IDTechEx Research has recently released a new market report ‘Technology 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.

The 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.

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.

Beckman Coulter has announced that it is a gold sponsor of the 2nd World Sepsis Congress, a free-of-charge online conference, hosted by the Global Sepsis Alliance, that will be held Sept. 5 and 6, 2018. Over the course of 17 sessions, more than 100 speakers from approximately 30 countries will discuss the wide-ranging implications of sepsis and how to raise public awareness of this often-fatal condition.
Sepsis affects 26 million people worldwide each year, and is increasing at a rate of 1.5 percent annually. In the United States alone, about 1.6 million people are diagnosed with the disease. Additionally, it is the third leading cause of death, claiming more than 258,000 lives in the U.S. each year.
“Sepsis is one of the world’s deadliest diseases that often goes undiagnosed,” said Peter Soltani, Ph.D., senior vice president and general manager of Beckman Coulter’s hematology business. “As many as 80 percent of sepsis deaths could be prevented with rapid diagnosis and treatment.”
“We are proud to be a sponsor of the 2nd World Sepsis Congress,” said Soltani, “since its goals align perfectly with our commitment to empowering healthcare professionals with the tools and resources that enable them to detect sepsis as early as possible during patient care.”
Delayed treatment of sepsis can cause cardiovascular collapse, tissue damage, organ failure and ultimately death. Even patients with less severe sepsis can progress to the more severe condition, septic shock, within 72 hours, and up to half of those patients will die as a result. Timely and accurate detection solutions, in an acute-care setting where treatment can be initiated, are key components to stopping the progression of the disease. In fact, when antibiotics are administered early to patients with septic shock, the likelihood of death decreases by 7.6 percent per hour.
In answer to the urgent need for a fast and an accurate detection solution, in June 2018, Beckman Coulter filed a submission for 510(k) clearance with the U.S. Food and Drug Administration for its Early Sepsis Indicator, a hematology-based solution designed to alert emergency room clinicians to any patient who might possibly be at risk for developing sepsis. It recently achieved European CE Mark, and is commercially available in select countries for use with the company’s DxH 900 hematology analyzer, which was released in May 2018.

Even tiny amounts of viruses can have disastrous consequences. RNA identification can reveal the type of virus present. A fast and sensitive technique based on optical detection has now been outlined. Scientists from Germany and Finland have demonstrated the binding of an RNA target to a probe made of gold nanorods and a DNA origami structure. Chirality switches triggered by binding can be measured by circular dichroism spectroscopy.
Identifying the pathogen-often a virus-that is troubling a patient is among the biggest challenges in healthcare. Viruses responsible for Zika fever, AIDS, and hepatitis C contain mutating RNA sequences. Physicians need to know quickly which type of virus their patients have acquired, but current techniques based on multiplying RNA are costly and time-consuming. Now, Tim Liedl from Ludwigs-Maximilians-Universität in Munich, Germany, and his colleagues, have developed a fast detection strategy based on nanoplasmonics, DNA origami, and an optical readout.
Light can induce plasmonic waves in nanosized metal structures smaller than the wavelength of the incident light. This resonance may lead to strongly enhanced light emission even from nanoscopic structures-a feature that is highly interesting for biosensing applications. Liedl and colleagues have created a nanosized sensing probe for RNA molecules.
The probe, a nanosized apparatus made of DNA and gold nanorods, was assembled by the so-called DNA origami technique, which exploits the specific interactions of the DNA bases to fold and glue together single strands in any desired form. The authors constructed two bars of parallel DNA helices loosely connected through a hinge in the middle of the bars. Gold nanorods were placed on top of each of the crossed bars. Both crossing arms were supplied with functionality at their ends: the scientists attached one single DNA sequence complemented with a blocking strand to one arm, and the complementing DNA sequence to the other. In the presence of target RNA, which could be a typical viral RNA sequence, the blocking strand would leave its DNA in favour of RNA hybridization, and both single DNA sequences would complementarily form a double strand whereby the two arms of the cross are pulled together. This structural change introduces chirality to the probe.
Chirality can be detected with circular dichroism. And indeed, the structural changes triggered by the RNA binding induced a circular dichroism signal detectable with a CD spectrometer. Concentrations as low as 100 picomolar of the target RNA were recognized, according to the authors. The scientists hope to establish this technique in lab-on-a-chip systems where few steps are required for sample preparation and low-cost miniature devices lead to sensitive results. Preliminary results on serum from blood with added viral RNA were promising.
The authors admit that the detection limits are still not low enough to be clinically relevant. However, they believe improvements should be possible; including, better protection of the nanosensors from serum proteins, a change to better resonating plasmonic metals, and expansion of RNA recognition sites. This could make the technique a promising diagnostic tool that is not necessarily limited to viral RNA.

MarketScreenerwww.marketscreener.com/news/Viral-RNA-Sensing-Optical-detection-of-picomolar-concentrations-of-RNA-using-switches-in-plasmonic–27285028/

Rheumatoid arthritis (RA) is an autoimmune disorder that occurs when the immune system mistakenly attacks the body’s tissues. Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis affects the lining of the joints, causing painful swelling that can eventually result in bone erosion and joint deformity.
Most RA patients are positive for anticitrullinated protein antibodies (ACPA), and these antibodies are highly specific for RA diagnosis. ACPA recognizes various citrullinated proteins, such as fibrinogen, vimentin and glucose- 6-phosphate isomerase. Citrullinated proteins are proteins that have the amino acid arginine converted into the citrulline, which is not one of the 20 standard amino acids encoded by DNA in the genetic code. Autoreactivity to citrullinated protein may increase susceptibility to RA.
While many candidate citrullinated antigens have been identified in RA joints, the involvement of citrullinated proteins in blood serum remains mostly uninvestigated. To that end, a team of University of Tsukuba-centred researchers set out to explore the expression and commonality of citrullinated proteins in peptide glucose-6-phosphate isomerase-induced arthritis (pGIA) and patients with RA, and went one step further to investigate its correlation with RA disease activity.
“We examined serum citrullinated proteins from pGIA by western blotting, and the sequence was identified by mass spectrometry. With the same methods, serum citrullinated proteins were analysed in patients with RA, primary Sjögren’s syndrome, systemic lupus erythematosus, and osteoarthritis as well as in healthy subjects,” study corresponding author Isao Matsumoto explains. “In patients with RA, the relationship between the expression of the identified protein inter-alpha-trypsin inhibitor heavy chain 4 (ITIH4) and clinical features was also evaluated, and the levels of citrullinated ITIH4 were compared before and after biological treatment.”
The researchers found that citrullinated ITIH4 was highly specific to patients with RA, compared with patients with other autoimmune and arthritic diseases or in healthy subjects, indicating a potential role for citrullinated ITIH4 in RA pathogenesis. Notably, its levels were decreased in correlation with the reduction of disease activity score after effective treatment in patients with RA. Moreover, antibody response to citrullinated epitope in ITIH4 was specifically observed in patients with RA.
“Our results suggest that citrullinated ITIH4 might be a novel biomarker to distinguish RA from other rheumatic diseases and for assessing disease activity in patients with RA,” Matsumoto says. “To our knowledge, this is the first report of its kind in the literature.”

MedicalXpresshttps://medicalxpress.com

An international team of researchers from the Hopp Children’s Cancer Centre at the NCT Heidelberg (KiTZ), the European Molecular Biology Laboratory (EMBL) and the German Cancer Consortium (DKTK) together with colleagues at the St. Jude Children’s Research Hospital in Memphis and the Hospital for Sick Children in Toronto has summarized hereditary gene defects which can trigger the development of certain malignant brain tumours (medulloblastoma). From their findings, the team has derived recommendations for routine genetic screening in medulloblastoma patients. Medulloblastoma is a rare malignant tumour of the cerebellum and occurs predominantly in children. Scientists believe that in many cases hereditary gene defects trigger the development of this malignant disease. However, there are no standards for routine genetic screening of patients, nor are there guidelines and a corresponding nationwide infrastructure for genetic counselling of affected families.
Scientists have now been able to characterize medulloblastoma more accurately and to derive recommendations for genetic testing based on analysis of 1022 patients with medulloblastoma. “We analysed genes that have been previously implicated in predisposition to any type of pediatric and adult cancer”, says Sebastian Waszak from the EMBL Heidelberg who is one of the study’s lead authors. It turned out that six genes were also frequently affected by genetic alterations in patients with medulloblastoma.
Considering the six significantly enriched genes, about five percent of patients had an increased risk of cancer. Taking into account all cancer risk genes, about eleven percent of the patients had an increased cancer risk. Looking at a particular tumour subgroup, the so called “SHH-activated medulloblastoma”, even 20 percent were identified to harbour a genetic predisposition to cancer.
These predisposing mutations occur in every single cell of the patient and can be also passed on to offspring. “Mutations of this kind often indicate a familial predisposition to cancer and therefore place special demands on the treatment of patients and the counselling of families”, said Paul Northcott from the St. Jude Children’s Research Hospital in Memphis, who shares the lead authorship. The results are particularly important because both materials from previous studies and patient data from four current or recently completed clinical trials were included in the analysis.
Based on these findings and other tumour features, the scientists developed criteria for routine genetic screening. “Hereditary disease factors usually have a significant impact on the whole family of the patient, We want to make genetic analysis available as a standard of care for patients with specific medulloblastoma”, says Stefan Pfister, KiTZ director, scientist at the German Cancer Research Centre, and senior physician at the Heidelberg University Hospital. To make this possible, Stefan Pfister and Christian Kratz from the Hannover Medical School have created a registry for patients with a hereditary cancer predisposition and a website that contains information for patients, families, and physicians (www.krebs-praedisposition.de).

The German Cancer Research Center (DKFZ)https://tinyurl.com/ya5akv4j