American Society of Plant Biologists

We didn’t make that up, the ASPB is an actual thing. Before you start in with your favorite Little Shop of Horrors plant references, you might want to wait. Some background: montbretin A (MbA), a natural compound with the potential to treat type-2 diabetes, was discovered in the ornamental plant montbretia 10 years ago, but it couldn’t be produced on a large scale until its biosynthesis was understood. Scientists have now discovered genes and enzymes responsible for MbA biosynthesis and demonstrated the potential for metabolic engineering of wild tobacco to produce this promising drug candidate. Seeing that the 2016 global diabetes drugs market was valued at ~$31 billion and is estimated to reach USD ~$45 billion by 2021, the question is, who will license the technology? Our guess, Novo Nordisk.

Money, meet Mouth

In a move that InsightCity writers believe will become more popular in the coming years, Medtronic announced it’s putting its money where its mouth is for their MiniMed 670G insulin pump system (not for the popular BBC antiques television show). Already well established for the treatment of type 1 diabetes, Medtronic is looking to take a larger part of the larger type 2 market. According to the announcement, “with this guarantee, Medtronic will provide flat-fee reimbursements up to $25,000 per pump over 4 years for qualifying diabetes-related inpatient hospitalization and emergency room admissions for eligible in-network patients in the United States.” These outcomes-based pricing models have been in play for a bit and they are evolving. Italy has used them with limited success since 2016, according to this Wall Street Journal article. We’re just sayin’, we hope it works.

Precision medicine + diabetes

Time to break down diabetes into more subtypes than the amount of Wilford Brimley parodies there are on YouTube. Ok that might be an exaggeration because there are a TON, but Swedish & Finnish researchers are making an argument that we should probably have more than just the current two subtypes. They propose keeping Type 1 as its own thing, but expanding Type 2 into four clusters that are more descriptive of their causes. The basic breakdown is: Cluster 1, severe autoimmune (the former Type 1;) Cluster 2, severe insulin-deficiency; Cluster 3, severe insulin-resistant; Cluster 4, mild obesity-related; and Cluster 5, mild age-related. According to researcher Leif Groop, this is “a real step towards precision medicine. In the ideal scenario, this is applied at diagnosis and we target treatment better.” Increasingly patient-centric approaches will always get a thumbs-up from us.

Adding CAR-T to the shopping cart

How about some exciting, multi-billion dollar deals to spice up the first quarter? First, Sanofi acquired Bioverativ, a hemophilia-focused biopharmaceutical company that spun out of Biogen last February. Since losing patent protection, Sanofi has seen flagging revenue from their flagship Lantus products—which occupy the #4 and #15 spots on IQVIA’s list of Top Medicines by Invoice Spending—and they’re hoping Bioverativ can give their treatment portfolio a boost. Similarly, Celgene boosted their pipeline prospects by acquiring Juno Therapeutics, who have a promising CAR-T candidate expected to be FDA-approved in 2019. Celgene also recently bought Impact Biomedicines, all part of a strategy to preemptively address profit losses when their blood cancer drug Revlimid goes off-patent in a few years.

5000-to-1, here’s hoping these odds are better

What does the greatest upset in modern sports have to do with diabetes? Read on. Leicester has been selected as the first UK city for a Novo Nordisk-led global initiative, Cities Changing Diabetes, which aims to stop the rise of type II diabetes in urban areas. Turns out Leicester has one of the largest populations with diabetes – almost 9%, well above the UK average of 6.4%. The upset? We must apologize to our European readers that we have to explain to football-naïve Americans that last year the Leicester City Foxes held 5000-1 odds to win the Premier League, and they did. Not since Roy Hobbs propelled the NY Knights into the World Series has there been such an upset. Let’s win one for the Gipper and knock out diabetes. Sports.

Eli Lilly dropping half a million pounds

An intensely competitive pricing environment for diabetes treatments has led to declining performance and deep cuts at the Indianapolis-based drug giant. Lilly plans to cut 3,500 employees, mostly by year end, and many through an early retirement program. (For the record, this writer would appreciate an early retirement program.) Other reductions will be achieved by closing a manufacturing facility in Larchwood, IA., and shuttering R&D facilities in Bridgewater, NJ and Shanghai, China. Lilly expects to incur one-time charges of approximately $1.2B and achieve $500M in annual savings.

Safe T first

Yay, we get to write another article about fewer needles in the lives of diabetics! Researchers in London are working on an immunotherapy approach to slow down the progression of Type I Diabetes, which would ideally result in a future where those diabetics won’t have to inject insulin daily. The disease works by attacking insulin-producing cells, so the scientists decided to try to get the lazy part of the immune system that wasn’t stopping that—regulatory T cells—to stop playing video games and get a job! (Sorry. Too close to home?) The scientists proved the safety of this approach in a recent Phase I study, so it will be a while before anything is marketed to the general public, but we just think this immunotherapy stuff is the bee’s knees.