Lilly CEO: Diabetes: We’ve Come Far — But Have a Long Way to Go

It doesn’t strike the kind of terror that cancer or Alzheimer’s disease do. But there’s a killer hiding in plain sight that might wreak even more devastation: diabetes.

Up until the 20th century, a diabetes diagnosis was often a death sentence.

Although diabetes had been recognized centuries ago by the ancient Greeks, there was still no effective treatment. That all changed in the 1920s with the discovery of insulin by two scientists from the University of Toronto, and with Lilly’s help in mass producing the first insulin for patients around the world. Today, there are people with type 1 diabetes on insulin treatment who have lived fairly normal lives for 75 years and more.

The bad news is that millions of people continue to suffer and die from diabetes and related conditions, such as depression and cardiovascular disease. Diabetes is a factor in 4 million deaths a year worldwide – including more than 15 percent of all deaths in North America – robbing patients of an average of eight years of life. Medical breakthroughs against diabetes are just as urgently needed today as they were a century ago.

Diabetes

Even as the discovery of insulin demonstrates the transformative power of medical advances, the growing devastation of diabetes drives home the need for continued innovation.

The International Diabetes Federation estimates that the number of people around the world with diabetes will grow by more than 50 percent – from 285 million today to a staggering 439 million – by 2030.

One in three American adults have diabetes or pre-diabetes. An increasing number of young adults develop type 2 diabetes because of obesity.

This is a health and economic time bomb. Among adults, diabetes is the leading cause of new cases of blindness, kidney failure, and non-traumatic amputations, as well as a leading contributor to heart disease and stroke. And caring for people with diabetes eats up 11 percent of total global health care costs – or nearly $400 billion a year.

The irony is that treatments for diabetes have become increasingly sophisticated as well as more convenient. We’ve developed new forms of insulin that help patients with diabetes better control their blood sugar, delivery devices that make injections simpler and more discrete, and even pills that can delay the need for insulin shots for years. Some new classes of drugs give people with diabetes greater sensitivity to what insulin their body produces, and others enable the insulin-producing beta cells to work better.

Even so, most patients with diabetes struggle to achieve important health goals.

It’s estimated that more than 85 percent of Americans with diabetes are not able maintain good control of their blood glucose, cholesterol, and/or blood pressure. While the consequences of diabetes can be significantly lessened if patients can take full advantage of what's already available, the simple fact is that there is no cure. As scientists carry on the search for that cure, we must continue to develop medicines that offer new and better options for patients and that lower the barriers to effective, long-term management of this devastating disease.

Exciting work going on right now in biopharmaceutical labs demonstrates the tremendous potential of medical innovation.

In the treatment of type 1 diabetes, new so-called immunomodulation approaches, such as Lilly’s teplizumab, hold the potential to slow down the deterioration of insulin-producing cells – treating the disease itself rather than just managing the resulting condition.

Further, advances in insulin delivery and glucose monitoring are creating the possibility of a “closed-loop system” – essentially an artificial pancreas that continuously monitors the body’s glucose levels and delivers insulin as needed.

Other advances could allow us to move from management of type 2 diabetes to true disease modification – slowing or halting the progression of the disease and forestalling the eventual need for insulin. And researchers are making progress on “glucose-plus” therapies that not only better control glucose levels but also address related aspects of cardiovascular risk.

To sustain this progress against diabetes, public policies – including cost-benefit analyses, reimbursement decisions, and prescribing guidelines – must enable and reward medical innovation.

Diabetes is a complicated, personal disease, and new medicines – even in an existing class – can improve the health of patients for whom available therapies are ineffective or hard to use. If prescribing or reimbursement rules force population-based standardization that neglects individual patient needs, then these potential new medicines will never reach many of the patients who stand to benefit from them.

It’s important to maintain the ability for doctors and patients to make informed choices from all available alternatives, and to let the market determine the value of new medicines – measured ultimately by how they work for patients.

At the same time, effectively managing diabetes requires more than medicine.

Patients need education and steady support to control this chronic disease – the face-to-face interactions in the doctor’s office are just the start. We must ensure the availability of health care resources to improve patients’ daily ability to live with diabetes.

The fact is, if we do these things, we can actually help hold down the enormous costs of treating diabetes, not to mention alleviating the suffering brought about by the long-term consequences of this disease.

With new medicines that improve individual patient outcomes, greater attention to helping patients manage their disease, and policies that encourage both, we can reduce the toll of diabetes even as we seek a cure.

We’ve already come a long way in the fight, and I’m convinced that future medical innovations will lead to more victories over this devastating disease.

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John C. Lechleiter, Ph.D., is chairman, president, and chief executive officer of Eli Lilly and Company , based in Indianapolis, Indiana. Previously, he served as Lilly’s president and chief operating officer. Lechleiter began work at Lilly in 1979. Prior to joining Lilly, Lechleiter earned a bachelor of science degree in chemistry from Xavier University and master’s and doctoral degrees in organic chemistry from Harvard University. He is a member of the American Chemical Society, Business Roundtable, and Business Council. Currently, Lechleiter serves on the boards of PhRMA; Nike, Inc.; United Way Worldwide; Xavier University; Fairbanks Institute (Indianapolis); Indianapolis Downtown, Inc.; and the Central Indiana Corporate Partnership.