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Technologies for Diabetes Management 2019-2029: Technology, Players and Forecasts

Including details of glucose test strips, continuous glucose monitoring (CGM), insulin pumps, insulin pens, digital health / digital therapeutics, side effect management and diagnosis

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This report covers the entire landscape for diabetes management devices, including mature, emerging and future options. The report has been researched via primary interviews with companies, physicians and diabetic individuals to characterize and predict the technology landscape for diabetes devices over the coming decade. In total, activities of 75 companies are covered throughout the report, ranging from the largest players to technology developers and startups developing the next generation of device options.
 
Historically, diabetics have monitored their blood glucose concentration by using disposable biosensors; following a finger prick, a drop of blood is placed onto a glucose test strip, which is inserted into a reader to provide the result. Whilst billions of test strips are produced each year, this sector as seen profitability shrink due to changing medical subsidies and increased competition. Alternative options have been developed to enable continuous glucose monitoring. These involve devices that are typically worn on the skin, using a sensor on a small needle to test glucose in interstitial fluid. There are now approved devices from several key players, with this industry growing each year.
 
However, challenges still remain with glucose monitoring devices, with the ultimate aim of providing the best experience for diabetics. CGM devices in the past have been reliant on test strips for calibration, as well as still being invasive or implantable, leading to discomfort. This has led to many players investigating glucose monitoring options which are less invasive, whilst maintaining the required accuracy and reliability. In addition, the possibility of pairing CGM devices with insulin pumps for increasingly automated "closed-loop" systems is becoming increasingly closer. These goals have been in place for decades, and the report follows all the latest news, trends and outlook in each of these technology frontiers around diabetes management devices.
 
However, managing diabetes is about more than just monitoring glucose levels. The report also covers other aspects of diabetes technology landscape, including insulin delivery, the role of digital health in diabetes, technology for managing side effects, technology for diagnosis and reimbursement, funding and investment examples. The report then includes detailed market forecast following two different methodologies. The first involves the collection of revenue data from companies throughout the space, with historic data back to 2010 by company and by sector. This is then projected given a series of assumptions based on IDTechEx's primary research efforts. The second forecast scenario involves looking at data for the diabetic population, including number of diabetics, split by type, percentage diagnosis, and then adoption rates by device type for each group. The two forecasts are then discussed and compared, providing with the reader with ample content from which to base business decisions and understand the dynamics in the space.
 
 
Market split between the largest players in SMBG (self-monitoring of blood glucose, i.e. test strips & glucometers) and CGM (continuous glucose monitoring)
Source: IDTechEx: see the report for more details of the changing dynamics in each of these sectors
As discussed, the report is split into 8 main chapters, discussing each aspect of diabetes management technology (not including pharmaceutical options). Following an executive summary, detailing the main conclusions and discussion of the report, the report introduces the challenges and opportunities in diabetes management, as well as going through the main patent holders and filing trends in the space. Then, topic chapters of the report are as follows:
  • Sensors for diabetes management: This chapter includes coverage of glucose sensing, from test strips and glucometers, to continuous glucose monitoring (CGM), and through to a discussion of emerging options in this space. In total, 37 different companies are mentioned in this section, ranging from the largest players in tests strips and CGM (e.g. Abbott, Roche, Medtronic, Dexcom, etc.) through to many emerging players or innovators attempting new approaches to glucose monitoring.
  • Insulin delivery: This chapter covers techniques from traditional vial-and-syringe and insulin pens, to insulin pumps and towards closed loop insulin delivery alongside CGM. Key trends discussed in this section include the integration of different connectivity and technology integrated alongside both insulin pump and insulin pens, the links from these devices into wider digital health ecosystems and the adoption of newer devices (particularly insulin pumps) by territory and demographic.
  • Digital health: Chronic diseases are a prominent early target for those in the digital health ecosystem, and digital health options for diabetes have been prominent. This chapter discusses activities from both the small and larger players, including major acquisitions and collaborations, in areas including diabetes management systems, device companion software and digital therapeutics.
  • Side effect management: The majority of the costs associated with diabetes are around managing side effects. This section focuses on new technology options emerging around areas such as diabetic neuropathy, foot ulcers and ketoacidosis. This includes various wearable, flexible and textile-based technology options.
  • Diabetes diagnosis: discussing the use of emerging technologies to aid the early detection of diabetes, thereby preventing long hospital stays and other complications.
  • Reimbursement options, funding and investment examples: These final elements to the report fill in details which are important for the broader space. Reimbursement, whether through insurers, national healthcare initiatives or otherwise, is still critical for the majority of diabetes devices. Funding and investment are also present, as with any large, transforming industry.
 
 
Over 75 companies are mentioned in the report, including many primary interviews, a patent analysis of the key patent-holders, and revenue data where relevant.
Source: IDTechEx
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1.EXECUTIVE SUMMARY
1.1.1.Executive introduction
1.1.2.Strategy comparison amongst the largest players
1.1.3.Diabetes management device roadmap: Glucose sensors
1.1.4.Focus shifts from test strips to CGM
1.1.5.CGM options are expanding
1.1.6.Diabetes management device roadmap: Insulin delivery
1.1.7.Today: Hybrid closed loop systems
1.1.8.The objective: Closing the feedback loop
1.1.9.Managing side effects accounts for 90% of the total cost of diabetes
1.1.10.Diabetes management device roadmap: Side-effect management
1.1.11.List of 75 companies mentioned in this report
1.1.12.Diabetes management devices: Historic revenue, 2010-2018 (by device type)
1.1.13.Diabetes management devices: Revenue forecast, 2019-2029 (by device type)
2.INTRODUCTION
2.1.Diabetes today, in numbers
2.1.1.Type 1 vs Type 2
2.1.2.Diabetes on the rise
2.1.3.The cost of diabetes
2.1.4.Managing side effects accounts for 90% of the total cost of diabetes
2.1.5.Diabetes management process
2.2.Diabetes management device roadmap: Summary
2.2.1.Diabetes management device roadmap: Glucose sensors
2.2.2.Diabetes management device roadmap: Insulin delivery
2.2.3.Diabetes management device roadmap: Side-effect management
2.3.Visualisation of activity and partnerships at over 30 of the largest players in diabetes management
2.3.1.Glucose sensors for diabetes management: players
2.3.2.Strategy comparison amongst the largest players
2.4.Patent trends amongst the largest players
2.4.1.Patents amongst the largest players
2.5.Future outlook for diabetes management
3.SENSORS FOR DIABETES MANAGEMENT
3.1.History of glucose monitoring
3.1.1.Academic research trends
3.1.2.Patents trends: shifting between techniques
3.1.3.Diabetes management device roadmap: Sensors
3.1.4.Glucose sensors for diabetes management: players
3.1.5.Test strips and glucometers
3.2.Glucose monitoring strip mechanisms
3.2.1.Development of the glucose monitoring assay
3.2.2.Strip monitoring through a glucometer
3.2.3.Profitability in the test strip industry is falling
3.2.4.Strip manufacture
3.2.5.Electrode deposition: screen printing vs sputtering
3.2.6.Business model for glucose test strips
3.2.7.Manufacturers of blood glucose meters
3.2.8.Electrode deposition: screen printing vs sputtering
3.2.9.New directions with glucometers: Connectivity
3.2.10.New directions with glucometers: Smartphone cases
3.2.11.Finger stick tests as a subscription service
3.2.12.Porters five force analysis of disposable test strip industry
3.3.Continuous glucose monitoring (CGM)
3.3.1.The case for CGM
3.3.2.Skin patches are the form factor of choice
3.3.3.CGM sensor manufacturing and anatomy
3.3.4.Sensor membranes are critical
3.3.5.Foreign body responses to CGM devices
3.3.6.Calibration of glucose monitoring devices
3.3.7.CGM: Overview of key players
3.3.8.Medtronic
3.3.9.Medtronic: Patents in CGM
3.3.10.Dexcom
3.3.11.Dexcom: Patents in CGM
3.3.12.Abbott Laboratories
3.3.13.Abbott: FreeStyle Libre
3.3.14.Abbott: SMBG vs CGM comparison
3.3.15.Abbott: Patents in CGM
3.3.16.Roche
3.3.17.Roche: Patents in CGM
3.3.18.PKVitality
3.4.Implantable glucose sensors
3.4.1.Implantable glucose sensors: Introduction
3.4.2.Key Players in Implantable Glucose Monitoring
3.4.3.Senseonics
3.4.4-6.... 3 other players
3.5.Other approaches for glucose monitoring
3.5.1.Beyond blood and ISF: Other ways to determine glucose concentration
3.5.2.Assessment of different analytes for glucose monitoring
3.5.3.Case studies by target analyte
3.5.4.Measuring glucose in sweat
3.5.5.Binghampton University
3.5.6.Measuring glucose in tears
3.5.7.Verily / Novartis: Contact lenses
3.5.8.Noviosense
3.5.9.Measuring glucose in saliva
3.5.10.Measuring glucose in breath
3.5.11.Measuring glucose in urine
3.5.12.Non-Invasive Glucose Monitoring
3.5.13.Sano
3.5.14.University of Bath
3.6.Conclusions: Glucose sensing
3.6.1.Focus shifts from test strips to CGM
3.6.2.CGM options are expanding
3.6.3.When will non-invasive glucose monitoring be commercialised?
4.INSULIN DELIVERY
4.1.1.Delivering insulin is a critical part of diabetes management
4.1.2.Diabetes management device roadmap: Insulin delivery
4.2.Insulin pens
4.2.1.Insulin pens: Introduction
4.2.2.Smarter insulin delivery informing decisions
4.2.3.Smart insulin delivery device manufacturers
4.2.4.Emperra: A pen to prevent missed doses
4.2.5.Novo Nordisk: Traditional players launch smart options
4.2.6.Companion Medical: Bluetooth connected pens
4.2.7.Common Sensing: Smart features for disposable pens
4.2.8.Digital Medics: First smart pen to market
4.2.9.Outlook for insulin pens
4.3.Insulin pumps
4.3.1.Insulin pumps: Introduction
4.3.2.Patent activity in insulin pumps is prominent
4.3.3.Insulin pumps currently available
4.3.4.Insulin pump breakdown
4.3.5.Disposable insulin pumps for type 2 diabetics
4.3.6.Academic frontiers: Smart patches for insulin delivery
4.3.7.Insulin pump technology roadmap
4.3.8.Outlook for insulin pumps
4.4.Linking insulin pumps and CGM: Towards an artificial pancreas
4.4.1.Today: Hybrid closed loop systems
4.4.2.The objective: Closing the feedback loop
4.4.3.Example: Towards an artificial pancreas
4.4.4.Unanswered questions about device security
5.DIABETES MANAGEMENT AND DIGITAL HEALTH
5.1.1.Chronic diseases are an obvious starting point for digital health
5.1.2.Diabetes apps
5.1.3.Growing ecosystem via acquisitions and partnerships
5.1.4.Roche & mySugr
5.1.5.Lilly & Rimidi, Lilly & Livongo
5.1.6.Blue Mesa Health & Merck
5.1.7.Glooko-Novo Nordisk in Diabetes Care
5.1.8.Other case studies: Digital diabetes management
5.1.9.BlueStar
5.1.10.Voluntis
5.1.11.DIABNEXT
5.1.12.iHealth Labs
5.1.13.Better Therapeutics
5.1.14.Amazon Tackle Diabetes Care
5.1.15.Alexa Diabetes Challenge Finalists
5.1.16.Sugarpod Champions Diabetes Care
6.TECHNOLOGY FOR MANAGING DIABETES SIDE EFFECTS
6.1.1.Managing side effects accounts for 90% of the total cost of diabetes
6.1.2.Diabetes management device roadmap: Side effect management
6.2.Diabetic neuropathy
6.2.1.Preface: Diabetic neuropathy
6.2.2.Optical measurement of neuropathy
6.2.3.Sudomotor function as biomarker for neuropathy
6.2.4.Gait measurement to assess neuropathy
6.3.Diabetic foot ulcers
6.3.1.Basic requirements of a diabetic footwear
6.3.2.Smart options for diabetic footwear
6.3.3.Sensoria
6.3.4-6.... 3 other players
6.4.Diabetic ketoacidosis
6.4.1.A severe lack of insulin can lead to Diabetic Ketoacidosis
6.4.2.Ketone monitoring via electrochemical sensors
6.4.3.Ketone test strips: examples and comparison to glucose test strips
6.4.4.Will we see continuous ketone monitoring?
7.TECHNOLOGY FOR DIABETES DIAGNOSIS
7.1.1.Diagnosis of diabetes is not a fast process
7.1.2.Remote Glucose Tolerance Testing is Possible
7.1.3.E. coli bacteria to change colour in the presence of sugar
7.1.4.Optical Sensors For Infant Diagnosis
8.REIMBURSEMENT FOR DIABETES PRODUCTS
8.1.1.Austria
8.1.2.Canada
8.1.3.France
8.1.4.Germany
8.1.5.Ireland
8.1.6.Netherlands
8.1.7.Switzerland
8.1.8.United Kingdom
8.1.9.USA
8.1.10.Reimbursement status for CGM by country
9.FUNDING AND INVESTMENT
9.1.JDRF $80million investment fund for diabetes
10.MARKET FORECASTS FOR DIABETES MANAGEMENT
10.1.1.Forecast assumptions
10.1.2.Forecasting in two different methodologies
10.2.1. Company revenue in diabetes management
10.2.1.Diabetes management devices: Historic revenue, 2010-2018 (by device type)
10.2.2.Diabetes management devices: Historic volumes & pricing, 2010-2018 (by device type)
10.2.3.Diabetes management devices: Revenue forecast, 2019-2029 (by device type)
10.2.4.Diabetes management devices: Forecast volumes & pricing, 2019-2029 (by device type)
10.3.2. Number of diabetics and adoption rates
10.3.1.Number of diabetics, diagnosis percentage and distribution between Type 1 and Type 2
10.3.2.Insulin pump use and adoption rate
10.3.3.CGM use and adoption rate
10.3.4.Comparison between the two methodologies
11.COMPANY PROFILES
11.1.List of company profiles
11.1.1.Bonbouton
11.1.2.Companion Medical
11.1.3.Dexcom
11.1.4.DIABNEXT
11.1.5.Emperra Diabetes Care
11.1.6.GlySens
11.1.7.Google - Verily
11.1.8.GSI Technologies
11.1.9.LifeScan (Johnson & Johnson)
11.1.10.Medtronic
11.1.11.Pkvitality
11.1.12.Sensoria
11.1.13.Siren Care Denmark
 
Annual revenue from CGM devices will overtake test strip and glucometer revenue by 2020.
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Report Statistics

Slides 260
Companies 75
Forecasts to 2029
 
 
 
 

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