More impactful than drugs or devices

More impactful than drugs or devices

There are many thought provoking studies coming out of the annual EASD conference being held in Stockholm this week and we will get to many of them however a study released by Novo Nordisk (NYSE:NVO) this morning captures one of the biggest issues facing diabetes. According to a company issued press release:

“New findings from the Perceptions of Control (POC) study showed adults with type 2 diabetes uncontrolled on basal insulin had a broader definition of control, perceived greater obstacles to maintaining control and that life was impacted significantly more than physicians expected.1

“There is a significant gap in perceptions of control between physicians and patients in how they define control, the obstacles and how being uncontrolled on basal insulin impacts patients’ daily lives,” said Meryl Brod, PhD, lead investigator of the POC research study. “Having a more open dialogue during consultations may provide more insight into these critical factors which could improve diabetes management and lead to more effective individualised treatment plans.”

It really should not surprise anyone that physicians tended to define control using clinical terms such as HbA1c and hypoglycemia while patients defined control as how much insulin they were taking or how much they had to think about their diabetes. This disconnection between how physicians view control and how patients view control is creating a communication gap which can impact outcomes. The fact is physicians far too often fail to take into account what it’s actually like to manage diabetes in the real world.

As the press release states; “The impact of being uncontrolled on basal insulin and how it interfered in one’s life was perceived as significantly greater than physicians believed including aspects such as mood/emotions, making plans and how much one accomplished during the day.”

Frankly this does not surprise Diabetic Investor as we’ve been saying for years that the majority of patients want to live their lives WITH their diabetes and NOT FOR their diabetes. That patients want diabetes management to PART OF THEIR LIVES NOT TO RUN THEIR LIVES.  This study data only confirms data we’ve seen from Healthy Outcomes, now called Incentmehealth, which indicated how the  psychology aspects of diabetes impacted how the patient managed their diabetes.

The sad reality is far too many companies in this wacky world ignore the needs of the majority and tend to listen to a very vocal minority. The harsh reality is only a minority of patients are actively engaged with their diabetes management, these people basically get it and don’t need help getting it. Yet these actively engaged patients also are very vocal and get far too much attention from drug and device companies. Companies simply assume that since these actively engaged patients feel a certain way that every patient feels this way when this just isn’t the case.

This group of actively engaged patients also tends to be not just very insular but also very provincial. Although they won’t admit it there is a definite bias towards patients with Type 1 diabetes and almost contempt towards patients with Type 2 diabetes as if they aren’t worthy. Diabetic Investor frankly has never understood this bias but it is very real.

Many times we have noted that diabetes management is 24 hour per day 7 day per week 365 days per year job with no days off. That while diabetes is manageable and controlled this does not mean that diabetes management isn’t demanding and that even the most actively engaged patients don’t get frustrated.

Over the years Diabetic Investor has seen many drug and devices that ignored how the patient actually manages their diabetes. The device area is littered with products designed by engineers to be used by engineers. The same can said for drugs just take a look at Afrezza. If anything the dismal performance of Afrezza shows that this supposed fear of injections is overblown. Yes in a focus group every patient wants alternate insulin delivery systems or a non-invasive glucose monitor but in the real world it is much different story. In the real world usability, insurance coverage and co-payments matter more.

This is why Diabetic Investor remains skeptical that interconnected diabetes management (IDM) will ever reach its potential. Yes this systems are way cool and whiz bang but will patients actually use them is another question. Here too companies in the IDM space spend far too much time listening to actively engaged patients rather than the majority of patients. The reality is there is not enough actively engaged patients to sustain a profitable business.

More than likely this study done by Novo will get scant attention, that other releases about drugs and devices will grab the headlines. This is unfortunate as these drugs and devices are going to be prescribed by physicians who given the results of this study don’t communicate well with their patients. It’s equally unfortunate that these same drugs and devices are going to be used by patients whose main concerns differ widely from their physicians. To Diabetic Investor this lack of understanding by physicians and differing views of control by patients is a recipe for disaster.

We’ve said it before and we’ll say it again the most effective tool for improving patient outcomes is patient education. This is not conjuncture or speculation this is fact backed by hundreds of studies. Yet drug and device companies continue to ignore this fact. They continue to listen to a vocal minority and fail to see what the majority really wants. They are overly impressed with whiz bang and way cool rather than getting the job done. Just as this study shows a major communication gap between the patient and the physician so too is there a huge gap between what patients really want and what companies are giving them.

As G K Chesterton once said “There’s a lot of difference between listening and hearing.”