10 Milestones That Defined the Decade in Diabetes
Wow, what a decade the 2010s have been in the world of diabetes!
Social media exploded to new levels and our Diabetes Online Community evolved along with it, as did the data-sharing from mobile devices and the throngs of Do-It-Yourself techies embracing a #WeAreNotWaiting mantra. Fueled by these patient voices, regulators opened up pathways to the first-ever commercial closed loop "Artificial Pancreas" systems.
We saw the emergence of new forms of glucagon and insulin that have been years in the making. Our choice of diabetes gadgets changed dramatically, yet we saw scientific evidence that across the board, health outcomes are not improving as hoped.
Meanwhile, a controversial healthcare law that was supposed to be a boon for people with chronic conditions ended up deepening the divide between the 'Haves and Have-Nots'. Politics, rising costs, and a culmination of unchecked corporate policies boiled over into an Insulin Affordability Crisis unlike anything our D-Community has ever seen.
It's a fascinating moment to look back, and even marvel in disbelief at all that happened. Here's a summary of 10 highlights we’ve witnessed over the past decade:
1. Healthcare reforms backfired
The sweeping Patient Protection and Affordable Care Act (ACA) adopted in March 2010 was supposed to be a game-changing moment that history would remember fondly. But while it helped many, the ACA also led to an incredible rise in high-deductible plans and increasing affordability and access woes that dominated discussion during most of the decade -- and continues, today.
2. The Insulin Affordability Crisis heated up
This issue wasn't born in the 2010s, but it reached fever-pitch as PWDs (people with diabetes) died due to insulin rationing prompted by lack of access. Rage against Big Pharma hit a boiling point and Congress eventually began taking notice, with all the major diabetes orgs taking stances and advocating on this issue. The expanding #insulin4all grassroots movement became a force pushing change at state and federal levels.
3. Social media and the diabetes online community ballooned
Smartphones evolved and created pronounced cultural change in the 2010s, and along with that came an explosion in social media use on multiple platforms -- Twitter, Facebook, Pinterest, Tumbler, Instagram, YouTube and more. Our community saw the rise of the online #DSMA (Diabetes Social Media Advocacy) experience that's created community locally and across the globe. Not all have survived this social media transition, like the beloved Diabetes Hands Foundation that dissolved in 2017, but there have also been new mediums and voices -- such as the nonprofit Beyond Type 1, which has come in strong with incredible social media skills that engage millions of people internationally.
4. Diabetes data sharing and DIY #WeAreNotWaiting were born
Believe it or not, at the start of the decade, we didn't have the ability to share diabetes data via smartphone. It all began with the iPhone 4 and culminated with advanced mobile tech that's allowed D-devices to share glucose data remotely. With this came the birth of the #WeAreNotWaiting movement in November 2013 (at our first-ever DiabetesMine D-Data event) and led to amazing iterations of do-it-yourself tools to help better manage blood sugars. We've also seen startups including Tidepool and Bigfoot Biomedical born out of this energy that are pushing -- and calling out -- established industry and regulators to change how they make decisions in the diabetes space.
5. FDA confirmed itself as friend, not foe
As we started the decade, it was safe to say the FDA was viewed as a roadblock for new diabetes technology. Not anymore. Now, the agency is considered a friend to our D-Community. They welcomed PWD voices into their decision-making, listened to us on important issues like test strip quality, and have routinely worked to accelerate its review processes with industry players to bring us new innovations and options for diabetes care faster. Part of this involves creating new pathways for making the tools interoperable -- something quite revolutionary compared to where we were just a few years ago.
6. Hello, diabetes closed loop systems!
Early generations of so-called "Artificial Pancreas" technology became a reality this decade. These combine insulin pump, CGM, and smart algorithm/data-management platform. In 2016, the FDA approved the Medtronic Minimed 670G, the first-ever early hybrid closed loop system offering Low Glucose Suspend. Then just recently in December 2019, FDA signed off on the Tandem Diabetes Control-IQ advanced closed loop -- all while thousands of PWDs are now using DIY non-FDA-regulated homemade systems across the world (see No. 4).
7. New rescue glucagons hit market, finally!
We hadn't seen a new form of fast-acting emergency glucose since the current, complex mix-and-inject kits came out in 1961. But in 2019, after years of research, we saw FDA approval for Eli Lilly's new nasal glucagon Baqsimi as well as a ready-to-use injection Gvoke from Xeris Pharmaceuticals. These usher in a new era of glucagon formulations and a shift in how we think about using glucagon beyond just emergency scenarios.
8. Novel insulins hit market
Even in the midst of the Insulin Affordability Crisis, our D-Community saw new insulin innovations that represent remarkable progress. The first-ever so-called "biosimilar" insulins became a reality, in the form of Sanofi's Admelog and Lilly's Basaglar introduced this decade. These are "copycat" versions that can be produced much cheaper than the originals, but for scientific reasons, cannot technically be called "generics." We also saw Novo Nordisk and later Eli Lilly introduce half-priced versions of their insulins that got remarkably quick regulatory OK. Not to overlook Afrezza inhaled insulin and the new longer-acting Tresiba basal insulin introduced as great new treatment options.
9. The insulin pump market contracted
We began the decade with many still reeling from the loss of the Deltec Cozmo in 2009. Sadly, the 2010s saw the demise of three other choices for insulin pumps -- the Animas pumps that had been around since 2003; Asante Solutions' clever snap pump, that went away after the company suddenly went bust in 2015; and Roche Diabetes' Accu-Chek pumps, pulled from the US market in 2017. Many feared that Tandem Diabetes Care was about to fail as well, and the former CEO confirmed they were on the brink, but fortunately the company rebounded and has come back strong with its Control-IQ system, the most advanced closed loop tech on the market heading into 2020.
10. Yet health outcomes still aren't great…
Even with improved tools and technology available, 2019 research from T1D Exchange illustrated that patient outcomes aren't always improving; they found that only a minority of adults and youth with type 1 diabetes in the United States achieve at-goal A1C results. Other research showed that glycemic targets are not being met by the majority of those with type 2 diabetes either. So just as we began the decade, we end it with the recognition of seemingly-endless work to do in improving care -- and life -- for those living with diabetes.
We're eager to see what the 2020s will bring -- especially some progress we may never have thought possible.