After a banner year for diabetes technology in 2022, there’s still plenty to look forward to in 2023.

Throughout 2022, we saw a wide range of advancements in diabetes technology. We saw launches for next-generation technologies, exciting clinical trial results, rumored spinouts and acquisitions and more.

You can read all about the biggest diabetes stories of 2022 here.

As we embark on a new year in 2023, there’s still plenty to look forward to in the diabetes space. Here are a few things worth keeping an eye on.

CMS decision could benefit CGMs

In October, The Centers for Medicare and Medicaid Services (CMS) published a new local coverage determination (LCD). That LCD modified coverage criteria for continuous glucose monitors (CGMs). The modification includes people with diabetes who receive insulin treatment or have a history of problematic hypoglycemia.

Analysts suggested at the time that the decision marked a win for CGM makers, including Abbott and Dexcom.

“The comment period on the proposed LCD will run through November 19, after which a final determination will be made,” BTIG analyst Marie Thibault wrote. “We expect potential inclusion in the final determination will catalyze increased CGM adoption in this patient population, benefiting both [Abbott] and [Dexcom].”

Thibault said an estimated 3 million U.S. basal-only patients could benefit from the decision.

Dexcom CTO Jake Leach told Drug Delivery Business News recently that Dexcom is “really excited” by the potential expanded coverage.

“We see that as just another validation of how CGM can really benefit people with diabetes,” Leach said. “This is a whole new group of folks that haven’t had access to it before. I think we’re going to really see some great outcomes as that population starts to use CGM more regularly. We’re really excited about G7 servicing that population when it becomes available.”

He expects to see that coverage come through in the second half of 2023. However, if it comes earlier, “we’ll be ready,” Leach said.

Expanded diabetes technologies

In 2022, we got a slew of next-generation technologies clearing major regulatory hurdles. That includes the Dexcom G7, Abbott FreeStyle Libre 3, Insulet Omnipod 5 and the Senseonics Eversense E3.

Given the general timelines for these technologies, it’s unlikely we see the coming generations this year, or even for a few years. However, that doesn’t mean these companies stop innovating in the meantime.

Insulet continues to expand its insulin delivery platform, developing a basal-only pod for individuals with type 2 diabetes. The company said in November that it intends to submit for FDA 510(k) clearance “soon.” Expect updates on that timeline at the very least in 2023, with potential clearance on the horizon.

Senseonics’ Eversense E3 offers a 180-day wear time, and the company already has plans to double that. It said in November that it completed enrollment of a pivotal trial for a 365-day sensor configuration. The company also submitted an IDE for enrollment of a pediatric cohort. While analysts expect a regulatory nod to come in 2024, we could see data for the 365-day CGM in the interim sometime in 2023.

Dexcom CEO Kevin Sayer told DDBN recently that the company has major technology expansion plans. That includes moving beyond diabetes to try and expand CGM use across a number of areas in health. The company plans to move to monitoring pregnancy and in the hospital setting, among other spaces. Sayer also said Dexcom wants to extend the life of its sensor. It currently has a 10-day wear time, but Sayer wants to increase that to 15 days.

Where does Medtronic stand?

In 2022, Medtronic CEO Geoff Martha cited uncertainty over approval timing for the company’s next-generation platforms. That includes the MiniMed 780G insulin pump and Guardian 4 CGM sensor.

A December 2021 FDA warning letter highlighted inadequacies in specific medical device quality system requirements at its Diabetes business’ Northridge, California, facility. Martha said on the company’s third-quarter (2022) earnings call that it achieved 90% of the FDA’s action items related to the warning.

In September, the law firm of Kessler Topaz Meltzer & Check announced a lawsuit in the U.S. District in Minnesota. It claimed securities fraud over how Medtronic disclosed its insulin pump problems.

That same month, Medtronic identified a potential cybersecurity issue through internal testing with its MiniMed 600 series insulin pumps (MiniMed 630G and 670G). Affected devices also include the Guardian Link 3 transmitter, Contour Next Link 2.4 blood glucose monitor and the CareLink USB.

Still, what 2023 holds for Medtronic remains a mystery. Data for the next-generation MiniMed 780G with Guardian 4 has been positive. The company also launched a 7-day extended infusion set for insulin delivery in 2022.

New diabetes technologies coming to the fore?

Sure, some of the big hitters in diabetes launched their new products in 2022. That doesn’t mean we won’t see other companies rise to the challenge in 2023.

In December, Korea-based EOFlow submitted a 510(k) application to the FDA for its EOPatch wearable, disposable insulin pump. Shortly after, EOFlow partnered with Diabeloop to commercialize EOPatch in Europe.

Tandem Diabetes Care had a busy 2022 that could result in a prosperous 2023. The company dipped into the M&A market, acquiring infusion set developer Capillary Biomedical in July. Just before the end of the year, Tandem made another move, acquiring AMF Medical, maker of the Sigi patch pump for insulin delivery. That deal closed on Jan. 23.

Beta Bionics’ timeline for the iLet bionic pancreas system remains unclear, but the company is preparing for a launch. It recently hired Dr. Steven Russell as its new CMO with an eye on the commercial release of iLet.

We could see further developments from both Eli Lilly and Ypsomed on the insulin pump front. Lilly broke off a partnership in pursuit of its own development program for pump technology. However, Ypsomed still aims to find partners for potential U.S. commercialization. It already has an automated insulin delivery system available in Europe through a collaboration with Abbott and CamDiab.

Embecta, the BD diabetes spinoff, also has a product under development. Analysts were hopeful to learn more at the end of the year about the company’s insulin patch pump, but so far Embecta has remained tight-lipped. More updates may come this year.

While there are no certainties for all these diabetes technologies, they represent examples of some offerings we may see in 2023.

What about diabetes drugs?

A big unknown in the diabetes space remains the diabetes drugs both on the market and under development.

NBC News recently reported that diabetes patients are scrambling to find Ozempic due to its rise in popularity as a weight loss drug. Novo Nordisk’s Ozempic is indicated as an adjunct to diet and exercise to improve glycaemic control in adults with type 2 diabetes mellitus. It first received FDA clearance in 2017.

It will be an interesting space to watch in 2023, whether it results in the rise of a new Ozempic alternative or if things return to normal on the supply and demand side.

Could Oramed’s oral insulin rise as that alternative? For now, not for those with type 2 diabetes. A recent announcement shared that its trial of the drug missed its endpoints, leading the company to consider discontinuing the development of the therapeutic for the type 2 population.

However, hope remains for the drug in other diabetes indications. The ORMD-0801 oral insulin capsule is currently under evaluation in a second pivotal Phase 3 trial. The company recently inked a deal to commercialize the oral insulin treatment in the Republic of Korea. It also picked up a new patent for its oral diabetes treatment earlier this month.