activity certainly have a part to play. Stress is also a critical factor. What is so surprising is the speed in which diabetes cases are rising, it is hard to imagine a way in which we can slow this down, we need political and social intervention. When we consider the figures for emerging diabetics, 85% of type 2 diabetes patients in the US are obese and the process which leads to this condition is clear to see; typically, people start to become overweight, which can lead to obesity, then they can become pre-diabetic before developing type 2 or even type 1 diabetes. Today, we have identified 1.9 billion adults who are overweight or obese and therefore we can expect an increase in diabetes further down the line.
Type 1 diabetes is more complicated because, predominantly, this type of diabetes is not the result of weight gain or poor lifestyle. However, what we are seeing today, in the US for instance, is a high percentage of type 1 diabetics who are overweight or obese due to the shift to a more sedentary lifestyle.
A large proportion of adults with diabetes is undiagnosed – why do you think this is, and how can earlier diagnosis and access to diabetes treatment be better supported?
This has a lot to do with the healthcare services that are available to carry out screenings and diagnostic procedures. There is a huge disparity in the number of medical professionals available to carry out these tests, with those in lower-income countries or remote areas experiencing poorer access to healthcare services. The other issue is that while only 50% of people are diagnosed, even fewer receive the necessary treatments.
Education around diabetes can also be lacking, not only for the patients but medical professionals, too. In low- and middle-income countries there are fewer trained diabetes educators and doctors as well as clinics where people can learn about how to manage their condition. Knowledge sharing is incredibly important, information needs to be made more widely available so that we can change the level of treatment in areas where patients are most in need.
Are there any notable developments in treatment which you would like to highlight?
I mentioned one key challenge at the top of the interview which relates to making medication more affordable, this is something that my organisation has been working on. Making medication affordable for a large population is one thing, improving the quality of treatment and ensuring patient adherence is another. For many type 2 patients the oral medications available to them today work well because they are at the beginning of the disease, however, as the disease progresses, patients need more intense treatments in the form of injections. Becoming insulin dependent can also be quite difficult, affecting not only physical health but mental wellbeing, too.
Type 1 and type 2 patients can experience other long-term health complications including foot ulcers, which could lead to amputations, kidney, and cardiovascular diseases. We need innovation for everyone, everywhere, not only to reduce the risk of comorbidities and improve life expectancy but to enhance the quality of life for those living with diabetes. The majority of innovation today is geared towards patients taking insulin, and we as an organisation are trying to improve treatment by switching or combining different types of insulin to enable better results. Another avenue we are focusing on is the development of treatment adapted to modern technology such as smart pens or insulin pumps (patch pumps, closed loop system or dual-hormonal artificial pancreas).
If we return to the idea of a holistic approach, we know a diabetic patient’s overall welfare is not simply down to pharmaceutical or chemical ingredients and algorithms, there are many elements of care to consider, and the patient must be a part of that process. A device that can be paired with a Continuous Glucose Monitoring (CGM) device to help the patient measure their glycemia, can, in the long term, enable them to reduce their risk of developing complications and comorbidities and give them a greater sense of control. The pharmaceutical part is also critical, we know that without insulin it is impossible for type 1 diabetics to survive, but there are also other hormones which are important for regulating glucose in the body. At Adocia, we are working on a formulation that comprises insulin as well as amylin analogs and have seen promising results from clinical trials so far. We are hoping to offer patients the possibility of using and combining these two hormones as a single treatment. These formulations are not currently compatible, meaning that if you want to use these hormones as part of your treatment, it could necessitate four injections of insulin and three injections of amylin per day. Beyond improving the quality of life for the patient, our combined formula could make treatment more effective and affordable. Our vision is not only to control hyperglycaemia, but also to prevent hypoglycaemia using glucagon, which remains one of the patient’s major concerns.
Beyond this approach, there is another so-called ‘grail’ that can be reached. Today, 25 million type 1 diabetes patients are living without β-cells, which are destroyed by their own immune system. There is a lot of work taking place around the world looking at how to transform stem cells into functional cells, including β-cells, which can then produce insulin and amylin inside the body. The challenge is how to transplant these cells into the body without the immune system destroying them, or the need for the patient to take immunosuppressants. Since immunosuppressants can leave the body susceptible to infection and disease, transplanting cells while using immunosuppressors should be avoided. We are therefore in the process of developing a cell cage to protect the β-cells from the body’s immune system and hopefully, one day, we will be able to make this an accessible, effective, and, most importantly, comfortable treatment for type 1 diabetes patients.
Gérard Soula PhD, MBA
President and CEO
This article is from issue 19 of Health Europa Quarterly. Click here to get your free subscription today.