Glucose Guardians: The Bristol cluster transforming diabetes care

Glucose—an essential sugar—and insulin—the hormone that regulates it—do a delicate dance in your blood each day. When your pancreas can’t produce enough insulin to regulate blood glucose levels, or the body can’t effectively use the insulin it makes, the result is diabetes. The condition damages blood vessels and can result in debilitating conditions like stroke or heart disease.

In an industrialised world, where sugar is commonplace in our diets and lifestyles are significantly more sedentary than our hunter gatherer ancestors’, our pancreatic systems struggle to adjust to this explosive rate of change. Currently, over half a billion people have diabetes globally, with the figure predicted to rise to 783 million by 2045. With complications that include cardiovascular disease, kidney failure and limb or sight loss, diabetes is a life-changing illness. In England alone, the NHS spent £1.53 billion (15% of the total spend on all prescription items) on drugs to treat diabetes in 2022/23.

A lot has changed in diabetes management in the last three decades. Continuous glucose monitoring (CGM) is currently one of our most effective tools in the battle against diabetes, but it has been a long road for patients. As a patient and a GP, Dr Brown, who was diagnosed with type 2 diabetes, has witnessed the revolution in glucose monitoring from both sides of the doctor’s desk. 

“As a GP,” Dr Brown begins, “the more we learned about diabetes, the more we understood that tight blood sugar level control was really important. 

“We learnt that a lot of the damage done by diabetes happens early in the disease. As a result, the emphasis in the research changed. It went from fully focusing on studying the relationship between diabetes and large vessel conditions like stroke and heart attack, to gradually shifting towards lifestyle choices to protect capillaries and avoid diabetes complications.

“The mentality, from the doctors’ point of view, shifted from ‘lecturing’ to empowering patients to help themselves. They learnt that diabetes management was best achieved by giving patients biofeedback, so they could understand what eating habits and other lifestyle choices would keep their blood sugar levels down. But this was only possible because the technology to measure blood glucose improved.

“Back then,” she continues, referring to her diagnosis in the mid-eighties, ”your only option was spot testing. You had a glucose testing strip that you’d add a drop of blood to, wait, wash, stick it in a machine and voila! The machines didn’t keep any records, so you’d have to write it all down and give it to your doctor. It could be very hit and miss, and testing with strips became really intrusive. It was always at the forefront of my mind, and many people I knew didn’t want to do it in public. With the monitors available today, it’s fantastic–you can completely forget.” 

Nowadays, the norm in CGM tech involves a sensor and a sticky patch. Puncturing the upper layers of skin, the sensor’s microneedles are embedded with molecules used to detect sugar levels from interstitial fluid (the juice between your cells). This information is sent from a transmitter within the sensing device to a receiver –often a smartphone– that processes and displays the data.

Armed with invaluable information on their internal chemistry, both those with diabetes and those at risk of diabetes can constantly track their blood glucose levels over days, months and years. They are empowered to make lifestyle changes like altering their diet, planning when and what to eat or taking up more exercise. 

Meet the Glucose Guardians

At the heart of Bristol, a cluster of startups dedicated to improving the technology that powers CGM started to emerge in 2014, when a newly formed startup called Ziylo spun out of the University of Bristol and started a journey to build a home for themselves and for other deep tech startups in the area by founding Science Creates.

What was perceived as an overambitious project then (“how are you going to build deep tech incubators in Bristol when all investment goes into Golden Triangle universities?”) exploded into a community of over a hundred startups spread over two –soon to be three– deep tech incubators, evidencing the thirst for science innovation and entrepreneurship in the area. 

The very first resident of Science Creates was Ziylo, who had developed a groundbreaking technology that could lead to the development of ‘smart insulin’–which meant it would be able to react and adapt to blood glucose levels. When the company was acquired by Novo Nordisk in 2018 in one of the biggest deals in the University’s history, Bristol’s research strength and commercialisation opportunities were suddenly put on the map. Soon enough, other startups working in deep tech started to coalesce in the area– among them the three companies looking to improve diabetes care through revolutionary technology for CGM.

Carbometrics: a better molecule for CGM

Built on the successful legacy of Ziylo and based at Science Creates’ St Philips, the Carbometrics team have created a groundbreaking synthetic molecule that binds to glucose and promises to pave the way for a new class of CGM sensors. Besides doing a better job at binding to glucose in blood, this molecule is also very chemically stable – which is crucial for the development of both highly accurate and much more durable sensors. Instead of replacing the sensor every few weeks, which is the current norm, the Carbometrics technology could lead to sensors that last for years.

Moreover, Carbometrics’ technology for long-lasting, highly accurate sensors isn’t only relevant to healthcare, but also in the production of vaccines, biological drugs, and potentially even food –industries where measuring glucose is critical but where suitable CGM sensors have been very limited so far.

Transdermal Diagnostics: CGM that’s better for skin and planet

Transdermal Diagnostics, a University of Bath spinout, joined Science Creates in 2022 to create the next generation of wearable CGMs. Transdermal Diagnostics’ unique sensing architecture draws out biological substances through individual hair follicles, making it the world’s first needle-free CGM system.

No needles means both less skin irritation and less waste. In Transdermal’s device, the transmitter is reusable and only the sticky patch is changed –preventing a high-tech combo of plastics and metals ending up in landfill and reducing the plastic footprint tenfold compared to standard CGMs.

Lifecare: CGM made micro

Imagine a CGM device no bigger than a grain of rice that can be injected under the skin and forgotten about (for a while, at least). This is what member company Lifecare have developed with Sencell, an ultrasmall device with 3D-printed nanobiosensors that detect changes in osmotic pressure—the force required to prevent water from moving across a membrane to balance out the concentration of dissolved substances on both sides—which are directly linked to blood glucose levels.

LIfecare’s ‘inject and forget’ system can last up to six months without calibration, eliminating the need to frequently change patches and transmitters – a big win for diabetes patients and for the planet alike.

Dr Brown wraps up: “There are so many factors that influence blood sugar, from the kind of meal you have and how quickly the body processes it, to when you choose to exercise. If I’d had the ability to watch the changes in real time when I was diagnosed, it would have revolutionised my life. 

As a physician, I truly believe that if patients are given the power to capture high-quality, trustworthy data, that will drive their motivation to make changes and keep up the good work.’