Treat to failure; The Pink Elephant in the room no one talks about.
What good is it to have advanced therapy options such as Byetta, Victoza®, Lantus and soon Bydureon when they are not prescribed? Diabetic Investor asks this question based on some recent conversations with some regular patients with type 2 diabetes. One example comes from our friends at Healthy Outcomes where a user asked the following question:
“My numbers keep going up and my doctor keeps telling me im eventuly going on insulin i know this but they have been doing this for a year. Im already taking metformin,actos, and gabapentin now he wants to put me on another pill. I was wandering if he is right or should i seek other info this is my pcp that tells me this.”
Another comes from a gentleman who’s A1c has risen from 7.7 to 8.9 who is currently taking Januvia and glyburide. Concerned that his A1c has risen so dramatically, he went to see his physicians who told him to change his diet and lose 12 pounds. Then after 3 months they would recheck his A1c and if there was no improvement they would add metformin to his therapy regimen.
Unfortunately these two examples are commonplace in the real world, where nearly 80% of patients are being treated by a primary care physician (PCP). PCP’s who lack the time and infrastructure to properly educate their patients and in the face of overwhelming evidence that their patients with diabetes should be treated more aggressively, remain stuck in the death spiral known as treat to failure.
The honest truth is that no one, not the American Diabetes Association (ADA), nor the American Association of Clinical Endocrinologists (AACE), nor the American Association of Diabetes Educators (AADE) or the American Medical Association (AMA), wants to talk about the pink elephant that’s standing in the middle of the room. Everyone sees the elephant but rather than ask what the heck this strange animal is doing in the room, they talk about anything but the obvious.
Until someone, anyone dares to speak up we will remain on the diabetes treadmill, running in place going nowhere. Nearly two-thirds of patients will remain out of control with A1c’s that aren’t even close to 7. We’ll continue to see unnecessary cases of blindness, amputations, kidney failure and cardiovascular disease. The cost to treat preventable complications will continue to skyrocket and patients who would benefit from more aggressive treatment options will continue to feel as if there is nothing they can do to manage their diabetes more effectively.
This treat to failure mentality not only has serious consequences for the patient but every company in the diabetes space. Yet, the very companies that would benefit from more aggressive treatment options remain silent and like everyone else in the room fail to take on this pink elephant. Rather than push these governing bodies of diabetes to speak more for the patient, they prefer instead to push their individual initiatives which make a nice sounding press release but do little to impact better patient outcomes.
Diabetic Investor is not trying to blame PCP’s for all the ill’s associated with diabetes and given the epidemic growth rate of diabetes we fully understand they are overwhelmed. It’s difficult, if not impossible, for a PCP, even one who is proactive with their diabetic patients to avoid the treat to failure mentality. Each day it seems they are getting conflicting messages from these governing bodies as to what exactly is the correct therapy regimen. It surly doesn’t help matters any when the FDA sends equally conflicting messages about which drugs are or are not safe. Add in the fact they must deal with insurers who are more concerned with controlling costs rather than improving patient outcomes and it’s easy to see the difficult road for a PCP.
The truly sad part here is even if no new drug comes to market there are several very effective therapy options available that, for one reason or another, are not used until it’s too late.
Considering that the diabetes epidemic shows no signs of abating isn’t it time for these governing bodies of diabetes to set aside any differences they may have and speak loudly with one voice, sending a clear and unmistakable message to PCP’s that this treatment to failure approach to diabetes management will no longer be tolerated. Does it not make sense to help PCP’s by providing clearer guidance as to what it and what is not an appropriate treatment path? For anyone who believes that PCPs’ can easily understand the current treatment guidelines Diabetic Investor recommends taking a look at these recommend guidelines, guidelines which are so confusing PCP’s already strained for time, prefer to ignore them rather than spend hours trying to figure them out.
Some will say that diabetes is not a one size fits all disease and you cannot simplify these recommendations as what works for one patient will not always work for another patient. While there is some validity to this argument, it’s also pretty obvious that when a patient goes from an A1c of 7.7 to 8.9 that whatever therapy option there on isn’t working and simply asking the patient to lose weight just won’t work. What happens if the patient does not lose the weight, something that often happens in the real world, what then? Or what happens if they lose the weight and their A1c is still too high? Would it not be better to take more decisive action and put the patient on a drug that is proven to effectively lower glucose levels and has the added benefit of weight loss?
While there is much disagreement on what the best treatment path is, there is near universal agreement that the longer a patient remains out of control the more damage that is done and the likelihood exists that this patient will develop complications. Would it not be better for everyone involved if PCP’s were given clearer guidance, with measurable targets and time frames so that the patient does not remain on the treatment treadmill to nowhere?
Frankly the time has come for everyone to stop ignoring the pink elephant in the room and begin discussing how to get this dangerous animal out of the room. The time has come to stop arguing over who gets credit or who’s doing more to help raise awareness. The time has come for industry and these governing bodies of diabetes to stop questioning each other motives and focus on the millions of patients who needlessly continue to suffer. The fact is the pink elephant is not just standing around in the room but is destroying everything in its path each time it moves. The time has come to get out the elephant gun and kill the beast.
