14 November 2021 is an important day in the fight against diabetes as it marks the 30th World Diabetes Day. It comes at a time when the social, economic and human cost of diabetes is expected to explode in the coming years. Nevertheless, notable technological progress should help to improve the detection, monitoring and treatment of the disease.
Diabetes is a disease that concerns the assimilation, use and storage of sugars by the human body. It leads to hyperglycaemia associated with severe and even fatal metabolic disorders. This chronic endocrine disease takes two forms. Linked to hereditary genetic factors, type 1 diabetes is caused when the pancreas produces little or no insulin. It develops mainly in children, adolescents and young adults. Linked to a person’s lifestyle, type 2 diabetes is caused by the misuse of insulin by the body’s cells. It usually occurs after the age of 40 due to excessive weight, poor diet or lack of physical exercise. Type 2 diabetes accounts for about 90% of cases.
According to the International Diabetes Federation (IDF)1, 463 million people - or one in eleven adults - are living with diabetes. However, half of those with diabetes are unaware of their condition. Undiagnosed and untreated, patients are exposed to disabling, if not fatal, complications (myocardial infarction, stroke, kidney failure, blindness, lower limb amputation, etc.). A silent and rampant pandemic, its growth curve will explode in the years to come. Diabetes will affect 578 million people by 2030 and 700 million by 2045.
Direct, indirect and intangible costs
The social, economic and human effects of diabetes are considerable. Global health expenditure stands at $760 billion per year. Key indicator: the treatment of complications accounts for more than half of the direct costs. In the UK, the cost of treating an episode of diabetic acidosis is £1,387. By extension, premature deaths and disabilities account for more than a third of overall expenditure. In particular, absenteeism is seen as a factor of reduced productivity. A source of anxiety and discomfort, the numerous repercussions on the quality of life of patients are also to be considered. The direct, indirect and intangible costs of diabetes are exorbitant and set to increase. The IDF estimates that global health expenditure will reach $825 billion in 2030 and $845 billion in 2045.
Diabetes and its complications are a major cause of premature death: more than four million deaths each year, or one every eight seconds. Between a third and a half of these deaths are attributable to cardiovascular disease, of which diabetes is the direct cause. It should be noted that diabetes is now one of the ten leading causes of death in the latest WHO ranking. A highly symbolic figure, the number of deaths attributed to diabetes has increased by 70% in twenty years.
Technological achievements
The prevention of type 2 diabetes, which is partly preventable, is a top priority. The WHO recommends, in particular, a healthy diet, regular physical exercise and avoiding the consumption of tobacco. Weight loss is considered to be a key factor in delaying the onset of the disease and reducing its complications. Early detection also plays a strategic role.
Notable technological progress has opened up new perspectives in this area. An artificial intelligence system approved three years ago by the FDA can detect diabetic retinopathy with a 90% level of accuracy.2 Another notable feature is that the machine produces an automated diagnosis that does not require the intervention of a health professional to interpret the images. This breakthrough is revolutionary and paves the way for further progress.
Many scientists are working to optimise the diagnostic offer, with promising results. Researchers at Queen Mary University of London recently succeeded in developing an AI that can measure the amount of fat around the heart, a predictive marker of the disease that is currently impossible to identify.3 Based on a simple analysis of cardiac MRI images, this tool provides an answer in just three seconds. It may also be able to calculate the level of risk incurred by each patient.
New treatment alternatives
Despite considerable progress in research, there is no cure for diabetes. The standard treatment consists of the regular administration of insulin through insulin pens, inhalers or special pumps. Several second-line treatment drugs help to standardise the disease, which also needs to be monitored continuously through increasingly sophisticated blood glucose monitoring devices. New therapeutic avenues are currently being explored. They are mainly aimed at improving patient comfort. American researchers are working on a pill that could replace insulin injections.4 Tested on pigs, this drug was found to be effective in reducing blood sugar levels in patients.
There are three other breakthrough innovations expected in the coming years, mainly in type 1 diabetes: the artificial pancreas, smart insulin and pancreatic islet transplantation. Already used in the United States and Canada for patients with unstable diabetes, this gene therapy has a major drawback that could soon be overcome. According to a team of American researchers5, transplanting these pancreatic cells into the anterior chamber of the eye would do away with the need for immunosuppressors.
Driven by constant and growing demand, diabetes is a promising field of investment, underpinned by technological progress. Through its network of experts, Candriam will identify the most promising research projects. It will also support companies that produce the most useful medical treatments and devices for patients.
Diabetes: a dynamic market... driven by the United States
One hundred years after the discovery of insulin and blood sugar control, the global diabetes market is reaching new heights. According to IQVIA, it reached $105 billion in 2020, an increase of 10.5% on the previous year. A notable fact: the United States represented 67% of sales, far ahead of the bloc of emerging markets, which accounted for a total of 11%. The diabetes segment is the second largest therapeutic area after oncology and made up 9.8% of the global pharmaceutical market, estimated at $1,174 billion. Another major finding was that two anti-diabetic drugs were among the top ten best-selling drugs last year. They appeared in sixth and seventh place in this ranking.
Note: all values are expressed in the manufacturer’s price, excluding taxes.
Source: IQVIA (April 2021)
Diabetes: key figures
- One in eleven adults are living with diabetes today: 463 million people;
- One in two adults with diabetes are undiagnosed: 232 million people;
- One in five people with diabetes are over 65 years of age: 136 million people;
- 10% of global health expenditure goes on diabetes, or $760 billion;
- 79% of people with diabetes live in a middle- or low-income country;
- 1,110,100 children and adolescents under the age of 20 have type 1 diabetes.
Source: Ninth edition of the IDF Diabetes Atlas (November 2019)
(1) “IDF Diabetes Atlas”, International Diabetes Federation (November 2019).
(2) “Pivotal trial of an autonomous AI-based diagnostic system for detection of diabetic retinopathy in primary care offices”, Nature (August 2018).
(3) “Automated quality-controlled cardiovascular magnetic resonance pericardial fat quantification using a convolutional neural network in the UK Biobank”, Frontiers in Cardiovascular Medicine (July 2021).
(4) “An ingestible self-orienting system for oral delivery of macromolecules”, Science (February 2019)
(5) “Operational immune tolerance towards transplanted allogeneic pancreatic islets in mice and a non-human primate”, Diabetologia (January 2019).