Could ‘around the pill’ solutions be the key to effective diabetes management?
Research with patients shows that they have particular needs at specific stages, from diagnosis to longer-term disease management, that pharma and technology could address.
In the crowded type 2 diabetes market, pharma companies need to find other ways, beyond blood glucose control, to differentiate their brands. In an effort to stand out, players such as Janssen have developed 'around the pill' support programmes that aim to help patients address the health and lifestyle issues which are causing them to struggle to maintain management of their disease.
Critical to the success of these programmes is a strong understanding of diabetes patients, their needs and behaviours, the obstacles they face at each stage in the patient journey and the levers that may bring about a change in behaviour.
So what do patients with diabetes think about their disease and what do they need to help them improve their health? An independent online and mobile market research study1 of 2,500 patients across Europe identified three key areas where patients need greater support:
1. Diagnosis
2. Compliance with treatment
3. Long-term lifestyle management
Dogged at diagnosis
Although significant strides have been made by physicians to improve patient care, the survey found that patients still didn't feel they were given an appropriate level of support at diagnosis. Many felt as though they were being lectured during consultations. To quote one patient in Spain, "To my doctor I'm just another patient. He does not support me. Whenever I visit him he is cold. He seems to blame me for my disease and he is very abrupt when talking about it – he just tells me that I have to follow the treatment."
"Even where patients' intentions were good, actual adherence to dietary advice was substantially lower than reported"
Around two thirds of patients claimed initial diet and exercise advice was vague and they wanted more detailed direction. This was particularly true in the UK, where only around 60 per cent were told to exercise more and eat less. Out of the range of advice given, patients were more likely to use a blood glucose monitor or take vitamins than to give up smoking, eat more healthily or exercise more. Even where patients' intentions were good, actual adherence to dietary advice was substantially lower than reported (14 per cent vs. ~50 per cent).
The lack of buy-in at diagnosis resulted in bad habits continuing, with 75 per cent of diabetes patients still classifying themselves as overweight.
Although they paint a slightly bleak picture, these findings do present pharma companies with an opportunity to support patients beyond prescription medicines. They could offer engaging tools which offer specific, detailed information on diet plans and levels of exercise, delivered in a friendly way and personalised to each patient's individual needs. Patients with diabetes are often very unsure about how to follow a healthy diet or what constitutes sufficient exercise. To quote one UK patient, "I think I would have liked to have been told the 'what ifs'. For example if I had two packets of sweets over an hour or so, what could that mean for my blood sugar level?"
Sanofi recently developed a patient support initiative called Diabetes Matters, which seeks to provide such detailed, accessible and personalised information through a range of channels, including YouTube and other websites, by DVD, print and phone, all available in a range of languages. Their aim is to support patients who don't feel they have sufficient access to information and need help to control their disease.
Overstated compliance
The second obstacle for diabetes patients is compliance with taking their medication as prescribed.
In the study, patients were interviewed by mobile phone, so that they could be asked about their diabetes at the moment when they were taking action, rather than just reporting on past behaviour. The findings revealed that patients did overstate their compliance. Just over half (51 per cent) of respondents believed they were being compliant, but in fact less than a third were taking their medicines as prescribed (this included both oral and injectable medicines). Pill boxes and reminders do help patients with compliance, especially if the pill burden is high. As a British patient explained, "The only way that I can make sure that my tablets are spaced out correctly and at the right days is to put them into one of the pillboxes. I use the one with four times a day for seven days and I do find this helps me stay online and on track with the medication."
But with advances in technology and new and more sophisticated ways of supporting improved health becoming available, can tools such as mobile health apps and other forms of medical technology support improved adherence? Perhaps, as long as they are based on a clear understanding of patients' behaviours and motivations.
"Apps need to educate patients about the risk of complications and convince them of the importance of adherence"
The most common reasons patients gave for not taking their medications as prescribed were disruptions to routine and unforeseen circumstances, such as being ill, or having to work late. However, the most mentioned reason for doing as they were told was a concern about the long-term complications to their health. This suggests that not only do mobile apps and other tech need to help with the practical aspects of reminding patients and helping them plan, they also need to educate patients about the risk of complications and convince them of the importance of adherence to their overall health in the longer term.
Aided by Apple
The final issue is successful long-term lifestyle management. Although patients did appear worried about their health in general terms and had high awareness of long-term complications, such as vision loss or circulation problems, their levels of anxiety about getting these particular complications were considerably lower. This suggests that patients were still burying their heads in the sand, and failing to properly grasp the link between lifestyle management, blood glucose control and longer-term medical issues. So, raising concern for long-term complications among diabetes patients is critical.
Wearable tech, such as Apple's iWatch and its recently-launched diagnostic ResearchKit app, could help to encourage patients to take more responsibility for their own health and negate this risk, as well as limit the healthcare costs associated with complications. Apple and other tech firms are keen to work in partnership with big pharma to deliver solutions that will improve patients' health. For example, Novartis is working with Google on a 'smart lens' to help measure diabetes patients' sugar levels through their tears.
As we look to the future it appears that evolving education, the use of technology and improved partnerships will become essential factors to help overcome current obstacles in the patient journey. Whilst no easy task for pharma, the rewards in supporting the patient beyond the pill could be significant.
Research background
1 Living with Diabetes was a three-stage market research study conducted among patients diagnosed with type 2 diabetes across Europe. Stage 1 was a quantitative online study of 2,500 patients in France, Germany, Italy, Spain and the UK. Stage 2 was a moderated online forum among 55 patients in the UK and Spain and Stage 3 was a mobile research study with 58 patients in the UK and Italy.
About the author:
Julie Denny is Director of Marketing for Research Partnership and has over 20 years' experience of working for market research organisations across various industry sectors. She has a passion for healthcare and is fascinated by the way that digital is changing the patient, physician and pharma paradigm. Julie was instrumental in developing the patient market research series "Living with chronic illness". She has a postgraduate diploma in marketing and a diploma in digital marketing from the Chartered Institute of Marketing.
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