What Am I Thankful for This Year?

Twitter Summary: What is @kellyclose thankful for in 2015? Heart safety, better tech, new drugs, and growth of @diaTribeNews – but still work to be done on health #equality

Every year around Thanksgiving and World Diabetes Day, I look back at the year and reflect on all that I am thankful for in the field of diabetes. For sure, 2015 has been filled with a lot to be grateful for – major scientific and technological advances, groundbreaking clinical data on reductions in serious heart complications, and more focus on personal care.

But I’d be remiss to call 2015 a grand slam, and I’m sure you feel the same. We’ve seen incremental and important steps, but I remain concerned about access to care, the number of people with out-of-control blood sugars, the expanding burden of complications, and the shrinking number of providers to care for a growing patient population. The need for better care has never been higher. When I was diagnosed nearly thirty years ago, 15 million people globally with diabetes didn’t have good control. Now, it’s in the hundreds of millions. If that’s not a sobering reminder of how far we have to go, I don’t know what is.

But let’s not forget the accomplishments. The amazing work of our peers and of researchers, policymakers, and managers around us. The long hours put into what for so many is a labor of love. The inspiring stories from people with diabetes who continue to live life to the fullest every day. We have so much to be thankful for, and I’m eager to share what I see as the field’s top accomplishments.

For complications, the EMPA-REG cardiovascular outcomes data was the best news of the year so far – by a long shot! This trial found that Jardiance (an SGLT-2 pill for type 2 diabetes) led to a 38% reduction in cardiovascular death in people at high risk for heart disease. If the clinical trial data applies in the real world, this drug could potentially save thousands of people from heart complications. Imagine: a drug that not only lowers blood sugar, but that protects your heart? This is the stuff I’ve dreamed of for years. I myself am now trying out Jardiance “off-label,” and I’m looking forward to more data of these drugs in other type 2 and type 1 populations. (Of course I would never advise even considering this without working with your healthcare team.)

I also am thankful for the continued progress in technology. I think back to The diaTribe Foundation’s book, Targeting a Cure, that was published in 2012; the automated insulin delivery section would need to be rewritten at this point, just because so much progress has come in three years. Adam and I participated in a home trial testing an artificial pancreas 24/7 – what a tremendous experience that was. The notion that a hybrid closed-loop system would be in a pivotal trial in 2015 was unthinkable a few years ago.

This year, it was also clear that many more people at intersection of healthcare and technology want to have an impact in diabetes. The tech field is entering diabetes in a bigger way, headlined by Google Life Sciences, now a division of Alphabet. The group announced two major partnerships in diabetes this year (Dexcom and Sanofi) on top of its partnership with Novartis, joined the American Heart Association in a $50 million initiative to treat and end heart disease, and named OUR disease as its first focus area. Tech companies bring tremendous consumer software and electronics expertise and just plain intelligence in user interface experience, and I hope these companies can take diabetes care to another level – better data, more actionable therapy recommendations, and far better user experiences. What do you think?

2015 also saw the toolbox expand with combination drugs and new insulins launching. This year, several new diabetes drugs were approved or launched in the US: the inhaled insulin Afrezza, basal insulins Toujeo and Tresiba, and combination pills Synjardy and Glyxambi, to name the main ones. Now with Tresiba’s approval, we can hope that Xultophy – a combination injectable drug with compelling glucose-lowering effects already approved in Europe – could join that list in the US in the coming year, as well as LixiLan, a drug of the same class. Compare that to when I was diagnosed, a time when drug options included insulin, sulfonylureas, and not much else. What does that mean for patients? It means more options, and it means the opportunity to find out what works for you.

What’s at the top of my gratitude list on the drug front? The inhaled insulin, Afrezza. It’s fashionable right now to be negative on Afrezza – it’s had a disappointing first year in sales, which isn’t uncommon for new insulin analogs, or just new products in general. While we have underestimated the challenges associated with Afrezza going on the market, we believe patients need alternatives – if everyone were at their goals using traditional treatments, we could all go home! But since we’re not, and since hundreds of millions globally aren’t at their glycemic targets, we think it’s very important to work on removing barriers to provide another alternative. We know that some people with diabetes struggle with injections, and for them, Afrezza can make it much easier to take insulin at mealtimes – and even though it’s not on the label, there is certainly word that it’s faster and associated with less hypoglycemia. For that, we’ll need to wait to get data from new studies, but in the meantime, we think more alternatives should be considered.

Last, I am thankful for the growth of The diaTribe Foundation. What began as a patient newsletter back in 2006 has grown into a full non-profit organization. Our staff has doubled in the past year alone, and we’re only getting (and dreaming) bigger. We used to send one issue every two months – now we’re at every two weeks – and working to bring you much more information daily through social media. I also always feel VERY grateful for the amazing team we have at diaTribe - Alex, Nicole, Reed, and Christie, with some incredible advice from our Board of Directors and all of our Advisory Board members, of course! And I love that my kids and husband always show excitement for what diaTribe is trying to do in the world. And to our readers, thanks so much for all of your support. We can’t improve diabetes alone. Find out how you can help us here.

In closing, I want to circle back to access and education. Progress in drugs and devices will only matter if these products can reach patients, and patients become more engaged in their own diabetes management. Equal access to healthcare is far from where it needs to be: at a population level we aren’t seeing the outcomes we should be, co-pays have never been higher for those fortunate enough to have insurance in the US, and out-of-pocket costs continue to rise. My hat goes off to the FDA, researchers, and industry members who have shown such innovation in diabetes drugs and devices – we need these tools to keep moving forward. And in tandem, let’s make access and education at the front of our minds as we enter a new year.

Here’s to 2016 being full of progress, happiness, and health.

very best,

Kelly Close