It’s so simple yet so complex

It’s so simple yet so complex

It’s been said that the shortest distance between two points is a straight line. Yet in our wacky world it seems that everyone is adding too many zigs and way too many zags. We’ve said it before and we’ll say it again there is nothing inadequate about the drugs or devices available. Sure, we can always use better drugs and more patient friendly devices. However, if the drug and devices we have are used as intended they will do the job quite nicely.

We have also said that for most patients the path to properly managing their diabetes isn’t that complex. This is even true for patients on insulin therapy. We have hundreds of apps that can calculate the proper amount of insulin to take. There are other apps which can remind patients that it’s time to take their pills. As we have said there are plenty of tools in the tool shed.

What none of these tools can do by themselves is provide motivation. They cannot without the patient build anything. Even when given clear easy to understand instructions and all the materials needed these tools will not build anything if the patient does not use them. The bottom line is companies are focusing on the how to when they should be focusing on the want to.

Ask any physician what’s the biggest obstacle between patients and better outcomes and almost universally they point to therapy adherence. That if patients took their meds as prescribed we wouldn’t have nearly two-thirds of patients not under good control.

Think of it this way most people understand that if they want to lose weight they need to make some changes to their lifestyle. There is no secret to losing weight. Yet we still have millions of patients who are obese.

The same goes for smoking, there are several proven methods for quitting. Yet, millions still smoke.
Diabetes isn’t that different, achieving good outcomes is not a complex algebraic problem. Yes, there are variables but none that cannot be easily figured out. In fact, we would argue that with all the toys patients have to play with figuring out the path to success is easier than ever. Yet the fact remains that most patients are not under good control.

We have said consistently that managing diabetes is job. A job that must be done every day. A job where the patient does not get any days off. Still it can be done just like any other job provided the patient has the want to the desire the motivation. This is what’s missing from our wacky world, everyone is telling the patient how to do it, but no one has to this point been to provide the stimuli that will motivate the patient. They all give the how to do it, but they haven’t provided they want to do it.

This is one reason we love diabetes for dummies. Take the Intarcia micropump, the most stupid elegant solution one that does not require a speck of thought on the patient’s part. The FreeStyle Libre is another example of stupid elegance. Trulicity, Bydureon and Semaglutide are also stupid elegant.

On the flip side look at something like the 670G. While not a true artificial pancreas it is a major advancement in insulin pump technology. Yet many patients who use the 670G hate it because it’s so damn complex. Don’t get us wrong there are also as many patients who swear by the 670G. However, whether they love it or hate it none of these patients would say the 670G is easy to learn or use. The patients who love it are motivated, they are engaged with their diabetes or in other words they fall into the minority of patients overall.

See what most patients want is stupid. They do not want to constantly be thinking about their diabetes. They want their diabetes management to be as simple as using Uber. Yet all the tools which are supposed to make diabetes management simple, all these way cool toys which talk to way cool apps do the exact opposite as they make the patient think about their diabetes when that is the last thing they want.

The reality is patients are people and not robots. Being human two things matter most, saving time or saving money. Let’s be honest while outcomes are important to most patient’s outcomes are a foreign concept, they cannot spend outcomes. Therefore, stupid is better, the less thinking the better.

Yet there is a major bias in diabetes to the clinical side. Listen we all know that better outcomes are the goal but what the people in our wacky world cannot grasp is they care more about this then the patient does. They cannot understand why more patients aren’t more engaged why they do not care as they care. The biggest problem is they think like clinicians, they do not think like patients.

See most patients aren’t looking 5 or 10 years down the road. Like many of the executives in this wacky world they are focused on the short term, what’s right in front of them. To many patient’s complications from poorly controlled diabetes is something that might happen and if they do they will happen way in the future and will happen to someone else. This is one reason patients skip taking their meds as they don’t have a sense of urgency. They don’t see any harm from skipping a dose.

What needs to change for any of these companies to have a true impact is stop worrying about providing the how to manage diabetes. Switch to focusing on helping patients get the want to manage their diabetes. This will not come from way cool whiz bang toys. This will not come from better drugs unless these new drugs are taken less frequently. The fact is the less interaction the patient has with their diabetes management the better. As the old saying goes – keep it short – keep it simple and most of all keep it stupid.

The path to better diabetes management, to better patient outcomes is not complex. What’s complex is getting the patient to want to manage their diabetes. The how to is easy.