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Karin's Corner

Beating Diabetes

Diabetes is a tough disease to live with – I know this first hand. I was diagnosed with Type 1 Diabetes (T1D) the summer I was turning 17, and it changed my life. At the time I was a competitive athlete, playing tennis on the Swedish National Team, and an excellent student. Nothing had prepared me for this diagnosis. We did not have diabetes in our family, and I had no friends with the disease. I saw it as a defect and a failure. It became something I would hide from everyone for many years.

Almost twenty years later, I received MD and PhD degrees from the Karolinska Institute, a post doc at Harvard, and worked on Wall street. I had taken a company public on NASDAQ and become a partner at a Venture Capital Fund, but I was really not feeling well. The spring of 2007, 18 years after my diagnosis, my kidneys and eyes were failing, my blood pressure was uncontrollably high and my hemoglobin was so low that I required blood transfusions. What happened? Well, diabetes had slowly but surely destroyed my system, and was on its way to take my life.

This was when I realized that I cannot hide my condition, and that the treatments on the market are not good enough – there must be a better way.

Fast forward 10 years, I had now been the head of Metabolic Strategy at JNJ, had a senior role in the world’s largest diabetes foundation, JDRF, and had run clinical trials in diabetes for a biotech company that I had helped take public. Most importantly, I had gone through two transplants and received a pacemaker. The pacemaker was placed due to repeated fainting episodes that would happen inconveniently, and often risked major injury and even death. Before the pacemaker, my heart would just stop because of diabetes nerve damage and complete body fatigue from all the injuries I had endured. I was also given a kidney from my father that saved my life, and a pancreas transplant from a deceased donor. I finally had a new chance to make life worth living again.

It is 2017. I am a strong, happy and very determined woman; but I am far from done. My company, Lyfebulb, is here to make a difference and I will not give up until we have accomplished our goals.

Diabetes is not a lifestyle disease.

It is a disease that slowly but surely kills, cripples and debilitates. I wish it were cured and abolished from our planet but in the meantime we need to address it much more aggressively.

Our current landscape of companies is driven by a few very large ones that have provided patients with the life-saving drug, insulin, since its discovery in 1921. These companies, namely US-based Eli Lilly, Danish Novo Nordisk and French/German Sanofi, are enormously dedicated to diabetes, patients and to research. The developments over the years included using insulin used derived from pigs and cows that was modified by the addition of zinc in the 60s to influence the absorption of insulin. Then, in 1977 Herbert Boyer of Genentech developed the first engineered insulin, so-called “human insulin”, and in 1982, Eli Lilly did a deal with Genentech and started selling Humulin. Insulin analogs were introduced in 1996 and 2001, which triggered higher pricing for the products, although marginal improvements in diabetes measurements such as long-term glucose control (HbA1c) were achieved. The price of insulin rose by a multiple of 25 from the 70’s to 1996, and in 2001 the price increase had risen to 35 times that of bovine insulin. At this point, Lilly owned the US market with an 85% share, and Novo Nordisk was mostly successful in Europe. What happened in the past 10 years is remarkable. The insulin market has tripled, currently being in excess of $30B, from $7B in 2006, and predicted to approach $45B in 2021.  The insulin market is currently one of the largest therapeutic markets in the pharma world, and before its patent expiry, Lantus (Sanofi) was among the  World’s 5 largest drugs by revenue and clearly by profit. Even after generic entry, Lantus is among the top 10 at almost $8B sales.

So have we beaten diabetes in those years? No.

Being diagnosed with T1D is no longer a death sentence, but we are far from done. Despite having the best doctors, education and access to care, I struggled with control and eventually suffered from microvascular complications clearly driven by diabetes. Insulin, for me, was not enough and I am not alone. Diabetes is still the most common cause for blindness, kidney failure and amputations in the developed world, and increases the risk for heart attacks and stroke by about 4 times. It also leads to depression, cognitive dysfunction, impotence, dental disorders and various other issues. It truly attacks every cell in the body and accelerates the aging process.

What is happening in the innovative landscape, such as academia and small companies, is not reflective of the severity of the disease.

While we are seeing major influx of capital and talent into important areas such as cancer, immunology, and infectious disease, we are not seeing the same in diabetes. The average endocrinologist is above 60 years of age. Young scientists are not lining up to do research in diabetes, and funding into disease organizations for diabetes is going down as evidenced by JDRF research funding. In fact, 2015 revenues were down by $84M from 2008 and $26M from 2014 (http://thejdca.org/jdrf-financials/).

The for profit side is not much better. Venture capital is not going toward diabetes, and the new IPOs are not diabetes companies. An analysis done by BIO, showed that of all private financing only 5.7% went to metabolism, while 24.2% went to oncology. Only 5.3% of IPOs were in the metabolism field, while 22.8% were oncology related (https://www.bio.org/articles/emerging-therapeutic-company-investment-and-deal-trends). In the established company’s deal-making allocations, metabolism did even worse, with 3% of all licensing and M&A deals being in metabolism, while 26% went to oncology and 28% to infectious disease.

There are some great examples of success in our space where risk takers have made money and delivered new therapies and devices to market that have made a differences. We applaud investors in, for example, Dexcom (Don Lucas) and Animas (HLM management), companies that brought us continuous glucose monitoring and consumer-friendly insulin pumps.

Currently, we believe in the future for several companies, for example the ten finalists in the Lyfebulb Novo Nordisk Innovation 2016 Award competition including marketing veteran, Jeff Dachis’s OneDrop, John Sjolund’s Timesulin and newcomer (and winner) Brianna Wolin’s FidYourDitto. http://lyfebulb.com/lyfebulb-innovation-award-at-the-innovation-summit/. Recently, JDRF, announced the launch of their T1D Fund which will aim to invest donated funds into companies and their first bet was on BigFoot, a company run by former JDRF CEO, Jeffrey Brewer.  

What is also interesting when you reflect on the diabetes industry is the lack of smaller, public companies that are willing to place bets on emerging technologies and settle for revenues that are less than blockbuster quantities. There are less than 20 public diabetes companies in the US, with a majority being very large, and at least half of them in devices (http://investsnips.com/list-of-publicly-traded-medical-equipment-and-device-companies-focusing-on-diabetes/).

These kind of numbers do not generate new drugs/diagnostics/devices to help improve the quality of life for people with diabetes. The total number of people with diabetes is growing exponentially. There are 29 million diabetics in the US, 86 million with prediabetes, and a worldwide prevalence of over 400 million. The cost of diabetes in the US is approaching $300B, up from $245B in 2012 (http://www.diabetes.org/advocacy/news-events/cost-of-diabetes.html?gclid=CMPI_KCe4NECFQ6BswodnE4PlQ ). Interestingly, the cost is not driven by the drugs that treat diabetes (12% of total), but by the cost for complications and hospital care.

So what can we do about this relative lack of innovation and disinterest from the medical and investment communities about a disease that is taking lives, crippling people, and causing enormous damage to our economy? In my opinion there is a big need to change our attitude toward diabetes. Type 2 diabetes is not a lifestyle disease that can just be addressed with diet and exercise. Type 1 diabetes is not a disease that can merely be addressed with insulin and better glucose measuring methods. More insulin in type 1 causes more difficulties in regulating sugar and a greater likelihood of complications. Not addressing the underlying problems with type 2 diabetes will never solve the problem of why certain families have both obesity and type 2 diabetes in every generation.

I was wrong when I hid my type 1 diabetes for almost 20 years, and I was wrong when I tried to show that diabetes did not affect me.

Type 1 diabetes does affect the person and we must take it seriously. I know that organizations advocating for diabetes often try to portray success stories of people running fast, jumping high, climbing mountains, and winning trophies, but that is not the norm and those people would be winners with or without diabetes. Before I was diagnosed with diabetes I was the third best tennis player in my country and the top student in my school. I was a competitive person and diabetes did not change that, it actually drove me harder, but my body eventually told me to stop.

We must encourage financial institutions such as venture capitalists and banks to invest more money into companies doing innovative work in the field. We must encourage research in academia, and we must push the large companies that are doing well selling drugs that save our lives. Only with a newfound interest in the area will we see talent moving to diabetes, and only with the clear articulation of an unmet patient need will we see the overall landscape shifting towards addressing the opportunity. Investing in metabolic companies is a target for Lyfebulb and we hope many will join us. It will bring both health and wealth to our constituents.

Together we can beat diabetes.

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