Out with the old, in with the new

As we close the book on 2019 and begin a new decade it’s worth looking back at the past decade and the many advancements in diabetes. There is no doubt in our mind that CGM was the most transformative technological innovation over the past decade. As we enter the new decade CGM systems are not just more accurate and patient friendly they are becoming more affordable an aspect that cannot be underestimated.

Before we go on let’s spend a moment on the affordability aspect of all diabetes products drugs and devices. Over the years we have seen many improvements in both the drugs used to treat diabetes and the technology used to monitor diabetes or deliver drugs. As we have stated many times while improvements in drugs and technology are welcome, we have the tools available today so that every patient if they choose to do so can easily manage their diabetes.

However it is also true that thanks to our convoluted healthcare system it is NOT a level playing field when it comes to patient access. The out of pocket cost of insulin is a prime example of this. Again as we have stated many times no patient should ever have to choose between buying groceries or refilling their insulin prescription. Insulin is a life sustaining drug for millions of patients. While we believe this issue has been somewhat over blown it is true that there are patients who through no fault of their own cannot afford the drug that keeps them alive.

The same can be said for much of the new technology available. Those patients with “good” insurance coverage have more choices. Unfortunately there are far too many patients who because of their insurance plan cannot afford or do not have access to these technologies.

It would be refreshing if instead of pointing fingers industry worked together to bring transparency to the system. In our opinion patients could care less about who does what and care more about being able to afford the drugs and technology they use. This is not a simple task as for competitive reasons many companies do not want to share in the public domain the discounts they offer or the rebates they pay. However until transparency is brought to the system patients will always feel that the system is rigged against them.

Let’s, excuse the expression, stick with the high out of pocket cost of insulin. From the start we have noted this issue impacts less than 5% of the overall patient population. Yet the issue has become a tinder box with patient advocates who only see that the WHOLESALE cost of insulin has increased dramatically over the last decade. What they do not see are the discounts and rebates given to payors, discounts and rebates used to gain favorable formulary placement. Nor do patient advocates have access to data which shows which patients have CHOOSEN high deductible plans or which patients do not have any coverage at all.

All everyone sees are the heartbreaking stories of a patient who has died because they could not afford the drug that keeps them alive. It’s no surprise this issue has become a hot button issue with our elected officials and the many who are running for President. Yet lost in this debate is one simple question, other than providing access to those who through no fault of their own cannot afford insulin, will lowering the out of pocket in any way result in better patient outcomes? Our connection has always been and continues to be that insulin could be given away for FREE but that would not result in better patient outcomes. The facts, yes, those pesky facts, tell us a far larger cost to the system are the many costly complications that come from poorly controlled diabetes.

So let’s get off the soap box and look to the future as it is very bright, particularly for insulin using patients. By the end of the next decade, thanks to CGM and insulin dosing algorithms, life for an insulin using patient will be blissful. The current crop of hybrid closed loop insulin delivery systems will get even better eliminating much of the heavy lifting done by patients and taking away the fear of serve hypoglycemic event. Tyler will be in full force during the decade doing the same for patients following multiple daily injection (MDI) therapy. Even patients using insulin plus orals will benefit as the insulin part of the equation will be augmented.

GLP-1 therapy will continue to grow and get a nice boost when the Intracia exenatide micropump arrives. Th reality is that the biggest issue that stands in the way of better patient outcomes continues to therapy adherence and this system eliminates that concern.

While we see a role for digital diabetes that role will not be as major as many see it to be for one simple reason, all the coaching in the world cannot force a patient to take their meds as prescribed. Our belief has not and will not change on this issue as until the patient has a real vested interest in their outcomes nothing much will change. And we are not talking about the patient “feeling” better no we mean real tangible rewards that the patient can see or touch.

Now I know we’ll get in trouble for this but heck after 20 plus years of covering our wacky world and telling the truth we’re used to getting in trouble so what the heck. It would equally refreshing if everyone acknowledged that the PATIENT bears some responsibility and should not be absolved of this responsibility. Diabetes is a MANAGABLE chronic disease IF the patient chooses to do so. Patients with diabetes are NOT handicapped, diabetes is NOT a disability. It may make patient advocates more popular by blaming everyone but the patient for the fact that nearly two thirds of all patients are not under good control, but it does not change that pesky fact.

As Momma Kliff used to say having a Diet Coke with a Lou Malnati’s deep dish pizza, or a Portillo’s Italian beef sandwich and large order of fries does not constitute being on a diet. Nor is it exercise walking from the bedroom to the couch to watch TV. There are many simple, painless and FREE things patients can do IF they choose to do them.

We would like nothing better than for patients to be treated as adults and with respect. Take away the guilt, the condescending attitude and the victimization. Give them the facts and allow them to manage their diabetes as they see fit. Make them aware of the choices they have and let them make that choice. In many respects this decade and the one to come are no different in that until everyone realizes that PATINETS ARE PEOPLE AND NOT ROBOTS nothing much is going to change.
Patient empowerment isn’t about a lower out of pocket cost of insulin or whiz bang way cool toys. Patient empowerment is all about providing clear, understandable information. Providing access to the drugs they need and the toys they play with. Then get out of the way and let them manage their diabetes.

As Momma Kliff used to say decisions have consequences but you cannot make an informed decision unless you have all the facts. It’s about time patients were given the facts so they can get on with their lives.