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Winter and the BUGS

Autoimmune diseases such as MS, Rheumatoid arthritis, psoriasis, Crohn’s and ulcerative colitis all have the basic problem where the individual’s immune system turns against itself as opposed to fighting the outside world. Something beyond the genetic set up is needed to trigger the disease and so far, celiac disease (or gluten intolerance) is the only autoimmune disease where we know what the trigger is – gluten. There are about 100 different autoimmune diseases, and in the US alone, about 50M people suffer from one or more of these conditions.

Type 1 diabetes is also an autoimmune disease, but in contrast to the ones I mentioned above, the treatment is rather different due to the progression of the disease. When a person is diagnosed with T1D, their insulin-producing cells are almost already all gone. Although scientists have shown that the human pancreas may have some regenerative capacity under certain conditions (obesity and pregnancy for example), we are not leveraging that in today’s clinical practice since there is no drug approved for that purpose yet, and we have not come up with a safe way to combat the immune system at the same time. That is the very issue with T1D, it is a constant battle between the body’s own immune system which is trying to destroy insulin-producing cells, and the lack of the body’s regenerative capacity in the pancreas. This battle can be distorted for years, and that is why some people are diagnosed as toddlers while others in their 40s! When one is diagnosed as an older individual, most often the disease is less aggressive, and perhaps these individuals still have some cells left and thus some endogenous (their own) insulin capacity.

Back to the contrast with other autoimmune diseases – in diabetes the treatment is to replace the missing hormone, insulin or to enhance the effects of insulin, while in other autoimmune diseases the treatment is to reduce the autoimmune attack since the tissue that is being destroyed often is regenerated in between flares. For example, in Crohn’s disease, the intestine is the target, but during long periods of time, there are no symptoms at all, and the goal of course is to maintain that status for as much time as possible without impacting other functions of the immune system.

So what are the risks now that we are entering the winter months? Well, for one, the flu season is upon us, children are gathering inside rather than outside, incubating their germs and spreading them more easily. There is no good scientific episode to show that the cold weather would trigger virus and bacterial infections, but common sense still says we seem to get sicker when we are cold. A person with an autoimmune disease, who needs daily medication to inhibit the immune system from destroying an organ system or tissue, is more vulnerable to catching and developing a more serious infection. The bigger problem is when the individual has caught an infection, and it spreads, since the best way to limit the damage is to improve one’s own system, but by doing this, the autoimmune disease is less restricted and can cause a flare.

My personal situation is further complicated by two organ transplants and the medication I am taking to reduce the risk of rejecting those organs. When I develop an infection, my doctors often reduce the amount of immune suppressing medication I take to allow for my own system to get rid of the infection in addition to quickly determining what the agent is that we are dealing with so that the right kind of anti-infective medication can be put in place. Targeting the virus, bacteria or parasite correctly and quickly is of utmost importance, and today’s analytical equipment is quite sophisticated but it still often takes days for the final result. Prior to having that, the doctors often prescribe some super duper antibiotic to kill off a majority of bugs, and in my case, that lead to opportunistic bugs taking over last year and three bouts of clostridium difficile ensued. When the immune suppressants have been reduced, I face two major threats, one being rejecting my kidney and pancreas on the basis of foreign bodies inside my body, and the second one my own autoimmunity may flare up and start attacking the new pancreas, like it did my first one.

My advice to anyone with an autoimmune disease, or with an organ transplant, is to try to avoid getting sick! Easier said than done, and one cannot live one’s life inside a bubble, but there are a few simple precautions:

1: avoid interacting with large groups of people (especially young children) inside during the winter months

2: wash your hands after using public transportation and before having food or drinks

3: do not eat any raw foods in restaurants, including pre-cut fruits

4: ask for water without ice when traveling to exotic places

5: if someone at work or in school is sick, do not interact with them

6: as soon as you start feeling a cold coming on, take precautions such as hydrate, rest, and if you have a temperature, seek medical advice asap

7: make sure you have taken the flu shot and any other vaccinations appropriate in the locale you are residing

 

 

Diabetes and Tennis:When I Was First Diagnosed

I used to play tennis every day and often more than 1 hr each day – I loved the game and I was very good at it. This was before I was diagnosed with diabetes – after that, I never won again and I lost my love for the game completely.

I don’t think diabetes is 100% to blame for this, but probably at least 50 percent. When I was diagnosed, the summer of 1989, I had just reached the finals of a large national tournament in Sweden, and even though I lost in the final, I had done very well, especially since I had suffered from tonsillitis three times during the spring preceding this event, and I had been seriously injured the year before.

However, after my diagnosis I lost my confidence in my body. I had never had such a failure in my life and here I was, at 17 years of age (I spent my bday in the hospital getting trained on injections and glucose monitoring), feeling like I was suddenly disabled. Little did I know that the complications they warned me about during those first few weeks with diabetes would be a reality less than 20 years later and that I would go through two transplants before I turned 40!

Tennis represented so much to me as a young person, I spent most of my free time either playing tennis, getting to tournaments, working out to play better or preparing ahead of games. I loved going to my club and I even loved hanging out after tennis, relaxing and feeling the work-out in my body and if I had won, feeling strong and confident.

I guess the closest to this feeling in my current life, is when I present at conferences or when I have an important business meeting. I have the same feeling of anticipation, preparation and then during the presentation I have a high – triggered by endorphins and I am on top of the world for the duration of the event. The problem is coming down afterwards.  Being in the zone is all and well, but afterwards I feel empty, anxious and even sad.

As a diabetic, sometimes these events could be affected by my disease. For example, if my blood sugar was running low and I had to go up on the stage for a presentation, I would need to quickly eat something to avoid the risk of passing out and the absolute certainty of presenting poorly because my brain did not have enough sugar to work with. When I was high, I could also feel it, since I would get slower in my thoughts and especially in my reasoning. I would rather be high than low, and my solution to avoiding this roller coaster was to always keep myself slightly high, but not high enough to be slow, blurry-eyed or lethargic.

After getting my pancreas transplant in January of 2010 I have not experienced any of these feelings and it is such a relief and such an advantage! I sometimes say that I did not know how hard it was living with diabetes before I got a pancreas transplant and realized what normal life is supposed to be and how good I felt. Achieving that feeling for everyone with diabetes is our goal, and while we pursue the cure, we need to identify a range of products that can help people with daily life.

I hope that I will get back to tennis one day, but for some reason, tennis more than any other sport is linked to my life before diabetes that I lost. I know that I have a new chance, and should be incorporating tennis into my life, but it is easier for me to exercise otherwise without ever feeling that diabetes, transplants and age have had a negative effect on my performance!

New York-based Lyfebulb is helping diabetes patients become ‘patient’ entrepreneurs

Lyfebulb showcases and mentors ‘patient entrepreneurs’ – entrepreneurs who are affected by chronic diseases and are building businesses which target those suffering from chronic diseases.

Karin Hehenberger was diagnosed with Type 1 diabetes in 1989, at an early age. Her chronic illness required her to go through kidney and pancreas transplants. With a dual perspective as a patient and a doctor, Dr Karin decided to do something to help other people impacted by chronic illnesses, to work on businesses that will help other patients.

Karin founded Lyfebulb with two close friends and colleagues, Riccardo Braglia, CEO of Helsinn, and Stephen Squinto, Venture Partner at Orbimed and Co-founder of Alexion. The idea was to build an organisation that bridges patients with industry. “After my experience as a medical doctor, healthcare executive, and Type 1 diabetic, I personally understand that there’s a gap in the development of solutions for patients and know the impact patients can have on improving solutions to their quality of care,” Dr. Karin says.

She wanted to showcase individuals who, like her, were not accepting of the role of a passive patient, but willing to take on the challenge of changing the future for themselves and others living with chronic disease. Lyfebulb calls these individuals “patient entrepreneurs” not to be confused with the meaning of ‘patience’. These people are anything but patient, but they are living with a chronic disease or closely related to someone with a chronic disease and they are not just sitting back waiting for solutions. They are out there creating products and solutions that may help them and others in the near term.

Although it is not a requirement that the founders be patients of chronic diseases, they have to be personally affected by diabetes or a chronic illness. They often have the disease themselves, other times a friend or family member is living with the disease.
Lyfebulb Entrepreneur Circle features people who have made their disease their career. They identify an issue in their lives with the disease and then they address that issue by creating a product or an entire company. At Lyfebulb, they maintain a blog and are active on social media as a way of building the community and getting valuable information to people living with chronic illness. They have hosted many events in different areas of chronic illness, including diabetes, cancer, and inflammatory bowel disease (IBD), which are informational as well as community building. They hold innovation summits with large companies where they ask patient entrepreneurs to apply, choose 10-12 finalists, and then bring them together to compete for monetary prizes and interact with a pharma leadership, VCs, and thought leaders.

“We have hosted 26 events in the three years since we started Lyfebulb in New York City, Stockholm, and Copenhagen. This year we are hosting our second annual Innovation Summit in Copenhagen, Denmark and next year, we will host another summit/award in another therapeutic area, in addition to diabetes,” adds Dr Karin on their events so far and future plans.

Lyfebulb has entered into a partnership with Novo Nordisk to grow the Lyfebulb Entrepreneur Circle and to establish the Lyfebulb–Novo Nordisk Innovation Award to recognize promising startups founded by patient entrepreneurs. The winner of the 2016 edition of the award was Brianna Wolin, CEO & Co-Founder at Find Your Ditto. Brianna has lived with Type 1 Diabetes and Celiac Disease most of her life. Find Your Ditto is the only mobile platform that connects individuals living with the same chronic illness locally for on-demand, in-person peer support to mitigate feelings of loneliness and depression. Users can find their ‘dittos’ and begin to feel like “it’s not just me.”

Lyfebulb also mentors patient entrepreneurs and they help certain companies secure funding through their network. While they do not have an incubator currently, forming a virtual one is in the pipeline. They are also contemplating on raising a venture fund called Lyfebulb Ventures, but may proceed with making specific investments into companies instead.

Source: Your Story

Press Contact for Lyfebulb: 
Shepard Doniger
BDCG, Inc.
561-637-5750
sdoniger@bdcginc.com

The Importance of Patient Entrepreneurs

Lately, there has been a change in the approach of how people are perceiving diabetes and the people living with the disease. 

When I was diagnosed with T1D in 1989, diabetes was considered a very serious disease. One changed behaviors, got on insulin, and tried very hard to avoid going high in blood sugar to avoid complications. Nowadays, the attitude is that we live with the disease and can be like everyone else! ‘The disease should not limit us, and if we use advanced gadgets we can live beyond the disease without thinking about it too much.’

As you can imagine, this attitude does not work with the chronic and progressive nature of the disease.

Despite all technology, we cannot live a life without thinking about diabetes all the time if we want to stay healthy.

This is the problem with today’s approaches and the spirit in which we are teaching our newly diagnosed friends and family. There are definitely individuals who, like me, want to understand every aspect of diabetes to treat it better and to find a cure for everyone. Though the larger group of people just want a life in which they can focus on family, work, hobbies and everything but diabetes!

So what can we do? The over ambitious few will always pursue additional detail, perfect blood sugars and the financings of products that make the control a little bit better with a lot of extra effort. Even I, being an MD, PhD, and life sciences executive for almost two decades, could not manage the technology day in and day out. I ended up attempting to stay stable, but was a little too high most of the time (which led to kidney and eye complications). So how can someone with a busy life who is less tech savvy use all these new devices?

For the people with little time to themselves, lack of access and training, we must find other motivators and ways to achieve control until we find real cures.

There are great examples of success using this principle – John Sjölund created a cap for insulin pens that tells the patients when and how much insulin was dosed; Jennifer Ross is responsible for Bemixed, a sugar-free, organic and delicious cocktail mixer; Jeffrey Brewer leads Bigfoot with a team of people motivated beyond money to create a closed loop that removes the burden of dealing with diabetes; Matt Loper motivated by his family’s plague with T2D is creating an incredible based adherence plan that helps patients improve their health and thus reduces costs for insurers and providers. Finally John Crowley’s career has been motivated by his children’s struggle with Pompe’s Disease, a rare neuromuscular disorder, to found Novazyme Pharmaceuticals in his quest to find a cure.

At Lyfebulb, we want to create an environment where leading drug/device/biotech and Healthcare IT, as well as consumer companies, listen to innovators and leaders from the patient communities – not just for marketing and advocacy but for innovation and strategy.

Patient Entrepreneurs are future leaders in their own space – they are motivated by their personal curse that they have turned into a passion and an opportunity to create wealth and power.

What could be better from a socioeconomic perspective than to move the cost from the victim to revenue generated by a patient leader?

As people living with diabetes, it should never be a sacrifice to modify our diets or change our behavior – it is an investment in our future! Take charge of your health and future – become or start supporting patient entrepreneurs!

Where Are They Now? 2016 LBNN Award Finalist: John Sjölund, CEO and Co-Founder at Timesulin

In continuing our “Where Are They Now” series where we follow up with the finalists of the 2016 Lyfebulb-Novo Nordisk Innovation Award, we spoke with John Sjölund, CEO and Co-Founder of Timesulin. Since the award, the biggest news for John is that his business was acquired by Bigfoot Biomedical and he will be joining the team to lead their initiatives to bring a connected insulin pen, with automated dose titration to market. Read on to learn more about the partnership, his opinion on Patient Entrepreneurs, and his piece of advice for those thinking of applying for the 2017 Lyfebulb-Novo Nordisk Innovation Award.


Bruna Petrillo: Hi John! For those who are not familiar with your company, tell us a little bit about Timesulin.

John Sjölund: We created Timesulin based on my own experiences of living with Type 1 diabetes for over 30 years. Living an active life and traveling, I was constantly struggling to remember if I had taken my insulin, via an insulin pen, or not.

Frustrated at not having any product that could solve my issue ever come to market, together with a friend, we 3D printed our first product. As I started showing it to more people, more wanted one. We had a business on our hands accidentally. The product is not used by hundreds of thousands of people around the world.

Timesulin is a replacement cap for the most commonly used insulin pens used today. It has a simple timer in it that tells you when you took your last insulin injection  -helping you to avoid a missed dose OR dangerous double dose.

BP: 3D printing- that’s great! You were a participant of the 2016 LBNN Award, could you tell us what your biggest take-away from the Summit was?

JS: I was amazed at the size of Novo Nordisk – both in terms of the physical size of their production facilities as well as a number of incredible talents engineers they had that participated in the summit. There are a lot of people with diabetes and we know that most of them desperately need help to allow them to live safer, more balanced lives.

Additionally, it was a fantastic opportunity to network with Karin of Lyfebulb and the other participants. The entire group is so passionate, so smart – I was amazed.

BP: Why do Patient Entrepreneurs matter?

JS: Unfortunately, it is very hard for people that are not living with a chronic disease, to understand the huge burden we have all day long to take care of it. It is never ending and relentless.

Being a patient, I believe, provides a unique window into the cognitive challenges of living with the disease and what tools, no matter how simple, can be created to reduce the burden.

BP: Since the LBNN Award, Timesulin has been acquired by Bigfoot Biomedical. Can you tell us a bit about this acquisition?

JS: We are absolutely thrilled to be joining together with the team at Bigfoot to continue to drive towards making diabetes simpler, safer and promoting better life balance. I have never encountered a team that has such a strong personal commitment or vision to dramatically change diabetes for the better.

Bigfoot will be incorporating the Dose Capture technology we have developed into their platform. What this means is we will have a comprehensive solution to dramatically make diabetes easier – through machine learning, automation and smart design, no matter how you decide to take your insulin.

we will have a comprehensive solution to dramatically make diabetes easier…

BP: How do see you the future of this partnership and Timesulin?

JS: As the future of diabetes. Connected products that allow for automated decision support and auto-titration is the final step, I believe, before smart insulins and ultimately a cure.

Patients who want to use closed loop systems (sometimes called artificial pancreas) should be able to leverage the best technology irrespective if they want to use an insulin pump OR an insulin pen. We will allow for this.

BP: What advice would you give to those applying for the 2017 LBNN Award?

JS: Spend time on your application since this is circulated widely before you have the opportunity to present in person.


Learn more about the 2017 Lyfebulb-Novo Nordisk Innovation Summit & Award and apply HERE.

 

Real Talk With Dave: Motivation & Diabetes

You can do it!

I know Diabetes is hard, but you can do it. There are days in which it seems impossible, but those are the days in which we push harder, gain strength, and fight even more for an end to this horrible disease. I have had my share of bad days, and still get them, but on those very days, I feel like I am learning vital life lessons on how to cope in a bad situation, how to treat others, and how to rise up.

Despite the needles, the blood, the emotions, the highs and lows, and the day to day tasks we have to remember to do, we are all awesome for being able to put up with these tasks and are all capable to keep on pushing through. I personally think it is so cool, as much as I would give up this disease on any given day, how we as Type 1 Diabetics have put up with so much that goes unnoticed. In my opinion, we all deserve awards, just saying. But that is because some people come and go in our lives and don’t quite realize all that we put up with daily or are even going through at that very moment. Regardless of the fact, YOU are amazing. We’ve all lived countless days with this disease, trying to make ends meet, trying new diets and workout routines, and meeting with our doctors just to get things right, but whatever may be going on, good or bad, you are awesome. Nobody else puts up with the things you do and that is why you are so cool.

When I see someone who has Diabetes or a chronic disease and they are doing something so great, whether they are working towards a great cause, doing what they love while dealing with their disease, or even just smiling, that is such an inspiration to me by seeing how they manage to stay so happy when I know that they are going through something that does present some challenges every now and then. I truly see the good in them and though I feel bad they have to deal with their disease, I am proud of them and applaud them for what they do and how they do it. We all are unique individuals with a desire to learn and grow, we all are creative and special, and when it comes to T1D, that is something that connects us all. If Diabetes hadn’t affected the millions of people it has, many of us wouldn’t have the social connections we have with each other right now or we wouldn’t have something to be inspired by.

What I am trying to say is that coming from a background with Diabetes and living it for almost half my life now,

I am filled with appreciation for the members of the Diabetic community as we are some of the strongest and bravest people out there.

Each disease has it’s own difficulties and struggles.When one is affected by Diabetes, it may seem like their life is over, but that is not the case. Diabetes can and will turn you into someone you didn’t think you could be. When I was first Diagnosed, my life turned around completely and I had taken a huge step back, but then I think of where I am now. I am alive, happy, and healthy, despite my Diabetes, and that is all that matters.

So I ask you so think of what your passion is and what motivates you to keep on going. After that, just go with it and live your purpose. Life is short and yes, you may have Diabetes, but that is okay, because you can live the life you want if you set your mind to it. I’m here for you, rooting for you, and cheering you along the way in this race to the finish line being a cure to end Type 1 Diabetes. You got this!

Live well,

Dave

Where Are They Now? 2016 LBNN Award Winner: Brianna Wolin

As we look forward to the 2017 Lyfebulb-Novo Nordisk Innovation Summit & Award, we are also taking some time to reflect back on last year. In our series, ‘Where Are They Now,’ we chat with the finalists of last years award to hear about the importance of the award in the future of diabetes management, and what they have been up to since then.

To kick off the series, we spoke with the winner of the inaugural 2016 Lyfebulb-Novo Nordisk Innovation Award, Brianna Wolin, CEO and co-founder of Find Your Ditto.


Bruna Petrillo: Hi Brianna! For those who are not familiar with your company, tell us a little bit about Find Your Ditto.

Brianna Wolin: Find Your Ditto is a mobile platform that connects people living with the same chronic illness locally for on-demand, in-person peer support. Individuals living with chronic illness(es) are 2-3x more likely to live with depression comorbidly than the general public; however, in-person peer support has demonstrated strength in combatting the concern. Find Your Ditto serves to mobilize peer support communities for chronic illness patients, ultimately seeking to influence poor self-efficacy and reduce the associated unnecessary healthcare spend annually.

BP: What is the importance of Patient Entrepreneurs?

BW: As I tell people frequently when speaking about my work on Find Your Ditto, Patient Entrepreneurs have a unique, crucial advantage in understanding their target market. We are both designers and users of solutions, situating ourselves at an often un-accessed crossroads where we can make more impressive impact on our own patient communities.

…Patient Entrepreneurs have a unique, crucial advantage in understanding their target market

BP: You were a participant of the 2016 LBNN Award, what was your favorite part, and biggest take-away from the summit?

BW: The summit was an incredible experience. As a near life-long diabetes patient watching the evolution of concerns in the diabetes community— most recently focused on #insulinforall— I was an average insulin consumer believing I was paying the big Novo Nordisk entities huge dollar numbers annually to stay alive without feeling that there was recent innovation in care nor particular concern from the big corporations for their patients. The summit provided me the opportunity to meet the real people behind the life-sustaining drugs I take every day. I learned deeply about their concerns regarding the slow pace of innovation due to the true corporate structure hold-ups and how they do, in fact, feel personally upset with the current state of the diabetes community’s relationship with the pharmaceutical industry. It’s easy to forget the faces and spirits behind our concerns as a community and the summit gave me new perspective about the desire for innovation within pharma.

BP: How did you feel when you found out you were the winner of the award?

BW: As most of the online community has seen, my jaw literally dropped when my name was announced {be sure you see that video clip!} I was surrounded by a cohort of true diabetes innovators and am forever grateful to be considered in their company and to call them close friends in this important field of patient entrepreneurship.

BP: What has been your biggest accomplishment since the LBNN Award?

BW: The Find Your Ditto team has been busy since the LBNN Award! Most notably, we’ve really adjusted our business model and secured healthcare system partners for paid pilots this year. Additionally, I was honored to be in the WiSTEM women-owned business accelerator within the #1 technology incubator in the US, 1871 Chicago.

BP: Tell us how you see the future of Find Your Ditto.

BW: As entrepreneurs, we’re always talking about our visions. My cofounder, Parisa, and I always speak about five years down the line— we imagine a world where no person living with chronic illness ever has to feel alone. We talk about the day where Find Your Ditto is a resource given to all patients from the moment of diagnosis through their chronic illness journey.

BP: What advice would you give to others who are applying for the 2017 LBNN Award?

BW: This year’s award promises to be everything last year’s was and more— complete with VC conversations and even a monetary prize! But, make no mistake— one of the biggest values in this award is being in the company of other diabetes innovators. As a mentor of ours, Ryan Gourley of TechArb, always says:

“just throw your hat in the ring.”

If you are thinking about applying but fear that you’re “not ready” or “not quite the fit”— put an application in! Use every opportunity available to you to get your idea out there. And contact me if you have any questions via LinkedIn or brianna@findyourditto.com.

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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