What Are the Most Solvable Problems in Diabetes?
The diaTribe Foundation’s 2016 gathering shares need for earlier treatment, data integration, prevention, amplifying patient voices, and reducing stigma.
By Payal Marathe
The diaTribe Foundation hosted its third annual “Solvable Problems in Diabetes” forum at the 2016 European Association for the Study of Diabetes (EASD) Conference in Munich, Germany. More than 150 guests gathered for this dynamic panel discussion, moderated by The diaTribe Foundation’s Kelly Close. This year’s panelists included renowned diabetes experts from around the world:
Dr. Tina Vilsbøll (University of Copenhagen, Denmark)
Dr. Bernard Zinman (University of Toronto, Canada)
Dr. Lutz Heinemann (Profil Institute, Germany)
The speakers offered nuanced perspectives as both researchers and healthcare providers who regularly work closely with people with diabetes. An overarching theme of the evening was the need to listen to people with diabetes: What do they need, and do they have ample opportunity to speak up? Below, see some of the top takeaways and memorable moments from this year’s event (the diaTribe team is already looking forward to a better-than-ever “Solvable Problems in Diabetes” during EASD in Lisbon, Portugal next year!).
Reimbursement and Affordability
Dr. Heinemann shared a story about Freestyle Libre in Germany to showcase how powerful the voice of people with diabetes can be. “Libre is a big success story in Germany,” he said. “Patients loved it even when they had to pay for it themselves, and now insurance companies are starting to cover it. Once the patient voice is involved, things can move forward.”
Starting Treatment Earlier
One prominent “solvable problem” identified by the panel was the “treat-to-fail approach,” or the notion in diabetes care that healthcare professionals should try one drug at a time, waiting for things to go wrong before trying something new. Dr. Zinman argued that a more appropriate approach would be combination therapy, started earlier on. This would simultaneously target – and fix – various factors that lead to diabetes, since it’s unlikely that one drug will be the “silver bullet” that will fix all factors responsible for diabetes, Dr. Zinman explained.
The panelists were especially excited about combinations of SGLT-2 inhibitors and GLP-1 agonists because of recent studies (on Lilly/BI’s Jardiance, an SGLT-2 inhibitor, and Novo Nordisk’s Victoza, a GLP-1 agonist) suggesting both drugs might preserve the heart and kidneys in people with diabetes. Heart disease is a leading cause of complications and death for people with diabetes, so drugs that can protect the heart are especially exciting and important. Dr. Vilsbøll shared that she’s already using SGLT-2 inhibitors and GLP-1 agonists side-by-side for some people with type 2 diabetes.
The speakers had a lot to say about diabetes prevention. They shared thoughts on how the healthcare system and society at large could better facilitate exercise and other healthy habits to reduce factors contributing to the development of type 2 diabetes. Dr. Heinemann pointed to his smartphone, calling the device “the biggest part” of his exercise routine – “my wife asks me every evening how many steps I’ve taken.” In his view, social media and exercise apps can be valuable in encouraging exercise in the way they foster healthy competition and hold people accountable for daily physical activity.
Dr. Zinman agreed that technology will be important in pursuing diabetes prevention goals, and suggested that the design of these types of apps will benefit from creativity. Take Pokemon Go – an app that lets users track down and “capture” Pokemon characters throughout their neighborhood – for example: “All of a sudden people were exercising more. So we have to be more innovative and imaginative in diabetes.”
A number of environmental changes can also facilitate healthier habits and prevent diabetes. Dr. Zinman advocated for calorie counts on all fast food menus, prominent placement of stairs instead of the elevators in a building (or at least clear signs pointing to the stairs), and better bike paths.
Big Data and Treating the Individual
“It’s a crime that we have all this Big Data on where you travel, what you buy, what you’ve eaten, but not on a patient’s information when he comes into a doctor’s office,” Dr. Zinman said, alluding to current gaps technology when it comes to the healthcare system. Innovations that improve the ways we use health data will enable more personalized care, a key for treating every person with diabetes differently, according to his or her specific needs. This is important because the factors that contribute to diabetes may vary from person to person, he explained. “I would estimate that there may be 25-30 different types of type 2 diabetes.”
Dr. Zinman described his ideal scenario for Big Data in diabetes care: “My hope is that in the future, it will be standard practice for a patient’s medical data to be downloaded from his or her mobile phone when visiting a healthcare facility so that the healthcare team will have actionable data upon which to make clinical decisions.”
Stigma and Listening to People with Diabetes
Emerging loud and clear from the panel discussion was the need for all parties in diabetes care to listen to what people with diabetes have to say. Pharma companies, regulatory agencies like the US Food and Drug Administration (FDA), healthcare professionals, as well as other players all have to appreciate patients’ perspectives. At the same time, it is necessary to reduce the stigma around diabetes and empower those living with it to speak up where it matters most.
Dr. Zinman drew a fascinating comparison between communities with diabetes and HIV/AIDS. People with diabetes haven’t organized in the same way, and in Dr. Zinman’s view, this is necessary in order to get government, regulators, and payers from insurance companies to understand the real-world needs of the people living with a condition like diabetes. He elaborated that the type 1 diabetes community has been more successful on this front than the type 2 diabetes community, in part due to organizations like JDRF, and likely due to the more immediate nature of treatment (i.e., taking insulin).
The voices of people with diabetes absolutely need to be heard – by drug and device developers, by regulatory agencies like the US FDA (and its European counterpart, the EMA) and by society at large so that there is better understanding of the global diabetes epidemic.