Glimpse at innovations in diabetes management in GCCGlimpse at innovations in diabetes management in GCC

There is a rising prevalence of diabetes globally. Approximately 537 million people aged 20 to 79 have diabetes, and the International Diabetes Federation (IDF) predicts that the number will rise to 643 million globally by 2030. Clinical studies have revealed that COVID-19 infection and mental health concerns have increased the risk of diabetes occurrence. Hence, there is a rising need to improve diabetes management and reduce the risk of diabetes-related acute and chronic complications such as retinopathy, foot ulcer, renal disease, heart attack, stroke, and ketoacidosis.

Current diabetes management strategies for people comprise glucose monitoring systems, hybrid-closed loop systems and pharmaceutical or biologic-based treatment strategies. Emerging approaches comprise incremental innovations to existing monitoring, drug, and delivery platforms and research and development of disruptive technology strategies for diabetes prevention and management.

Glucose monitoring

Glucose monitoring is a vital component of effective diabetes management. There is a rising need for continuous glucose monitors (CGMs) for people with type 1 diabetes (T1D) as it avoids multiple finger pricks for blood glucose testing. While most current CGM technologies comprise microneedle-based sensors for assessing glucose in interstitial fluid (ISF) samples, emerging non-invasive technologies can also assess glucose. Currently, most of the existing non-invasive technologies have lower accuracy in glucose sensing compared to the minimally invasive devices. However, the accuracy of the non-invasive devices is likely to improve in the next two to three years.

In 2023, Nemaura Medical’s non-invasive wearable glucose sensor, sugarBEAT, received Saudi Food and Drug Authority (SFDA) approval. The approval has the potential to improve the health of approx. 4.27 million Saudi Arabian adults with diabetes, which accounts for about 17.7 per cent of the adult population in Saudi Arabia.

Apart from improvements in accuracy, rising consumer focus through over-the-counter devices and device miniaturisation for convenient wearability are some focus areas for incremental innovations in CGMs. Dexcom, Abbott, Medtronic and Senseonics are a few leading industry participants for CGMs that use minimally invasive microneedle glucose sensing techniques. Within the Gulf Cooperation Council (GCC) region, some of the leading industry participants include Medtronic, Abbott, Dexcom and Roche.

Key emerging non-invasive technologies include radiofrequency and optical sensing methods in development stages by companies such as Know Labs and LifePlus. The Mean Absolute Relative Difference (MARD) of most non-invasive CGMs is currently above 10 per cent. However, the accuracy will likely improve in the next few years, which will pave the way for introducing non-invasive glucose sensing methods for diabetes management. Such a development will also enable the adoption of CGM use among people with type 2 diabetes (T2D).

Emerging artificial pancreatic systems

Hybrid-closed loop insulin delivery systems, or artificial pancreas, are emerging as an important tool for diabetes management, especially among T1D patients. The artificial pancreas comprises three core components: CGM, an insulin pump and an internal or external digital device for monitoring blood glucose levels. The HealthPlus Diabetes and Endocrinology Centre, Abu Dhabi, has been offering Medtronic’s MiniMed 780G to people with type 1 diabetes since 2021.

Currently, some of the major challenges of using artificial pancreas include the need for manual complex carbohydrate calculations, a narrow glucose target range, and a need for more accuracy in measuring the flow and volume of insulin delivery in real-time. There are also very few artificial pancreas systems that have regulatory clearances. Emerging innovations in this space are addressing some of the major pain points. For instance, Beta Bionics has developed US FDA-cleared iLet Bionic Pancreas which does not require the user to manually calculate carbohydrate intake but needs the user only to be carb aware. Sequel Med Tech’s US FDA-cleared twist system allows the accurate measurement of every insulin dose that is delivered. Currently, only Insulet Corp offers US FDA-cleared tubeless insulin pumps. However, more companies such as Embecta and PharmaSens will be closer to launching and commercialising tubeless insulin patch pumps for increased user convenience.

Artificial pancreas systems are also being developed for people with T2D; companies such as Beta Bionics, Sequel MedTech, and Embecta are already working on them. Emerging innovations that comprise all-in-one modular bionic pancreas devices have the potential to transform global diabetes care in the long term.

Disruptive insulin delivery technologies

Multiple daily insulin injections are painful, and there is a need to change the insulin delivery site continuously for optimal insulin delivery. This can have an adverse impact on patient compliance. Microneedle-based insulin delivery or the use of insulin pumps may not be fully reimbursed, which can lead to increased out-of-pocket costs for diabetics. Emerging innovations in insulin delivery are addressing some of these challenges through the development of smart insulin pens and pumps that provide better glycaemic control and reduce pain when compared to manual syringe-based delivery.

Connected smart insulin pens, patch-based tubeless insulin pumps, implantable insulin delivery devices, and insulin jet injectors will be a few of the key innovations that will transform insulin delivery strategies. For instance, in 2023, Gulf Drug launched EOPatch, a wearable insulin pump from EOFlow, in the UAE. Gulf Drug is also preparing for the launch of EOFlow in other GCC regions, such as Saudi Arabia. This will enable precision diabetes management for the region.

There is rising interest in the development of oral or inhalable insulin formulations that can help improve patient compliance for diabetes management. MannKind Corporation’s Afrezza is the only US FDA-approved inhalable insulin formulation currently available. Companies such as Oramed and Biocon are developing oral insulin formulations that are in Phase 2-3 clinical trials. Hence, oral insulin formulations may be launched in the next few years to help improve diabetes management and patient compliance.

The way forward

In the next few years, there will be rising collaborations among insulin delivery companies and CGM providers to develop hybrid closed-loop systems for effective diabetes management. There will also be increasing device-software collaborations to help improve automation in artificial pancreas systems and automated diabetes care. As the usage of mobile devices and the internet is steadily increasing in the GCC regions, there will be an expansion in the applications of health technologies to include innovations for the prevention and management of lifestyle diseases such as diabetes.

For instance, algorithms such as Tidepool Loop and Diabeloop will be used more often to automate diabetes management in the future. Adoption of such technologies will also help offset the adverse impact of rising GCC healthcare expenditures, which are increasing due to the rising incidence of obesity and diabetes in this region.

There is also a steady rise in global funding for diabetes management technologies. Biolinq raised US$58 million in 2024 to advance its intradermal glucose sensor through clinical trial studies. In 2023, Persperion received US$4 million to fuel the research and development of sweat-based glucose sensors. Rising funding will help develop new user-focused technologies for precision diabetes management in the future. Non-invasive glucose sensors, miniaturized artificial pancreas systems, and oral insulin formulations will be key growth opportunities in connected diabetes care.

Vandana Iyer is Research Director for the TechVision Practice at Frost & Sullivan.