Devices for a Diabetes Epidemic
This article was originally published in Start Up
With an increasing emphasis on tight glycemic control in diabetes care, innovative devices could play a big role, but diabetes is a deceptively complex market. Innovative companies need to differentiate themselves, yet not venture too far outside existing industry dynamics. As the first real-time continuous glucose monitors come to market, a handful of start-ups hopes to be ready for the second generation. Many of these are taking a side excursion into the market for in-hospital glucose monitoring, once a sleepy market but now growing rapidly as outcomes data shows reduced mortality and morbidty in intensively managed hyperglycemic hospital patients.
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Numerous physiologic pathways lead to obesity; those related to hunger, satiety, the breakdown and absorption of nutrients, and the regulation of energy. Given the complexity of obesity, it's not surprising that diet and exercise aren't currently effective and that drugs have had only modest success. Bariatric surgery, on the other hand, which reduces the size of the stomach (and, in some versions, also reroutes part of the small intestine so that food bypasses it) is extremely successful. Many patients that have undergone the Roux-en-Y gastric bypass procedure have sustained losses of 50% of their excess weight out to ten years and beyond. Now companies with minimally invasive devices for the treatment of obesity hope to fill the therapy gap between dieting and invasive surgery. It's too early to claim victory, but start-ups and scientists are benefiting from a better understanding of why gastric bypass surgery works.
In the past, it has been challenging for developers of non-invasive glucose monitoring systems based on optical platforms to separate out the signal generated by glucose from a high level of background "noise." Freedom Meditech, which uses a beam of red light to detect the concentration of glucose in the eye, believes it overcomes this problem and expects to sell its devices directly to consumers and through traditional diabetes product distribution channels. The company is also in the final stages of development with an in-office diabetes screening system that employs similar technology to identify individuals who may have undiagnosed diabetes or pre-diabetes.
It's the end of a dynasty in the traditional market for self blood glucose testing--the test strips and hand-held monitors that patients have been using as the mainstay of their diabetes management. The four major companies, once differentiated players in a high growth market, have cut R&D and marketing budgets in the face of increasing commoditization. But a new era in continuous glucose monitoring has begun, and that sector is poised to grow in coming years, according to "US Markets for Diabetes Management Products," a report published in May 2009 by the Medtech Insight division of Elsevier Business Intelligence.