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Interview with Professor Lutz Heinemann

We are pleased to present this fascinating interview with Professor Lutz Heinemann, a clinical advisory board member of Afon Technology.

The full transcript of the video is below.

Interviewer: Hello, everybody. Welcome to this interview with Professor Lutz Heinemann who is the latest clinical advisory board member of Afon Technology. Hi, there Lutz. Thank you for joining us. I’m going to ask you to start by introducing yourself and telling us a bit about your experiences.

Professor Lutz Heinemann: So, as you’ve heard, my name is Lutz Heinemann. By profession I’m an engineer and biologist, so I’m not a physician.

However, I’m working in the area of diabetes, diabetes technology for 35 years, or probably some more. So, I’m not 100% sure who I am these days. Nevertheless, I have some insight into diabetes, diabetes treatment, modern technology, digitalisation and so on. So, in order to be really up to date I’m the editor of an American Journal, the Journal of Diabetes, Science and Technology, which allows me to see many manuscripts about what’s going on and what I use and type of things to treatment of patients with diabetes and things. This is also what probably brought me to this interview,

Interviewer: So, tell us about what you what you personally feel are the biggest challenges facing the world of diabetes and diabetes technology.

Professor Lutz Heinemann: So how many hours do I have? There are a number of aspects that are of interest. Let’s say we have to separate between patients with type one and type two diabetes, the type one diabetes patients are the minority when it comes to numbers, however, these are the patients that require insulin treatment all the time.

What we have seen in the last decades is that since a big move from blood glucose conventional finger pricking, conventional blood glucose monitoring and subcutaneous injection via a syringe towards a modern technology, that means automated insulin delivery by means of insulin pumps, continuous glucose monitoring and so on.

So, these patients are in a good position these days, I would say. There is no healing of type one diabetes. So, there is no stem cell implantation or other on a large scale until now. But with these modern technologies, these patients can live a close to normal life. Nevertheless, coming back to the question of challenges, you have to handle a lot of technologies.

You have issues with technologies that happen all the time. But there is a good balance from my point of view. Don’t forget about the cost sets in some aspects in many countries. And if you talk about the patients with type two diabetes that are the majority 80, 90, 95%, depending on the country, there is not just one type 2 diabetes, there are subgroups, some of them that especially those who need the insulin therapy are somewhat similar to the patients with type one diabetes.

Many of the other patients they have now GLP-1 Analogues. They have interesting new options that also reduce body weight and so on. So the challenge here is a little bit more of the cost factor. That means the prices of these modern drugs. The other patients on insulin therapy, they also, to an extent, again, it’s about cost, use CGM systems for continuous glucose monitoring and also modern insulin pens, smart pens for the insulin administration.

Just one little challenge. On the other hand, with all the technology, you have a lot of light. So, a lot of positive things.

One negative thing is, and that is a lot of waste generation. In other words, you have a lot of plastic or plastic material, packaging and so on. So, there is a need, from my point of view, to have glucose monitoring systems that are more durable, that don’t require replacement of the glucose sensors all the time.

Interviewer: Very good point, especially in today’s, today’s world with with the climate challenge we all face. How how has diabetes technology changed in the time that you’ve been working in the industry?

Professor Lutz Heinemann: Might depend on my age, but there was a lot of change in the last 30 plus years. In other words, when I started to be interested in view of my background, I think its understandable that I have some some interest in technology.

There were only relatively, by today’s standpoint, simple and big devices for glucose monitoring, syringes and needles and at the technical levels that we see these days. So I think that’s a big plus and big advantage for patients with diabetes. How much technology has improved in the last 30 years to the level that I tried to describe a second ago.

So technology is much better now. I’m not saying that we are there, that we have the ideal situation, but for many patients and this is what they asked for, they can live a life which is close to normal. And I’m not saying normal because as I indicated, there are still some challenging things. They have to be aware of all the noises, the alarms, the other signals their devices that are making.

Some families say, oh, my husband or whoever is always beeping because there’s an alarm here, a signal there. So technology requires some attention. Nevertheless, patients can work, they can enjoy life. So things have changed a lot to the better. Technology has improved things for people with diabetes, it’s fair to say.

Interviewer: What is it that you look for when you’re for the when when you’re working with the company or consulting or working with a company? What is it that you look for within that company?

Professor Lutz Heinemann: The willingness to accept open, critical, somewhat sometimes nasty questions. In other words, when I work with a company, the company should be open to reflect on what they are doing, how they’re doing it, and why they are doing it. And so sometimes the companies have a tendency to invite you to a nice restaurant, give you a good wine and so on.

This is not why I’m working with companies things only my own body weight to a level that I don’t want to have it. And so I think the they should have an interesting new development, something which is not on the market yet so that we don’t have the need to product of a syringe or something boring but something which really brings something to the table which might help patients to treat their diabetes even better in the future. So some what an open mindset is what I’m asking for.

Interviewer: Having recently joined the advisory board at Afon, what is it about the company and their technology that excites you?

Professor Lutz Heinemann: So, the number of activities I’ve seen over time with respect to non-invasive glucose monitoring, so and nearly all of them failed and many of them have promised a lot. But now we are coming to my understanding and Afon Technology is really a good example to a level that non-invasive glucose monitoring might become a viable product for patients with diabetes.

Interviewer: It’s very exciting, isn’t it?

Professor Lutz Heinemann: Yeah.

Interviewer: On the cusp of something very big. You received the Leadership in Diabetes Technology from the Diabetes Technology Society in 2007. Tell us about the work that led to this accolade.

Professor Lutz Heinemann: This is some years ago. I cannot 100% exactly say why I was selected, as I tried to indicate in my little introduction about what I’m doing or why I’m doing it. I think the Diabetes Technology Society, which is a US based society driven by David Klonoff, an American diabetologist, I’m working very close with. He, I believe, acknowledged my interest in a range of topics. So as you might have also heard from the other statements made in the last minutes, I am interested in many aspects of diabetes technology. Not only the mainstream topics sometimes also somewhat to the little ones. Just as a little example, I just published an article about diabetes technology and pets. So in other words, you might smile about it, but if you know how many dogs and cats have diabetes also for them diabetes technology, non-invasive in the future, can be of attraction.

So there are many different topics, for example, the skin reactions to adhesives and so on. So and I think the broadness of my and sometimes I’m already also can be very much behind topics of companies sometimes hate me for this and this is something that diabetes technology society wanted to acknowledge by giving me this award which was very kind of them.

Interviewer: So, five years later you picked up the Artificial Pancreas Research Award from the same society. Why did you win this award?

Professor Lutz Heinemann: It’s interesting. You get awards, of course, for a lot of work. I was the coordinator of a European project, the AP@Home Project. So when we started the project, it’s interesting, how is it already ten years plus ago, the AP, I would nowadays would say the AIB systems were not commercially available. There was still a lot of open questions and the European Union was willing to fund this large EU project, which I believe we published a lot of studies, we’ve done a lot of meetings and so on. So I think our work has helped to push ahead the development of AIB’s and some things we see these days and as I tried to indicate, my, my job was to coordinate many European researchers to solve issues, get money and so on.

So there’s a lot of work behind the scenes when you are coordinator of such a project. Clearly you have a team, or charity. Nevertheless, there must be somebody who’s front person. I’m not saying that I did all the work, but somebody has to get to the whole story ahead. And I think this is what it was acknowledged by this award.

Interviewer: Wonderful. And you have studied trends in the use of diabetes technology, presenting findings at the 2020 EASD Virtual Conference. Tell about tell us about this research.

Professor Lutz Heinemann: Yeah, trends. It’s a little bit I tried to be a trendsetter myself. In other words, I try to bring up topics that I believe that probably require more attention. I think I mentioned my interest in plastic waste. We also the Diabetes Technology Society and myself, we have an interest in green diabetes. So we try to convince the companies and it’s interesting how positive many of the companies we act with, when they design new products, to have this in mind. Clearly if you design a product today until it comes to the market, the number of years in between, but as you and your body language also indicated climate change, heatwaves like we see it today.

There’s a need for us, for all of us to move out of our comfort zone. And so taking this topic as one example, I think this is a trend where also it’s important that people like myself that are not working for a given company organisation, but have somewhat of a distant critical position to, to mention start talking in some head like another trend some ten years ago when a number of the current CGM system came to the market of patients with skin reactions and some of them were severe.

I think that our work has helped to push the companies to develop better adhesives and so on. So there are a number of such aspects that I believe are always showing up and has to be acknowledged, has to be presented at such meetings to the audience to make them more aware of aspects that require attention that help them, also to communicate with some patients, to understand what are their needs. I understand. The focus on drug development is now on new therapies for type two diabetes.

Interviewer: Why aren’t we seeing new insulins, apart from maybe the Lilly insulin in 2020? I ask this question because I noted that one of your scientific interests is one of your scientific research interests is in insulin pharmacology.

Professor Lutz Heinemann: So clearly currently as I tried to indicate in one of my first statements I have a big interest in it. And it’s it’s a huge advantage for patients if they can improve their glucose control and at the same time lose body weight, something patients really appreciate. We have the cost aspect of it mentioned already also before so there is no more on Lilly and this is the topic for them currently at least at the last ADA here in San Diego with a lot of presentations, also awards given for these developments. So this is the topic currently. Will we see new insulins? Yes, we see new insulins, it’s probably one aspect is there also again from a cost side, there are a number of companies trying to develop biosimilar insulins. In other words, the insulins, the insulin analogs mainly that we have on the market are not out of patent. So we can have companies that come along as a copycat of insulin Glargine, insulin hotspot.

And so there are a number of companies, many of them from India or China, that are developing novel insulin, novel in parenthesis by manufacturing these already on the market insulins and tried to bring it to the market, we saw to a lower cost in order to achieve certain market share. So these are not new insulin. However, what we also have seen in bio for example, Novo and also Lilly is a development of weekly insulins that only you only have to inject every Sunday, for example, probably also to have monthly insulin in the future. These are clearly the insulins, not primarily for patients with type one diabetes. We would like to have more flexibility if it comes to exercise or whatever, but for many patients with type two diabetes, I saying these weekly insulins are really presenting a good solution because they only need a certain coverage of their basal or somewhat annual insulin requirements.

And these weekly insulins which which are a long acting insulins, and really long acting ones is something which is very attractive further and be insured inside the company’s developments for other insulins, organ specific insulin, smart insulin is still a topic which is quite interesting because there would be an an insulin depot that you can apply into the body and the insulin is released from this depot depending on the current glucose levels, this would be of interest. But then you have the ideal insulin therapy. So there’s there’s plenty to come regarding new insulins.

Interviewer: And so so wanted to talk about your biggest achievements in diabetes care. What if you would have to name one single biggest achievement? What would it be?

Professor Lutz Heinemann: That’s a bit tricky to ask a scientist about a sole achievement. Nevertheless, I am known somewhat for the glucose CLAMP technology. In other words, probably not these days that much anymore. About 20, 30 years ago, when I was a young man, we have developed the glucose CLAMP technology to an accepted scientific method to describe or recognise for us the pharmacodynamic properties of insulin and other anti-diabetic drugs. So the glucose CLAMP setting keeps blood glucose constant by varying the glucose infusion rate, intravenous and glucose infusion.

And this glucose infusion reflects on the blood glucose lowering activity of a given insulin. The insulin can also be inhaled or other routes of insulin administrations and then have the time action profile of a given insulin and the other antidiabetic agents. This helps you and the physicians and the patients to optimise their diabetes therapy. Because then they know, okay, when to expect the highest metabolic effect if you apply the insulin dose prior to a meal or during night or whatever. So, we bought a lot of clients, some new data to insulin therapy. And I think this is something which is somewhat combined to my name.

Interviewer: Wonderful. Very impressive. And can I ask you as a final question, can I ask you to talk us through a day in the life of Lutz Heinemann? Professor Lutz Heinemann.

Professor Lutz Heinemann: As you can see in my background, it’s still dark here in San Diego on the US West Coast. I’m with you. It’s 5 a.m. and with me it’s 1 p.m. and I’m speaking in the UK. So my wife and I, we are going back and forth between the US West Coast and Germany, so I’m up early. As I indicated I’m the editor of a US Journal, which has some interesting reputation in the area of diabetes technology. So one of my early tasks in the morning hours is to check how many new manuscripts have come in, what are the views of colleagues on these manuscripts to make decisions and so on. So this is something I regularly do in the morning hours because you need focus and quiet time to read manuscripts. And I also normally answer all the emails that show up overnight from Europe while you are sleeping and tried to respond in due time to these emails. Normally from 50 or whatever in the daytime. And then I try to push ahead my own publications, my own activities.

Normally, like now I have a number of phone calls, video conference or some other activities in Europe. And this is one of the reasons why I am up so early because now in the afternoon in Europe, you can reach people and talk to them and try and try to convince them to do some work for you and so on. So this is what I am regularly doing until noon time. Then I have a little nap, then a hike, riding my bike on a road bike with my wife and enjoying life, then San Diego, as you might know, is a nice city. We quite often go to the beach and in the afternoon hang out there, enjoy a sunset. And then I am in bed early because I’m up early in the morning. To repeat the process. Over and over again.

Interviewer: Well, thank you so much. It’s been wonderful to speak to. That’s Professor Heinemann. Thank you so much. Appreciate your time.

Professor Lutz Heinemann: Thank you very much for having me.