Insulin delivery for idiots

Insulin delivery for idiots

It seems that everyone these days wants to be in the insulin delivery business. As Diabetic Investor previously reported Johnson and Johnson (NYSE:JNJ) not only wants to be in the pen needle business but has purchased Calibra Medical makers of the Finesse insulin delivery system. Although we wouldn’t call the Finesse a patch pump as in our eyes an insulin pump is basically a mini-computer which is programmed and controlled by the patient, there are a host of devices which are designed so that the patient is not injecting themselves on a regular basis.  Another player in what Diabetic Investor calls the disposable insulin delivery arena is Valeritas, the makers of the V-Go™.

This morning the company issued a press release which stated the following; “Valeritas announced today the results from a recent retrospective analysis that looked at data relating to the clinical experience and feedback of patients with Type 2 diabetes who used the V-Go™, a wearable device for the delivery of insulin. The retrospective analysis of self-reported data from V-Go patients has been published in the current issue of Endocrine Practice, a peer-reviewed journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. Results from the analysis showed that V-Go helped patients to improve their glycemic control, and patients also reported a positive overall experience with regard to their general satisfaction, mealtime insulin compliance, and comfort while on the V-Go.”

Unlike the Finesse which delivers a pre-set amount of insulin when the patient presses on the device, the V-Go delivers a pre-set amount of insulin continuously not unlike a conventional insulin pump. The main difference being unlike a real insulin pump where the amount of continuous insulin delivery, the basal rate as it is called, is not controlled by the patient nor can the patient shut down insulin delivery without removing the V-Go.  Without going into an overly technical discussion of insulin pump therapy there are times when a pump patient wants to temporarily stop insulin delivery or lower the amount of insulin being delivered for a short period of time. A perfect example of this would be when a pump patient goes to exercise and knows their glucose levels normally drop during this period, to offset the possible onset of a hypoglycemic event the patient can either suspend insulin delivery or temporarily lower their basal rate.

Several thoughts came to mind while watching the videos which are on the Valeritas web site, First and to Diabetic Investor this is inexcusable, none of the videos show a patient testing their glucose levels before administering insulin. While the spokeswoman does mention glucose monitoring it’s almost an afterthought as though this step is unnecessary. Equally disturbing was the relaxed attitude towards such critical factors as insulin on board, duration of insulin action and insulin to carb ratios. Basically the message sent by these videos is that insulin pump therapy is simple, easy and anyone can do it; when in reality this is far from the truth.

Now before all the real insulin pump companies start bitching that we are giving insulin pump therapy the short end of the stick get real. There is no question that insulin pump therapy is very effective; there are hundreds of studies which prove this fact. But this is REAL insulin pump therapy and not dumbed downed insulin pump therapy which is being sold by Valeritas. The simple fact is a patient would be better off practicing multiple daily injection therapy (MDI) than using the V-Go, as with MDI they can control how much and when insulin is administered. For that matter given the choice between the V-Go and the Finesse, Diabetic Investor would recommend the Finesse based on the fact that it’s the patient who’s in control of insulin dosing and not the device that’s in control.

The real problem isn’t just with message Valeritas is sending; the real problem is that companies are doing their best to dumb down insulin therapy without taking into consideration that insulin is not just an effective drug but also a lethal one when not used properly. Once again this comes down to patient education something which is critical for any patient taking insulin. Companies like Valeritas seem to believe the doctor knows what’s best for the patient and that a patient will follow the doctor’s instructions exactly.  When everyone knows this is not how things work in the real world.

Let’s be clear here Diabetic Investor strongly believes that in the hands of well-trained and properly educated patients insulin therapy is extraordinarily effective.  It is also equally true that insulin when improperly used can lead to hospitalization and death. The fact is putting a patient on insulin without also educating them on the benefits and drawbacks of insulin therapy is akin to handing the patient a gun loaded with just one bullet and telling them to play Russian Roulette. It’s only a matter of time before they pull the trigger and that lone bullet will be in the chamber.

If a patient wants to be on a real patch pump there is a perfectly good system on the market which is being used by thousands of patients – The OmniPod from Insulet (NASDAQ:PODD). Looking at the two systems side by side Diabetic Investor would argue that the OmniPod is not only a better overall system, but far safer than the V-Go, as the OmniPod allows the patient to be in control over how much and when insulin is delivered.

To Diabetic Investor the V-Go is the poster child for what’s wrong with the insulin delivery market. In a desperate attempt to differentiate themselves from everyone else in the space Valeritas has chosen to over-simplify and dumb down the insulin delivery process. They know that the V-Go isn’t a real insulin pump nor is it a true patch delivery system. They seem to believe that patients and their physicians will be duped into believing that the V-Go is the perfect insulin delivery system because insulin therapy really isn’t all that complicated and what the heck it’s not like insulin can kill anyone. Frankly if someone chose to write a book about the V-Go we have the perfect title; “Insulin delivery for idiots.”

The bottom line here is let’s stop trying to dumb down the insulin delivery process with systems like the V-Go and instead give patients and their physicians tools which will actually make insulin therapy not just effective but safer. Let’s properly train these same patients and physicians on the use of insulin therapy, giving them the education they need to achieve better outcomes.  It’s time for everyone to get real and understand it’s not how the insulin is delivered that’s a problem, the problem is insulin therapy just isn’t that simple and there is no way getting around that fact.