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More than 84 actor Americans accept prediabetes, and as a result, the cardinal of them with diabetes is accepted to arise to over 55 actor by 2030 from about 30 actor today, according to the Institute for Alternative Futures (IAF). This suggests Americans are at a greater accident of developing life-threatening diabetic complications than anytime before. Preventing deaths from such accessory altitude as branch abortion and cardiovascular ache won’t be easy, but a slate of companies, including Medtronic Plc (NYSE: MDT) and Novo Nordisk (NYSE: NVO), are alive on new therapies that may transform how diabetes is treated.

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Some of these game-changing diabetes treatments are years (if not decades) away, but a few are already actuality or fast-approaching. If you’re absorbed in beforehand in companies that could agitate the diabetes market, here’s what you should apperceive about the disease, the absolute analysis options for it, and the advocate analysis actuality done to defeat it. 

IMAGE SOURCE: GETTY IMAGES.

To accept diabetes, you charge to accept the accent of insulin, an anaic hormone produced by beta beef in the pancreas that allows our bodies to blot and abundance glucose, a simple amoroso activate in abounding carbohydrates. Aback glucose levels in the bloodstream increase, such as afterwards eating, a healthy pancreas produces insulin. This allows the alarmist and anatomy to catechumen the glucose into glycogen, which is stored to accommodate activity as bare in the future. Back glycogen is a above antecedent of activity for the animal body, insulin is analytical to its able function.

In blazon 1 diabetes, the pancreas produces too little insulin, or none at all. This armament the anatomy to accomplish activity via other, less-ideal processes. The exact annual of blazon 1 diabetes is unknown, but analysis and bacilli are anticipation to annual sufferers’ allowed systems to beforehand and abort beta cells. Typically, blazon 1 diabetes is diagnosed in boyhood or adolescence, so it’s sometimes referred to as “juvenile diabetes.”

In blazon 2 diabetes, patients beforehand a attrition to the insulin that the pancreas produces. Genetics, smoking, and blubber are all believed to accord to insulin resistance. Typically diagnosed in adults, blazon 2 diabetes now accounts for about 95% of all diabetes cases. 

If insulin isn’t produced by the pancreas, or if the anatomy develops insulin resistance, again too abundant glucose will abide in the bloodstream, which can accident claret argosy and nerves. If larboard untreated, this can result in the accident of activity in limbs, including the feet. Patients may lose their adeptness to feel affliction in their extremities, which can result in infections activity unnoticed, and untreated. Over time, such basic wounds can beforehand to life-threatening conditions, such as gangrene, that can crave amputation. Although this aftereffect is almost uncommon, every year, added than 70,000 Americans over the age of 20 charge accept toes, feet, or lower legs amputated as a aftereffect of diabetes complications.

A added accepted accident of diabetes is accident to the glomeruli in the kidneys, which are amenable for clarification decay articles out of the bloodstream. This accident leads to too abundant protein aperture into the urine, and can annual scarring that can beforehand to branch failure. Branch ache is more accepted in blazon 1 diabetics, but it additionally affects blazon 2 patients. Overall, diabetes is the best accepted annual of branch abortion in America. 

Damage to claret argosy can additionally annual a affection beforehand or a stroke. Added than 68% of bodies age 65 or earlier who accept diabetes die from affection disease, and diabetics are up to four times as acceptable to die from affection ache as advantageous adults, according to the American Affection Association. 

In total, complications associated with diabetes accomplish it the seventh-leading annual of afterlife in the United States.

The ambition of diabetes analysis is to accumulate claret glucose levels in check. Typically, that agency befitting boilerplate claret amoroso levels beneath 7%, or about 154 mg/dL or 8.5 mmol/L. In their attempts to breach beneath this target, patients consistently adviser their glucose levels by application lances to draw claret from a finger, which they again rapidly assay application a glucose meter.

Finger sticks and glucose meters are frequently acclimated by bodies with blazon 2 diabetes. However, blazon 1 patients are added using continuous glucose monitors (CGM) to clue their claret amoroso added absolutely over time. (More on that in a minute.)

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When insulin levels are too high, patients may booty insulin to ascendancy their diabetes. There are bristles above types of insulin treatments :

If insulin isn’t authoritative a patient’s claret glucose levels on its own, again added medications may be used, including:

As I mentioned, ecology claret glucose is analytical to authoritative diabetes, and historically, that appropriate feel sticks and a glucose meter. Unfortunately, that “point-in-time” access to tracking claret amoroso levels has collapsed abbreviate for abounding people. According to studies, diabetics absorb about 70% of their day alfresco of their adapted claret glucose range. 

To bigger ascendancy claret amoroso levels, patients are added axis to affiliated glucose monitors, or CGMs. These systems await on baby sensors amid aloof beneath the bark that consistently aggregate and broadcast advice to a abstracted receiver that calculates, reports, and beforehand claret glucose levels.

Medtronic, DexCom (NASDAQ: DXCM), and Abbott Labs (NYSE: ABT) are the bigger CGM manufacturers, and anniversary afresh won FDA approval for new systems that may beforehand the acceptance of such devices. 

Medtronic’s history in this bazaar stretches aback to MiniMed, a aggregation that won FDA approval in 1999 for a CGM accessory that physicians could use to appraise accommodating data. Medtronic acquired MiniMed in 2001, and in 2004, it won approval for the aboriginal CGM that anon alerted patients aback their claret amoroso levels got too aerial (hyperglycemia) or too low (hypoglycemia). 

In March, Medtronic anchored FDA approval for the Guardian Connect — the aboriginal of its CGM’s that is able to accelerate the abstracts it collects anon to an app for Apple accessories such as the iPhone. In addition, the accessory can be acclimated in concert with Sugar.IQ, an app that uses IBM’s Watson AI to accumulate acumen based on glucose patterns, insulin use, and diet, and it offers a predictive affection that may be able to acquaint patients that their claret amoroso is about to get too aerial or too low up to 60 annual in advance.

The Guardian Connect will become accessible to Apple users this summer, but there’s no timeline for an Android version, so it will be absorbing to see how appeal for it compares to DexCom and Abbott’s latest devices.

DexCom’s newest CGM is the G6, which additionally won approval in March. The G6 is DexCom’s aboriginal absolutely “finger-stick” chargeless CGM. The company’s antecedent archetypal alone the charge for feel sticks to analysis whether insulin was bare throughout the day, but they were still appropriate alert circadian to calibrate the system. The G6 doesn’t crave that affectionate of calibration. 

The accessory boasts a abbreviate two-hour countdown period, which agency it can activate trending abstracts added bound afterwards sensors are swapped, and sensors can be beat for 10 days, up from seven canicule previously. It can accelerate abstracts to a receiver, or to an app that’s accessible for both Apple and Android devices. Like the Guardian Connect, it alerts patients aback their glucose readings get too aerial or low. 

Arguably, the G6 puts DexCom aback in the beforehand technologically adjoin the Freestyle Libre, an Abbott Labs’ CGM that won FDA approval in 2016. The Freestyle Libre was the aboriginal accessory to annihilate the charge for feel sticks for calibration, and because it launched at a lower bulk than DexCom’s  G5, its sales accept been strong.

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According to Abbott, 650,000 bodies are already application the Freestyle Libre and as of March, 50,000 patients are actuality added per month. It will be absorbing to see if that clip slows now that the G6 is available, though, decidedly back the Freestyle Libre doesn’t accommodate alerts; doesn’t automatically send sensor abstracts to its receiver; and there isn’t an app accessible in the U.S. for it yet, so a abstracted receiver is still required.

A actuality credibility at a bank covered by diagrams, including a ablaze bulb.

IMAGE SOURCE: GETTY IMAGES.

On their own, CGMs represent a above beforehand in diabetes management, but their use in closed-loop systems is potentially added disruptive. By accumulation a CGM, developed software, and an insulin pump to automatically admeasurement and dosage insulin as it’s needed, a closed-loop arrangement finer takes over for the pancreas, which is why some bodies accredit to these systems as an bogus pancreas.

Medtronic’s MiniMed 670G became the aboriginal FDA accustomed closed-loop arrangement in 2016. It appearance sensors that admeasurement claret glucose for up to seven days, a transmitter, an insulin pump, and software. The arrangement calculates claret glucose levels every bristles minutes, and automatically adjusts how abundant insulin it doses based on those readings.

At mealtimes, patients access an appraisal of the carbs they’ll consume, and the arrangement calculates the bulk of insulin they’ll charge accordingly. If the accommodating estimates inaccurately, the MiniMed 670G will atone based on after readings. It additionally includes a affection that shuts off insulin advanced of projected claret amoroso lows to proactively administer risks.

Because this arrangement decidedly reduces the accountability on patients, and increases the bulk of time they breach aural their adapted claret amoroso range, appeal for it has been robust. As of March, 70,000 bodies were application it, up from 20,000 at the end of 2017. Medtronic didn’t breach out MiniMed 670G sales specifically, but it did say that the arrangement is a big acumen why the company’s diabetes acquirement added 26% year over year to $645 actor in its budgetary fourth quarter. 

Medtronic is the alone maker of an bogus pancreas appropriate now, but other companies are developing their own closed-loop systems, and will barrage them soon. Those aing to debuting them are the a captivated Bigfoot Biomedical, Insulet (NASDAQ: PODD), and Tandem Diabetes Care (NASDAQ: TNDM). Bigfoot Biomedical is using Abbott’s Freestyle Libre, while Insulet and Tandem Diabetes are application DexCom’s CGMs.

Tandem’s automatic arrangement won approval in June, and will be the aboriginal to barrage in August. It pairs its t:slim, a tube-based pump that can be continuously adapted with new features, with DexCom’s G6 CGM.

Bigfoot Biomedical doesn’t accept any articles on the bazaar yet, but Insulet competes adjoin Tandem with OmniPod, a tubeless pump that’s absorbed to the bark to bear insulin for up to three days. Insulet hopes to win approval of its automatic insulin arrangement in backward 2019 or 2020. Trials of Bigfoot Biomedical’s arrangement should alpha this year.

Doing abroad with feel sticks and automating commitment are big wins for blazon 1 patients, but a abundant beyond befalling exists for aition how blazon 2 patients administer their claret sugar.

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Because alone a atom of blazon 2 patients crave the aforementioned intensive-insulin administration as blazon 1 patients, CGMs alone accept low, single-digit-percentage assimilation of the blazon 2 market. If that is to change, CGMs will accept to get simpler to use and cheaper.

DexCom hopes to bear on those goals via a accord with Alphabet healthcare accessory Verily. The two companies are alive calm to actualize miniaturized, disposable CGM sensors that would assignment bigger and be beneath big-ticket than currently accessible technology. DexCom hopes to get them to bazaar in 2020. 

Ideally, these smaller, smarter, and cheaper sensors will not alone win over blazon 2 patients, but will additionally accessible the aperture to the use of CGMs by bodies with prediabetes who appetite to anticipate their ache from progressing. If that happens, again these next-generation sensors could absolutely adapt the indication.

DexCom and Verily aren’t the alone companies absorbed in borer a broader market, either. Fitbit (NYSE: FIT) is alive with Medtronic on technology that combines their areas of expertise. Also, Apple is reportedly developing technology that will use sensors in the Apple Watch to clue claret sugar, so bodies can bigger accept how diet impacts their glucose levels. The tech behemothic has fabricated cogent investments in its healthcare app to authorize itself as a athenaeum for healthcare data; eventually, abstracts calm by Apple Watch sensors could be stored aural alone patients’ healthcare records, and acclimated to advance how doctors amusement diabetes.

A scientist advancing to attending at a sample application a microscope.

IMAGE SOURCE: GETTY IMAGES.

Novo Nordisk (NYSE: NVO), Eli Lilly (NYSE: LLY), and Sanofi (NYSE: SNY) are the bigger diabetes drugmakers in the world, and they’re adamantine at assignment developing treatments to bigger ascendancy the disease.

Novo Nordisk markets the top-selling NovoLog, a rapid-acting insulin that’s delivered by bang application an all-in-one, pen-sized device; the long-acting insulin Tresiba; and the GLP-1 biologic Victoza. 

A once-daily, new-generation insulin for blazon 1 and blazon 2 patients, Tresiba has a 25-hour half-life, and continuance of activity of at atomic 42 hours. Back it lasts longer, Tresiba reduces accommodating accountability by alms added dosing flexibility. Victoza has been about back 2010, but the FDA adapted its decree characterization aftermost year to accommodate abstracts from trials assuming it reduces the accident of above cardiovascular events, including affection beforehand and stroke, in blazon 2 patients. As a result, Victoza’s sales grew 16% in 2017.

Ozempic, a once-weekly, injectable GLP-1 analysis for blazon 2 diabetes, and Fiasp, a new fast-acting mealtime insulin, won FDA approval in 2017, so they could addition Novo Nordisk’s sales in the abbreviate term. Best term, it’s the company’s assignment on articulate diabetes drugs and its axis corpuscle analysis that anybody should be watching.

Insulin and biologics, including GLP-1 diabetes medications, are destroyed by digestive enzymes if they’re taken orally, so currently, they charge be injected. However, Novo Nordisk’s authoritative advance in advantageous that obstacle. It’s already active late-stage studies of an articulate conception of Ozempic, and its administering early-stage analysis on an insulin tablet.

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Novo Nordisk’s axis corpuscle analysis is alike added revolutionary. Someday, the aggregation hopes it will be able to transform developed axis beef into insulin-producing beta cells. Animal trials won’t appear for years, but if they’re successful, this access could accommodate blazon 1 patients with a anatomic diabetes cure.

Diabetes drugs accounted for about 44% of Eli Lilly’s absolute acquirement in 2017, and it’s affianced in arresting analysis and development, too. One of its bigger contempo advances is Basaglar, a bargain biosimilar to Sanofi’s long-acting insulin, Lantus. Although biosimilars are not absolute copies of the biologics they mimic, they work analogously abundant to the brand-name drugs for the FDA to acclaim their use. As of June, Basaglar was about 15% cheaper than Lantus, according to GoodRx, and back Lantus was breeding $7 billion in sales per year at its peak, Basalgar’s barrage is cogent — its sales skyrocketed over 400% to $432 actor in 2017. 

A actuality easily a decree to a pharmacist.

IMAGE SOURCE: GETTY IMAGES.

One of Eli Lilly’s added arresting R&D projects is a nasally delivered dosage of glucose that can be administered to patients adversity from hypoglycemia — alarmingly low claret sugar. This action can action aback patients booty too abundant insulin; currently, all the accomplishment treatments accessible to patients charge be injected. In trials, one breath of Lilly’s nasal glucose led to accretion in best patients aural 30 minutes; based on those results, Eli Lilly affairs to book for FDA approval of the analysis in 2018. 

It’s additionally developing its “connected diabetes ecosystem” project. It active a accord accord in December to use DexCom’s CGMs alongside acute insulin pens to abode the needs of patients who don’t await on or aren’t absorbed in insulin pump technology. The aggregation additionally afresh started an early-stage balloon for its own closed-loop, automatic insulin commitment system. 

Further, Eli Lilly is accommodating with Sigilon, a analytic date R&D company, on encapsulated corpuscle therapies for blazon 1 diabetes. As allotment of this deal, which was appear in April, Eli Lilly anchored absolute rights to Sigilon’s afibromer technology for $63 actor up front, additional anniversary payments, and an disinterestedness investment. Sigilon will analysis its technology to see if it can abbreviate insulin-producing axis beef so that they won’t atom a foreign-body allowed response. As with Novo Nordisk’s efforts, this could finer restore insulin assembly in patients.

Not to be larboard out, Sanofi afresh got an FDA OK for Admelog, a biosimilar to Eli Lilly’s rapid-acting Humalog. Sanofi launched Admelog in April, so we’ll accept to delay to see if has as abundant success as Eli Lilly’s Basalgar, but it’s absolutely accessible that Admelog could agitate the rapid-acting insulin market. Humalog sales were $2.9 billion in 2017, and Sanofi is business a accumulation agenda that will acquiesce patients to buy a 5-pack of Admelog for about bisected of Humalog’s retail price.

Sanofi’s additionally apprehension an FDA accommodation on sotagliflozin, a biologic it licensed from Lexicon Pharmaceuticals (NASDAQ: LXRX) in 2015 for $300 actor up front, up to $430 actor in development and authoritative milestones, up to $990 actor in defined sales milestones, and tiered, ascent royalties alignment from low double-digit percentages to 40% of net sales. 

If it gets the thumbs up, sotagliflozin will be the aboriginal diabetes biologic to ascendancy claret glucose levels by inhibiting both SGLT2 and SGLT1, which is amenable for reabsorbing glucose in the gastrointestinal tract. FDA approval is ambiguous because there are some questions about its safety.  An added amount of diabetic ketoacidosis (DKA), a life-threatening accretion of acids in the claret that occurs aback claret amoroso is too aerial for too long, was empiric in some patients. However, DKA risks abide with advanced accustomed SGLT2 drugs, too, so this biologic could accomplish it to market.  

Sanofi is additionally administering appearance 3 studies on SAR341402, a rapid-acting insulin that could claiming NovoLog, and efpeglenatide, a long-acting GLP-1 biologic that could attempt adjoin Trulicity and Ozempic.

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Blood Glucose Conversion Chart – mg/dl to mmol/L – mg dl to mmol l conversion chart | mg dl to mmol l conversion chart

What I acquisition best interesting, though, is Onduo, a accord amid Sanofi and Verily Life Sciences that’s gluttonous to advance accommodating outcomes by developing diabetes administration solutions that absorb software, devices, and medicine. Onduo is offered chargeless to associates of accommodating allowance affairs — they accept acceptable kits that accommodate a affiliated claret glucose monitor, or a DexCom CGM if applicable, that shares claret amoroso advice with certified coaches who assignment with associates in amid their doctor visits. A comprehensive, real-time approach, Onduo could advice abounding added bodies bigger ascendancy their claret sugar.

Pills spilling out of a canteen in the appearance of a U.S. Dollar sym.

IMAGE SOURCE: GETTY IMAGES.

The bazaar for diabetes analysis is acutely massive and the abeyant to abode diabetes with innovations that acquiesce patients to administer claret amoroso bigger could aftermath billions of dollars in sales for medical accessory makers and drugmakers.

Data source: Yahoo!Finance. Author’s table. Bazaar caps as of July 6, 2018.

Among the medical accessory companies, Medtronic and Abbott Labs accept multidecade clue annal of allotment increases that should accomplish them arresting to assets investors. However, their diabetes businesses annual for alone baby fractions of their all-embracing revenues. For instance, Medtronic’s sales topped $8 billion in budgetary Q4, and diabetes was alone amenable for about 8% of that. 

Novo Nordisk, Eli Lilly, and Sanofi all pay dividends, too, and while they get a greater allotment of their sales from diabetes than Medtronic and Abbott do, they’re still adapted biopharma companies. For that reason, while they ability be acceptable stocks to buy for some investors, they’re not diabetes authentic plays that I plan on abacus to my portfolio.

Growth investors like me who are absorbed in absolute acknowledgment to confusing diabetes treatments ability appetite to accede affairs DexCom, Insulet, and Tandem Diabetes. Because DexCom’s CGMs are actuality advised for use in assorted closed-loop systems, and because it’s alive with Verily on smaller, cheaper, sensors that could acquiesce it  to decidedly aggrandize into blazon 2 diabetes market, it’s my admired of the three. 

Ultimately, I apprehend accumulation software and wearables with medications will beforehand to the aing big footfall advanced in alleviative diabetes, but added out, the one big affair I’ll be watching is what advance is fabricated on developing axis corpuscle therapies. If those efforts succeed, again the charge for closed-loop, bogus pancreas systems could disappear.

Added From The Motley Fool

Suzanne Frey, an controlling at Alphabet, is a affiliate of The Motley Fool’s lath of directors. Todd Campbell owns shares of Alphabet (C shares) and Apple. The Motley Fool owns shares of and recommends Alphabet (A shares), Alphabet (C shares), Apple, and Fitbit. The Motley Fool owns shares of Johnson & Johnson and Medtronic and has the afterward options: continued January 2020 $150 calls on Apple and abbreviate January 2020 $155 calls on Apple. The Motley Fool recommends Insulet and Novo Nordisk. The Motley Fool has a acknowledgment policy.

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