The Evolution of Diabetes Technology: Insights from Professor Chantal Mathieu

Diabetes care is on the brink of transformative changes thanks to advances in medical technology and a deeper understanding of the disease's pathophysiology.

In an enlightening interview with Professor Chantal Mathieu?from Katholieke Universiteit Leuven, Belgium, we delve into the current state and the promising future of diabetes management.

Prof. Mathieu shares her insights on the challenges and exciting developments in diabetes technology that could significantly improve patient outcomes.

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Overview of Professor Chantal Mathieu's Expertise

• Chantal Mathieu, MD, PhD, holds a pivotal role at the Katholieke Universiteit Leuven, where she is the Chair of Endocrinology at University Hospital Gasthuisberg.
• Her extensive research includes the prevention of type 1 diabetes, the immunological roles of vitamin D, and beta-cell functionality.
• Prof. Mathieu's work has been widely recognized, earning her numerous awards, including the InBev-Baillet Latour Prize for Clinical Research.
• Additionally, she serves as the president of the European Association for the Study of Diabetes (EASD) since 2023, further highlighting her influence and leadership in diabetes research and advocacy.

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What concerns you most about the future of diabetes care and diabetes technology?

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Prof. Mathieu:?Well, I am an optimist, and when I look at the positive things that are evolving in the world of diabetes,

I do believe that we have now a completely different forecast for all types of diabetes,

where we are getting better and better insights into the pathophysiology of the diseases.

And this opens also the possibility for disease modifying therapies.

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In type 1 diabetes, we now start to understand how the disease exists, who gets the disease,

so we're able to make the diagnosis at much earlier stages,

and also the first disease modifying therapies are entering the clinic.

So that makes me optimistic.

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Also in type 2 diabetes we now have disease modifying therapies.

Let's think of the GLP1 agonists and other incretin based therapies that can be considered as disease modifying.

They alter obesity, but they also alter complications of diabetes: they protect the kidney and the heart.

And so this makes me very optimistic.

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Where the worry lies, is in type 1 diabetes access to care.

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We live in Belgium, in a very privileged country, where access to specialist care for those living with type 1 diabetes, children and adults is quite good.

Our spread of endocrinologists and the level of education of our endocrinologists on type 1 diabetes care is excellent.

Access to technologies, for which we have fought very hard, is quite broad for people living with type 1 diabetes, ranging from glucose sensors to even hybrid closed loop systems, that are almost all coverable with our present reimbursement features.

We have a quite unique system where the technology and the education is provided in the specialist centre.

So that makes it very accessible.

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The worry is for type 1 diabetes access, not so much that people don't find a way to these technologies and to the specialist,

but the acceptability of the technology for some people, and the level of education around technologies that we're able to provide to people.

The fact that some individuals don't embrace technologies because of misunderstandings.

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In type 2 diabetes, there, the worry is mainly the numbers.

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The fact that type 2 diabetes is still on the rise and that non-specialists have to take care of people with type 2 diabetes.

90 percent of people with type 2 diabetes are treated in primary care.

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That means that we need to get our primary care physicians completely on board, when it comes to modern treatments of people with type 2 diabetes.

And that means therapeutic interventions, but also the use of technology.

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And when it comes to technology in type 2 diabetes, the boom is perhaps even bigger than what we saw in type 1.

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It's not only sensors, but also decision making or decision assisting apps.

• Apps that guide us in food choices,
• apps that guide us in exercise,
• in decision making on insulin doses, etc.

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And these technologies also need to enter primary care.

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If diabetes, like you and me, is our main business, it's also already challenging to stay informed about all the sensors, all the technologies, all the apps.

But imagine if you are in primary care where you're supposed to know the latest antibiotics for a pneumonia, or you know, the latest anticonceptive agent for any woman.

Being fully informed about technology in type 2 diabetes is a challenge.

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And so that is my worry, that there will be a complete disconnect in type 2 diabetes?between

• those who have access to all these fantastic technologies that support treatments of those living with type 2,
• and the vast majority, who will not have access to these technologies.

Also because the vast majority of doctors and nurses and dieticians will not have the complete access to these technologies.

That's a worry.

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So finding ways to inform people living with type 2, but also the medical and the paramedical people accompanying them is a challenge.

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What exactly excites you most about diabetes care in the near and distant future?

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Prof. Mathieu: To me, the most fun is the disease modifying therapies entering in type 1 and type 2 diabetes.

But also, of course, the technology explosion.

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In type 1 diabetes, disease modifying therapies are coming.

In the near future combining the immune therapies, for instance with islet transplantation from our stem cell research is also coming our way, but that will take a few years.

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At present, it is really the boom in technologies with now hybrid closed loop systems, with algorithms improving, with sensors improving,

all targeting, reducing burden of those living with type 1 diabetes and improving outcomes.

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And so there, technology is exploding,

algorithms are improving,

and meal announcement probably being the first low hanging fruit that will disappear.

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And then also, not only for people with type 1, but also for those living with type 2, even without insulin: all the apps,

• the healthcare apps,
• the food apps,
• the exercise apps,
• the dose decision apps for people with insulin,

all coming our way.

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I'm not sure if I dare to ask you, but when do you think type 1 diabetes will be cured?

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Prof. Mathieu: When I started 35 years ago, I always said: I will see it,?that people with type 1 are treated differently.

• I mean the disease modifying therapies are now here, they are entering the clinic.
• Screening for early preclinical stages of type 1 diabetes is here.
• The stem cell derived islet transplantations are happening.
• Encapsulation is being tested.

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I don't dare to put a term on it, but I hope to live long enough to see it happen.

Now things are really going rapid in type 1 diabetes.

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And in type 2 diabetes, if you look at the results of the incretin based therapies, the weight loss, the beta cell protection…

we are seeing a new phase of type 2 diabetes where significant weight loss and normal glycemia can be achieved.

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So, it's perhaps not a cure, but it's a completely different way of treating these forms of diabetes that we will see in the near future.

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What do you consider to be the strengths of INNODIA or other companies that you have founded or co-founded?

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Prof. Mathieu: So INNODIA.org is what we call in Dutch an iVZW, an international organisation without a profit.

So it's like a charity. That is actually a legacy of the projects of INNODIA that ran until the beginning of this year, 2024.

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INNODIA.org is a network of clinical trial centres and also a group of experts.

We now have over 80 members, experts that can be consulted for advice on clinical trial design, biomarker selection, and on protocol design.

And so what we want to do with INNODIA.org is really accelerate this path to prevention and cure

by guiding small companies, big companies, or academics who want to test specific interventions to prevent or arrest type 1 diabetes.

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We have more than 80 centres, and every day new ones are coming.

In Belgium, I think four or five centres have already been identified.

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Everybody, every centre who says, I want to be a clinical trial centre can just become a member.

If you are an associate member, you can apply for free.

If you want to have a voice and vote in the general assembly, then you need to pay 1000 euro.

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But so everybody can join, everybody can be accredited to become a clinical trial centre for INNODIA.

We have interesting webinars to train all clinicians to be ready for the disease modifying therapies that are coming our way.

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So I encourage more and more big centres to become a member of INNODIA.

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The feature of giving advice to companies and to others who want to test therapies is very important, because we really want to end this disease before I, perhaps not retire, but before I die.

We need to do the right tests.

We need to do the right trials.

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At the moment, several trials are running in INNODIA.org , one of which is Fabulinus , a trial by Sanofi, looking at CD40 ligand interference, but many more are coming.

So that's one thing we want to do, and that is to end type 1 diabetes.

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Another project that I want to mention is EdenT1fi , a project in the context of the innovative health initiative of the European Commission,

where we work together as academics and industry partners, to find the best way to screen for early stages of type 1 diabetes.

We want to measure how to do it, what is the impact, how to monitor.

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We have different countries in Europe where this is being tested.

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Belgium is not one of them because here we have the Belgian Diabetes Registry.

And so we want to start again with the Belgian Diabetes Registry also to expand and try and screen the general population,

not only the first degree relatives that we are able to do now with the Belgian Diabetes Registry.

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Also, is there a link with INNODIA.org where we will offer to the centres that are part of innodia.org to test first degree relatives or friends of people with type 1 diabetes with a capillary test.

So to make the burden of screening less important and then have the confirmation via an IV test.

But here we need to talk with the Belgian Diabetes Registry to see how we will organise it in Belgium.

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Via innodia.org all the members will be encouraged to screen first degree relatives, but also broader family members and friends of children with type 1 diabetes

so that we can identify people at the preclinical stages.

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And they all come into one big registry called the Pre T1D Registry.

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When trials are coming to Europe, we can rapidly enrol these people and offer them disease modifying therapies.

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So many projects are ongoing.

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What is interesting for technology is that in the trials we're doing, we're also including sensors

because we want to test also the finer metrics, not only HbA1c, but also time in range, time in tight range, time below range, et cetera.

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And even more in Edent1fi, we have a partner Medtronic who is also looking at whether they can make the algorithms for prediction of hyperglycemia finer in those with pre clinical stages of type 1 diabetes and predict who will go on to the clinical stage of type 1 diabetes.

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That will be particularly exciting, because screening, early detection, disease modifying, therapies and technology are all coming together.

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If we were meeting three years from now, what should have happened for you to feel happy with the progress that you've made for yourself, for your companies, or in diabetes care in general, for you to be happy with the progress?

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Prof. Mathieu:?In three years, I would hope we not only have one disease modifying therapy for type 1 diabetes in clinic,?and then I mean in routine clinical use,

so that every person in the late preclinical stages of T1D, so stage 2 T1D and stage 3 T1D, so the newly diagnosed clinical type 1 diabetes would receive a disease modifying therapy as standard of care, trying to protect the beta cell mass.

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In three years, I would hope we not only have one, and the first one will be Teplizumab, but that we would have more disease modifying therapies in our hands already,

and that we have a rich pipeline of products that we are testing at that moment in people with even earlier stages,?so people with just antibodies against the beta cells, so the so called stage 1 T1D.

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I would also hope that our hybrid closed loop systems are a bit less hybrid, but are able to indeed not need boluses anymore,

but that they would detect mealtime, and that they would give them automatic.

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That we would have sensors that would live longer, and would eventually also measure more metabolites than just glucose.

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For type 2 diabetes, I would hope that we have multiple incretin based therapies also in clinic, again, disease modifying, at an affordable price, which will be a big challenge.

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And that also more people with type 2 diabetes would have access to glucose sensors.

Again, affordable, so that also people with basal insulins in our country and non insulin treated people with type 2 diabetes could use these glucose sensors, be it intermittent, to guide them in their therapy.

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So these would be my dreams in three years.

And I think several of them would be possible.

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Do you think it's possible that Teplizumab will be reimbursed within three years?

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It will be clinically accessible.

And I would guess looking at the number of people getting the diagnosis of T1D per year, it should be an accessible therapy in most countries.

So I would hope for reimbursement, at least in my little country.

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Conclusion: Pioneering the Future of Diabetes Care with INNODIA

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As we stand on the threshold of groundbreaking changes in diabetes management, propelled by technological innovations and deeper scientific insights,

the insights from Professor Chantal Mathieu, a renowned diabetes researcher, underscore the potential and urgency of advancing diabetes care.

Her conversation reflects both the challenges and the profound optimism she holds for the future.

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Diabetes technology, particularly in managing type 1 diabetes, has made significant strides, yet issues of access and educational disparities remain.

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Prof. Mathieu's work through initiatives like INNODIA offers a beacon of hope.

INNODIA.org , an international non-profit organisation, is at the forefront of accelerating diabetes research and clinical trials across Europe, aiming to revolutionise prevention and treatment strategies.

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The organisation's inclusive approach allows various centres to join and contribute to the global effort against diabetes.

By participating in INNODIA, members gain access to a wealth of expertise and the opportunity to be involved in cutting-edge clinical trials and educational webinars.

This collaborative effort is crucial for devising and implementing disease-modifying therapies that promise to change the landscape of diabetes care.

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For those interested in making a significant impact, or simply staying informed on the latest developments in diabetes research, joining INNODIA could be a transformative decision.

Furthermore, INNODIA encourages the general public to participate in proactive health measures, such as screening for type 1 diabetes,

to identify and manage this condition from its earliest stages.

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To join the fight against diabetes, to contribute to pivotal research, or to start screening initiatives within your community, visit INNODIA.org .

Together, we can work towards a future where diabetes care is more effective, accessible, and preventive,

aligning with Prof. Mathieu's vision of a world where diabetes is no longer a lifelong burden but a manageable and potentially preventable condition.

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Kind regards,

Inge