It’s Complicated

Though many diabetes patients comply with treatment, others struggle – and, left unchecked, the disease can lead to several comorbid conditions. Stephen Gough, Chief Medical Officer at Novo Nordisk, discusses the impact of one such complication – cardiovascular disease – on type 2 diabetic patients and how the pharma industry is trying to help.

How has the treatment of diabetes evolved?

The pharmaceutical industry has come a long way in its ability to address diabetes. At Novo Nordisk, for example, we developed our first insulin products in 1923 and continue to produce treatments for both type 1 and type 2 diabetes today. Metformin, DPP-4, SGLT-2 inhibitors, and recent innovations like GLP-1 RAs are especially effective in blood glucose-lowering in comparison to previous treatments, but there are still issues for pharma to address. For example, we need to innovate on the drug delivery front. Injectable therapies, though useful, aren’t suitable for everyone. Exploring new options will help us better support patients.

What challenges do patients face?

Diabetes is associated with many other conditions – including cardiovascular disease, the leading cause of death and disability in type 2 diabetes patients. We recently conducted a study, CAPTURE, to address a gap in the knowledge of the global prevalence of cardiovascular disease, as well as its risk and management in people with type 2  diabetes (1). Nearly 10,000 participants took part in the global study. We found that one in three people with type 2 diabetes have established cardiovascular disease (CVD), and 90 percent of those had atherosclerotic CVD (a build-up of fat, cholesterol, and other substances in the artery walls). The study also showed that only 20 percent of people with type 2 diabetes and atherosclerotic CVD are receiving a glucose-lowering treatment with proven cardiovascular benefits.

These data show that people with type 2 diabetes need to be more aware of their risk factors, and that physicians need to not only actively screen for them, but also prescribe blood glucose-lowering therapies with proven cardiovascular benefit if patient outcomes are to be improved.

What are you doing to help?

We developed an oral form of semaglutide – a GLP-1 RA – that works by boosting insulin levels and stabilizing blood sugars. Previously, the GLP-1 RAs were only available as injectables and, despite the efficacy in reducing hyperglycemia, body weight, and cardiovascular risk, only 5–10 percent of people with type 2 diabetes are treated with a GLP-1 RA.

Our oral formulation was approved by the FDA in 2019, but our GLP-1 RA portfolio isn’t limited to this one option. Injectables are still a vital part of the diabetes management landscape, so we also manufacture a once-weekly injection of semaglutide, which also helps combat the symptoms of type 2 diabetes. We’re also working on a once-weekly insulin injection, icodec. It’s important to expand the variety of available treatments to suit the broad and varied needs of people with diabetes.

What steps need to be taken for the future of diabetes management?

Recent clinical guidelines from professional bodies, such as the American College of Cardiologists and the American Diabetes Association emphasize the importance of an integrated, multidisciplinary approach to treating diabetes – in particular, bringing together endocrinologists and cardiologists – to reduce the cardiovascular risks and other potential complications of this disease.

For us, partnerships with policymakers and with organizations in the public-private space is integral. Two examples of initiatives we’re involved in are Changing Diabetes and Cities Changing Diabetes. Through the former, we work alongside patients, lawmakers, and healthcare professionals to address diabetes risk factors in urban areas, ensuring that people with diabetes are diagnosed earlier and that they have access to adequate care. Through the latter, we collaborate and form cross-sector links with businesses and organizations to build cities that help us all live healthier lives.