Earlier this week, Novo Nordisk released results of a sweeping new survey about how patients — both type 1 and type 2 — struggle with insulin therapy, and what doctors accredit that to.
Entitled the Global Attitudes of Patients and Physicians in Insulin Therapy (GAPPTM), the survey was conducted among almost 3,000 physicians and patients in eight countries “with the objective to learn what they perceive to be the biggest functional and emotional unfulfilled needs and challenges in the management of diabetes today, specifically relating to insulin treatment.”
Here’s a summary of what they found out, according to the PR agency representing Novo (some of which is a no-brainer if you’re insulin dependent yourself):
- More than one in three diabetes patients skip doses or fail to take their insulin as prescribed, stating that they have done so on average three times in the last month, and 77% of physicians estimate that in reality this number could be as high as six doses.
- 88% of physicians report that there are a significant proportion of patients still not reaching blood glucose targets, and four in 10 people with diabetes say they struggle to effectively control their blood sugar. Being too busy or simply forgetting to take the insulin are the main reasons cited by both patients and physicians for patients missing insulin doses.
- 67% of patients taking insulin are concerned about experiencing a hypoglycemic event in the future and physicians share patients’ concerns, with 74% stating that they would treat closer to recommended targets if it weren’t for fear of major hypoglycemic events.
- Nine in 10 patients wish there was an insulin that could be dosed less than once a day and effectively manage blood sugar.
The company’s executive summary of results reads this way:
- Busy lives make it hard to comply with prescribed regimens
- Fear of hypoglycemia may contribute to poor control
- People with diabetes are looking for less invasive insulin options
Like I said, no-brainer. Because yes, diabetes patients are real people, and real people aren’t perfect. We have busy lives and sometimes forget things, even important things — although those of us with type 1 quickly learn the hard way what happens when you forget to take your insulin (hello, ER!)
Naturally, we worry about hypoglycemia. Lows not only suck, but they’re scary and can be very dangerous. And obviously we’d like to dose less often and more conveniently. D’oh!
The press release includes a quote from Professor Luigi Meneghini, associate director at the Diabetes Research Institute in Florida, who says: “These results are consistent across countries and it is encouraging to see that physicians understand and empathize with the issues people with diabetes face.”
Really? I wonder, has it been your experience that doctors understand and empathize with how hard it is to live on insulin? Most of the patients I hear from wish their doctors could walk just one single day in their shoes.
In any case, this survey is a clever move by Novo Nordisk. Not only is it great market research, but it allows them to position themselves as extremely “patient centered” while at the same time blaming any shortcomings of insulin therapy on us users. Notice how the headline says “Patients Fail…” Sure, the drugs are perfect; we aren’t.
Maybe all of this praise for doctors is fuel for the new physician-targeted dosing product Novo has just introduced. NovoDose is a “mobile dosing guide” for physicians to look up insulin guidelines that’s available in the form of an iPhone app. Wow, at least it’s mobile, so that’s pretty forward-thinking.
But the other thing I’m asking myself in regards to patients “failing” is: what about the issue of access to insulin for those who so desperately need it?
Did you hear about how Novo Nordisk actually pulled insulin off the market in Greece recently in a wrangle over government price cuts? Yikes! This is people’s survival we’re talking about here.
I heard an NPR story about this on my car radio two days ago in which a young type 1 woman effected was being interviewed. Her voice sounded so desperate, it gave me chills. There are surely lots of others out there who skimp on insulin because they can’t get access to it, and/or can’t afford it. (Makes me so appreciative of what I have)
The NPR story ended with the statement that Novo was considering making a “more affordable, generic version of the product” available in Europe soon. This made me want to scream! For how long have we been clamoring for such an option here in the US?
The official word is that generic insulin has difficulty getting past the FDA because it is a “biologic drug” — which complicates manufacturing guidelines.
Yet according to this ADA article from 2007, Novo Nordisk (along with Eli Lilly) has actively pushed back on FDA action on approval of generic insulin. Grrrrr. (See Scott Strumello’s update on Medco’s positive efforts here.)
So while appreciate that the GAPP study sheds light on some day-to-day challenges we insulin-dependent people face, I’d really like to see Novo use their muscle in ways that might be even more beneficial to patients.
After all, according to leading analysts, “Novo Nordisk is one of the most successful pharma companies on the planet.” If they can’t help patients be less likely to “fail,” then who can?
One thing that got me very angry with this summary (theirs, not yours Amy) is the suggestion that “missed insulin doses” are the reason we aren’t hitting our target BGs, since that is the very next sentence. What about all the times we get the insulin dose “perfect” and STILL cannot hit our BG target?
It makes it sound like we’re too busy or stupid to follow the doctors directions, not that we have insufficient tools to effectively duplicate an extremely complex biological process.
So if I go out on a five hour ride and don’t need to take insulin for my meal 4-5 hours after I’m done, does that mean I failed? Just as Mr Twain said years ago, there are three kinds of lies: Lies, Damned Lies, and Statistics.
I found this mighty interesting: ‘Nine in 10 patients wish there was an insulin that could be dosed less than once a day and effectively manage blood sugar.’ LESS THAN ONCE A DAY? Frankly, I have friends who, unfortunately, took only Lente insulin, ONLY ONCE EVERY DAY, during the 1960′s and in the 1970′s and are now suffering complications. During those days, they never experienced hypoglycemia, just continuous HYPERglycemia. At the same time, I was taking NPH and Regular twice daily. I experienced frequent hypoglycemia, fortunately never needing to be hospitalized for it, and remain complication-free to this day.
There is little acknowledgement from the leading insulin providers that efficacy failure (most frequently, hypoglycemia) is a major flaw in all of their products and these companies really should be pursuing versions of their products that cannot cause hypos. Instead, startups such as SmartCells, Inc. (outside of Boston) and Toronto-based Diabecore Medical, Inc. (www.diabecore.com) are the only companie’s pursuing hypo-free insulin. Novo’s contribution to research? Potentially insulin pills, and degludec, which is another competitor to Lantus (apparently, sales uptake on Levemir is well below expectations, so they went back to the drawing board, but to suggest that NVO’s latest is an innovation is a pipedream). I find Novo Nordisk’s relentless P.R. to be much about nothing really. It is startups that are addressing the unaddressed patient needs, not the giants of the drug industry.
Another thought: those wishing to take less insulin or inject quick-acting insulin less frequently have an option. They can go on a Dr. Atkins style, low-carbohydrate diet and just take their long-acting insulins. However, it is very boring and probably not very healthy, from a nutritional standpoint!
There’s also cost involved. My insurer pays 50% of the cost towards my insulin, and only “approved” types. So, they will pay half of my $300 month cost of insulin for Novolog or Lantus only. Anything else (Walmart Reli-On) aren’t covered. Also, if I call my doctor to report numbers and he says “Go from 40 units a night to 50 units a night” this requires a new prescription. And my insurer needs to approve it.
My doctor used to think I was “skipping doses” but in reality I was occasionally skipping meals. I don’t have a large appetite (some do some don’t) and sometimes I forget to eat and therefore I don’t (obviously) give any insulin for a meal. My doc still counted this as a skipped dose even though my blood sugars stay in range. So I’m well aware these statistics are ya know…a bit goofy.
The insurance stuff, the insulin stuff, is sooo frustrating. I can’t get into it because I lose my mind. I’m so glad you dive right in for us Amy!
Novo is trying to develop a 3X a week insulin. That’s where the “less than once a day” insulin response is coming from – the respondents were set up to answer that way.
I would prefer to NEVER inject insulin again.
My guess is there’s no info on people skimping on insulin because of cost because they asked doctors, not patients. Patients who can’t afford insulin every month probably can’t afford to see a doctor every 3 months either.
If something can be developed that will reduce the number of daily injections needed that would be welcomed. However, we are dealing with a complex living mechanism that does vary and as Val points out, no matter how perfect the doses are, sometimes BG targets will not be met, due to other factors.
Dear Big Pharma:
Thanks for spending lots of money on a study about something everyone already knows about, and then spinning the “results” of that study into a way to put blame back on patients instead of the inadequate medications and dosing tools YOU provide us.
One word….Afrezza….
Oral-lyn – Generex – GNBT is the future! No insulin antibodies, fast acting – mealtime REAL insulin absurbed through the buccal lining so no injections!
Maybe these poor people cannot afford to test themselves 4+ times per day. What about generic test strips. I still cannot believe that 1 test strip costs over $1.00. It must cost less than pennies to make.
I just started on insulin. Type II +. My glucose readings are all over the map. I was at 455 last night. Took the 70-30 dose. This morning it read 133. Take a combination of 500 mg Metformin Time release 3 times a day, plus I usually take at least 2 500 mg cinnamon supplements. This brings things under control normally. Cannot tolerate 3 Metformins so normally cut it back to two if the sugars are okay. By trial and error mostly, I find that 100 glucose is equal to approximately 10 units of the insulin for me. So if I start the morning out at 133 I wait until the dose wears off. (drink a lot of tea). It normally starts low. After about 4-6 cups of tea and supplements it levels out around 229. I try to make this happen before I take a dose in the morning around noon. If I am eating out which is normal for me I increase the dose by 5 units. So if it is at 229, I will dose at 20 units. If I know I am going to be eating out, I make it 25 units. At night I wait for it to wear off. I am normally around 300 at midnight. So I take 30 units normally at night. That brings me down to between 135 with a low level at 80. As I have adjusted the levels, it normally is within 100-120 range when I get up. That is me. No one else. You have to adjust the levels by trial and error in small steps. The danger with insulin is low. It is mainly in converting glucose to fat. That means substantial weight gains if you are not careful. Exercise is definitely needed to offset that conversion. Then there is the no-no factor. If my levels go too low, I feast on foods I normally cannot have. Like an English Muffin and a small amount of honey. Like a serving of mashed potatoes with a meal. Both normally convert to sugar in the 100s of units for me. A Ritz cracker is worth 20-30 units easily in my case. These no-no foods I have avoided for years religiously. It is not hard for me to go from 80 to 300 in one easy step so I have to be very careful. The 10 units per hundred does seem to work for me though.
Amy,
In keeping with the Mark Twain quote above. There are a couple of important points to keep in mind.
This report is based on the result of a 20 minute survey. Nearly half the respondents were doctors and over half of them were PCP/Generalists. Among the patients, less than 12% were T1, the rest were T2. Sweeping? Really?
Bottom line? A carefully conceived study by a pharma giant to produce results that will help them promote their products. Call me cynical.
Fair Winds,
Mike
[...] This post was mentioned on Twitter by DiabetesMine, DiabetesMine, DiabetesMine, Ellen H Ullman, Ellen H Ullman and others. Ellen H Ullman said: RT @DiabetesMine: [Blog] Mind the GAPP – Novo's new research on why patients "fail" with #insulin therapy http://tinyurl.com/2bu5xfv #d … [...]
@Erin – LOL, great summary. Seriously, what other industry would release study results — with a lot of PR — touting how their customers use their product wrong?! Dodos that we are…
I fervently wish there was a way that all doctors that prescribe insulin for PWD would have to spend just ONE day managing insulin for themselves! They might not be so quick to blame ‘us’ the next time we don’t hit our targets.
We all know that people sometimes lie in surveys, especially when it concerns compliance. Diabetes is sometimes more art than science with many factors like stress, illness and other invisible things that go on. Fact is, we have to manage with the tools we’ve got an that’s all about affordability too, depending on the country.
A sad fact of a diabetes diagnosis is that in most places, doctors and support people just don’t have the time or the resources to educate. I have 33+ years with D and I’m still learning. Roll that into some kind of education course, and you’d almost make a diploma-study course! It’s that complex as far as I’m concerned.
Patients get diagnosed. They may get put on tablets or a insulin mix, get sent to a dietician, many of whom still advocate high carb diets, and then mostly leave the patient to cope by themselves (maybe with insurance not allowing enough testing strips) and with a bit of info that is already overwhelming. It’s a recipe for disaster in d-management in my book.
What I want to know – why does the survey say “fear of hypoglycemia may contribute to poor control” as if it is all in our minds? How about the reality of hypoglycemia and the very real dangers it poses? Why can’t it be acknowledged that the effects of insulin are often unpredictable?
This is the problems with surveys like these, they make such sweeping statements. I wouldn’t think that there is a diabetic on the planet that would skip taking insulin if they hadn’t worked out their timings and glucose levels in conjunction with their diabetes diet plan.
They insult the intelligence!
Hi Amy I find your web site interesting. I have been bloging about diabetes because my seven year old grandaughter has type one diabetes. Let me know if interested in exchanging links.
Hi Amy,
Is there an opportunity to talk to you about how this survey was created and what Novo Nordisk wanted to learn> This is not the first time we have conducted surveys with both patients and doctors, and we have more information I can share with you to put it in context. I welcome the opportunity to share this information with you, as we did with the other patients and journalists who covered the survey.
I will say, for the record, that this was a global survey and had nothing to do with any other U.S. marketing initiatives, including NovoDose, as you mentioned above. Diabetes is treated very differently in other parts of the world, and as a company that operates in 179 countries, we recognize that one solution is not going to fit all.
If you or any of your readers have any questions about the survey, I welcome the opportunity to discuss. I do hope we can connect this week.
Best,
Ambre Morley
Associate Director, Product Communications
Novo Nordisk
Why would your company stop selling insulin in Greece b/c of a pricing dispute with the government? Particularly a government that has not seemed particularly gun-shy about spending more money than they have anyway?
You make some very valid points. But I would remind everyone that Novo is a business that exists to make money. It’s not reasonable to think that they would sell at a loss (if that’s is what is happening).
As to the findings themselves, it fits me quite well. I am thankful to have an MD who is a type 1. He has some understanding of the challenges we face. But targets remain elusive. At the end of the day its up to the individual to be responsible for their own health.
[...] and Africa Diabetes Care Devices Market Outlook …SBWire (press release)all 8 news articles »J&J Sold Insulin Pumps After Learning of Defects, FDA Says – BusinessWeek 01/10/2012 J&J Sol…Food and Drug Administration said. The agency faulted the J&J unit for …and more » Insulin [...]