Predicting the future is hard enough at any time, but even more so when a global pandemic clouds the crystal ball.
Nevertheless, Professor Jonathan Shaw, deputy director at the Baker Heart and Diabetes Institute, was prepared to share his thoughts with the limbic about what to expect in diabetes in 2022.
On the topic of COVID-19, Professor Shaw said endocrinologists can expect to hear much more about the impact of COVID-19 on people with diabetes.
Clinically, the impact of lockdowns may well include delayed diagnoses and sub-optimal management.
“Clearly there has been reduced access and it’s come from many directions – people not wanting to go [to appointments], and even if they are offered telehealth choosing to wait and see what happens, services being restricted and of course now, so many staff being furloughed which means technically the service can be available but might not be available.”
Professor Shaw said the disruption from COVID-19 at a research level has also yet to become fully apparent.
“I think it is going to take 2-3 years for us to really see the impact of all the restrictions in research. I’m not sure we’ve seen it yet. The problem has been that funding continues and we continue to pay staff but staff aren’t being as productive as they would like to be because of the voluntary and involuntary restrictions. That means that as funding comes to an end, studies won’t have been completed.”
He said people will continue to hear this year about the links between diabetes and COVID-19. For example, a 2021 report from the CDC provided evidence of a higher incidence of newly diagnosed diabetes in children after a COVID-19 infection.
“We still don’t have much in the way of high quality data on that but I think that is an evolving story,” Professor Shaw said.
“We will also see information on whether vaccination works as well or works differently in people with conditions such as diabetes. Again, it’s always such a rapidly changing environment that it can be hard to establish studies that do this well.”
Management of diabetes
Professor Shaw said there will continue to be more information forthcoming regarding the use of SGLT2 inhibitors and who benefits the most, including people who don’t have diabetes but have heart or renal disease.
“I think there is at least one other major trial, not focussed particularly on diabetes, that will be coming out this year – essentially more information about the value and the role of those medications.”
“In terms of new treatment, I think the next thing we will see and I don’t believe it will be launched here this year but might be in the US – is these combined GLP-1/GIP receptor agonists.”
“The leading one in terms of what is published… is tirzepatide. There are already a good number of papers about it. It has a much bigger effect on weight and HbA1c than we have seen with anything else before.”
“This brings about the possibility of many people normalising blood glucose, not just making it a bit better, and getting weight reduction of the sort that people are looking for.”
Professor Shaw said other drugs produced weight loss of 1.5, 2, 3, or 4 kg when targets were often 10, 15 or 20 kg.
“It does look like this has that kind of capacity. Maybe not up to 20 kg but 10, 12, maybe even 15 kg is not uncommon with this agent.”
He said that higher doses of semaglutide (up to 2.4 mg) and dulaglutide (up to 4 mg) were also in the pipeline with larger effects on weight loss though not as much on blood glucose.
“We are now getting our hands on tools that are effective and safe, that we haven’t had before. For many years we have had weight loss drugs that either don’t lead to much weight loss (up to 5 kg) and or have had side effects. Either that it is an unpleasant drug to take or there is uncertainty over the long term benefits.”
“The other thing that will continue to evolve is technology in diabetes and that will relate both to progress in technology, mainly to do with pumps and glucose sensors, and also their funding.”
“Exactly when is very hard to predict but it will happen and we will see these technologies being used more and more widely.”
Disclosures: Regarding his comments on tirzepatide, Professor Shaw said he has worked with Eli Lilly.