From a century of insulin to a future of personalised diabetes care

For Miranda, being diagnosed with Type 1 diabetes was devastating. She was just 15 years old and although she knew it was a serious condition, she had no idea just what an impact it would have on her life.

Treatment for diabetes may have changed considerably since the initial discovery of insulin 100 years ago, but the burden for people living with the condition remains palpable. From weighing her food to carrying jelly babies wherever she goes, the daily impact diabetes has had for Miranda, now 28, is significant.

Type 1 diabetes means Miranda's body produces no insulin so, in order to survive, she must use a pump attached to her stomach which injects insulin directly into her body numerous times a day.

“Living with diabetes is a 24-7 condition,” she says. “It's like having a full-time job – you don’t switch off from it. You ride the rollercoaster and learn how you react to certain things and develop different coping mechanisms.

“Sometimes the most difficult part of diabetes can be the really small things like not being able to be spontaneous with food or picking out clothes to wear. I even had to choose a wedding dress which would accommodate my insulin pump. I don’t mind telling people I have diabetes, but I didn’t want my wedding day to be about my condition, I just wanted to be like everyone else for the day,” she adds.

INNOVATION: TURNING THE TIDE ON AN EPIDEMIC

Despite the daily challenges, Miranda, from South Wales knows how lucky she is to have access to life-saving treatment and personalised care. She believes this has allowed her to live her life to the fullest and do things she may never have tried were it not for having diabetes, such as running a marathon and working as a charity fundraiser.

“I wish I’d known when I was first diagnosed that I was still going to have a really good and exciting life - that I’d still do amazing things like go to university, run my own business, run a marathon,” she says.

“I like to keep challenging myself to show diabetes doesn't stop me from doing anything. It’s the private achievements that I am really proud of like getting through Christmas Day with my glucose levels in a good range,” she adds.

According to Diabetes UK, there are currently more than 4.9 million people in the UK with diabetes, 90% with Type 2, 8% with Type 1 and 2% with a rarer type1. Diabetes is a serious and complicated condition where a person’s blood glucose level is too high. This happens either when the body doesn't produce enough of the glucose regulating hormone insulin, the insulin it does produce isn't effective, or when the body can't produce any insulin at all2.

Type 2 diabetes can be as a result of excess body weight and physical inactivity3,4. Type 1 is triggered by a still unknown cause which makes the body attack the insulin-producing cells in the pancreas, stopping the hormone from being made and meaning the body cannot regulate glucose levels itself5.

Diabetes UK predicts that almost one in 10 of us - 5.5 million people - could be living with diabetes by 2030, with up to 17 million - or one in three UK adults - at an increased risk of developing Type 2 diabetes alone6.

This is why it is essential to find innovative new ways to prevent the condition, improve care when it does occur and limit the long-term health and societal impacts of diabetes in the future.

HOW THE DIGITAL REVOLUTION IS MAKING IT PERSONAL

Insulin has saved millions of lives worldwide over the past century and there is little doubt that its discovery is one of the greatest medical breakthroughs in history, revolutionising both the treatment of diabetes and outlook for patients.

But scientific endeavour never stands still and research continues to uncover new and exciting insights not just about treating diabetes, but about the disease itself.

As well as finding that there are many more types of diabetes than the well-known Type 1 and Type 2, the age-old understanding of who gets each of those two main “types” has been turned on its head. Type 1 was typically seen as a "childhood disease" as it is typically diagnosed in children, teenagers and young adults, however it can in fact occur at any age. Type 2 diabetes was seen as more of an "older person's disease" as it is most often found in the over 45s, but it is increasingly being diagnosed in children, teenagers and young adults7,8.

Just as every person is unique, every person’s diabetes is unique to them, as is their journey living with the condition. Diabetes Your Type encompasses a new approach to tackling the condition, focussing on personalised care from precision medicines and individualised treatment plans to improve patients’ lives.

Jessamy Baird, Managing Director at Sanofi UK, says: “Each person living with diabetes experiences something individual to them. We’re at a key turning point in healthcare with the digital revolution accelerating and delivering innovation at a record pace. Our focus is now centred on how we ensure we meet the individual needs of patients by combining precision medicine with digital technologies and devices to help them better manage their condition, their general wellbeing and even their mental health.”

USING THE POWER OF TECHNOLOGY TO IMPROVE OUTCOMES

There has been a complete paradigm shift in recent years with how people with diabetes manage their conditions. Although insulin-based medicines still have a huge role to play, a new path is being forged which takes their care beyond medicine and into a more comprehensive ecosystem of diabetes care which in turn harnesses the power of digital health. 

These upcoming changes will see the use of real-world data, analytics and widely used technologies such as mobile phones linked to Continuous Glucose Monitors and even smart pens to enable every individual to manage their diabetes based on their personal daily needs.

Miranda, who has been using an insulin pump for the past three years, says: “Technology has been a real game changer for me and completely lifted the burden of living with Type 1 diabetes. 

“It means I can physically show people what it’s like living with diabetes – the charts and graphs the tech produces, which shows them my optimum 
glucose range then what has happened when I’ve eaten a bowl of porridge, it’s gone up then back down. It’s easier for them to understand and 
that's really empowering as a person living with diabetes.”

ADDRESSING THE HIDDEN IMPACT

Although earlier diagnosis, greater treatment options and new innovations are making it easier than ever before to manage diabetes, people living with the condition often still face challenges to seamlessly fit their care into their daily lives.

Education is vital to help people feel more in control of their diagnosis but also for healthcare professionals to understand not just the physical impact but the mental toll living with diabetes can have on individuals.

For Kevin, 29, who works as an automation engineer in Dublin, Ireland, and was diagnosed with Type 1 diabetes when he was 14, there have been difficult days dealing with the condition.

“If you are not controlling your diabetes, it doesn’t just affect your blood sugar it can affect your eyesight and your healing capacity,” he says. “If you think about the impact it can have on you too much, it can really drive you down into a black hole.

“If that happens, I find setting myself goals for a week’s time, a month’s time gets me through it. I would be lying if I said it doesn’t bring down my mental health because it has in the past and I am sure it will again in the future but I try to keep a positive outlook,” he adds.

It is in the area of mental wellbeing that new digital capabilities will soon start to make an impact on how patients are treated more holistically.

According to Baird: “This is a great time for digital innovation. We can enhance what the NHS currently provides with better self-care for patients using digital devices and we believe there is a willingness among those living with diabetes to adopt these technologies. It is also about helping reduce health inequalities to ensure all patients have access to the right support tools at the right time.

“But it’s about so much more than just physical wellbeing – it’s about mental health too. That is why we are using Artificial Intelligence to approach new ways of providing psychological support for people potentially with diabetes or other chronic conditions which we hope we can talk more about soon.”

A FUTURE FOR INDIVIDUAL CARE

The future of diabetes management and patient care has shifted from being a one-size-fits-all approach to one completely focused on individuals. One hundred years on from the discovery of insulin, diabetes is no longer about treating and caring for everyone in the same way and, thanks to the promise of the digital age, that personalised, holistic care is fast becoming a reality.