Are we getting off track yet again?
Merle Martin once wrote, “There is nothing so simple that it cannot be made difficult.” Although Ms. Martin was not writing about diabetes devices she may well have been, as once again it seems diabetes device companies are doing their best to over complicate the lives of patients when it’s the exact opposite that needed. It seems to Diabetic Investor these companies are still fascinated with whiz bang technology that only a handful of patients will understand or even use. They just can’t get it through their heads that patient’s want simpler not more complex solutions, solutions that don’t require a PhD or advanced degree in engineering to learn and use.
Recently Diabetic Investor has been taking a closer look at some of the newer approaches to help patients who follow insulin therapy. Everything from more sophisticated short-acting insulin to devices which are supposed to make existing insulin treatments work better. The general theory here is that patients will achieve better overall outcomes using these new insulin’s or devices, yet the question that isn’t being asked is do patients really need or even want these new insulin’s or devices. Nor is anyone bothering to ask whether payors will actually reimburse for these newer products assuming, of course, they make it all the way to the market.
Just by way of example take the simple task of injecting insulin, which in reality isn’t all that simple already. As we have noted on many occasions insulin using patients should, and yes we are saying they should, understand concepts such as insulin to carb ratios, duration of action, target glucose and insulin on board. Patients following insulin therapy SHOULD monitor their glucose prior to dosing but again this is not always the case. For many insulin users, their physician has dumbed down dosing decisions by telling them to inject a specific amount at a specific time. Physicians know all too well that most of these patients aren’t monitoring their glucose regularly and in an effort to keep the patient compliant with their therapy regimen they provide them with simple guidelines or instructions.
This is one reason so many device companies are desperately trying to develop an interconnected diabetes management as they believe armed with this tool patients will achieve better overall control. They believe patients will take the time to enter all the ancillary information that we noted in the last paragraph, regularly monitor their glucose and follow the systems recommendations. Never mind that most insulin patients don’t know what their individual factors are or want to take the time to find out. Again as we have noted before this one of the structural flaws with interconnected diabetes management, it assumes patients actually have a solid understanding of their diabetes when in fact most don’t. Or put more simply – garbage in equal’s garbage out; which isn’t exactly a great idea when someone is administering insulin, a drug which if dosed improperly can kill the patient.
The fact is most insulin using patients would like nothing better than to inject their insulin and be done with it. They really don’t want to perform any complex calculations or attach something to their body that may or may not help them better manage their diabetes. While it would be nice if they didn’t have to worry about when they inject, the real issue isn’t when they take their insulin rather whether they are actually taking it. Numerous studies have shown that therapy non-compliance isn’t just a problem with pill popping patients but extends to insulin using patients as well. This is yet another reason Diabetic Investor sees the GLP-1 market exploding, all the patient has to do is inject.
While we know that glucose monitoring is going to hell in a hand basket, thank goodness there are companies like Intuity Medical and their Pogo device. Rather than over complicate the process of glucose monitoring they have simplified the patient’s life and actually made testing easier.
Or what about the dramatic increase over the past ten years of insulin pens. It’s a well-known fact that insulin pens are more expensive than the old syringe and vial system yet pens have gone from barley 5% of the market to more than half the market and still growing. This growth did not happen by accident or coincidence; insulin pens have made insulin therapy easier for the patient. HELLO!
Does anyone seriously believe that an insulin using patient will want to attach a patch to their body every three days and inject through this patch? This is almost as crazy as attaching a patch filled with insulin to the patient’s body and then making the patient click on the patch to get their insulin. Do the companies who developed these products truly believe this is a simpler, more elegant solution than an insulin pen? Do they seriously believe a patient will achieve better outcomes when these convoluted systems can only deliver insulin in pre-determined amounts?
The reality is all of these so-called solutions are nothing more than attempts to cover up a structural flaw with insulin therapy, which is no one wants to take the time or pay for these patients to become educated on the proper use of insulin. Primary care physicians, a group that treats 80% of all patients with diabetes, are themselves undereducated on the use of insulin therapy. The problem isn’t insulin or how the insulin is delivered, as with so many things in the diabetes world the true problem is all the whiz bang technology in the world cannot replace a well-educated patient. Once everyone recognizes this fact and decides to do something about it then there is a chance, but until that time all these so-called innovations are nothing more than a diversion from dealing with the real problem.
