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8/25/09 9:15 PM

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Taking our online relationships offline

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It's been a whirlwind summer, full of great conferences like ADA, Friends for Life, AADE, and an excellent social media blogging summit hosted by Roche.

It was exciting to see so many of our d-friends in real life (and in one place); especially since we often communicate by blog posts and e-mails alone! The blogging summit had a wide agenda and hit on a number of topics – but I was most intrigued by the focus to help pharmaceutical companies engage in social media (and with bloggers) the right way.

What is the right way? First, bloggers encouraged Roche to be a part of patients’ community. Our trust must be earned, they said, and it can't be bought. We want companies to care about the impact their product or service has on our lives & make sure they remember that diabetes is 24/7: we don't get to leave diabetes after a 9-5 shift! It was pretty clear they realized that, in my view – we met many people at Roche with diabetes and everyone certainly seemed eager to understand it better.

Also, we talked about the importance of acknowledging we can’t all be perfect. It's important for people with diabetes to know that your numbers won't always be a perfect 104, and that it's ok, because we're human. It's normal to feel guilty about aspects of living with diabetes, and it's important to acknowledge these feelings. There were some complaints about having “104” on the boxes of meters, etc – this is always a catch-22 to me, because of course if they had 200 or 400, I think our doctors and educators wouldn’t really like it.

One thing the other blogs have mentioned is the high price of strips. Since our work at Close Concerns focuses on the business of diabetes, I thought I would weigh in on this. The revenues that blood glucose monitoring companies have been taking in, on a per-strip basis, have actually been declining for some time now, although the number of new people with diabetes has meant that the overall market has increased slightly the last couple of years – it grew 3% by our estimates in 2008 (hardly a banner year) and we believe it will decline this year by about 5%. That’s due to a number of factors, but we think managed care has been pushing blood glucose monitoring companies and basically refusing to pay as much for strips as they did in the past. At the same time, smaller companies from outside the US have entered and began to compete on price, driving prices down. These companies don’t offer as much in terms of quality and education, in our view. So, although the companies do not report profitability, we can say that revenues are declining and will decline further. It’s not to say that the companies are going bankrupt – far from it, since blood glucose monitoring revenues will still likely exceed $7.5 billion globally in 2009 – and may reach over $9 billion by 2014. But from a growth perspective, this is far, far less growth than insulin and oral drug companies are seeing. And, insulin pump companies are growing much faster, if from a smaller base.

So from my view, the fact that blood glucose monitoring companies are profit-mongers couldn’t be further from the truth. Companies like Roche as well as the other big blood glucose monitoring companies do go way out of their way to make sure quality of the products is very high, the education is well-funded, and the customer service is good. Heck, at Roche, we even met someone from customer service (a “card-carrying” type 1 himself!) who explained all the customer service was done in Indianapolis itself – which I thought was a positive, so that management could hear from them all the time about what patients are thinking. I asked him whether the customer service is getting more calls, just from people with diabetes and their caregivers, looking for help, who may not have access to a doctor or educator – that was true, in this economy, for sure. Anyway – I personally found it a little uncomfortable hearing this company accused of selling strips for over $1 that it made for $0.01 each – while we didn’t get the exact answer on economics, our models suggest that the companies are spending far, far more than that – and while the average pharmacy cost for some strips exceeds $1, the manufacturers actually do get far, far less than that (under 50% that by our math, though those are only estimates).

I'm thrilled we had an open dialogue with a pharma company about social media and engaging patients. It's a step in the right direction – and we're clearly walking before we learn to run. Big thanks to Roche for hosting us and to Amy Tenderich and Manny Hernandez for giving great talks that day – and to everyone there, who taught me so much!

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8/10/09 5:20 PM

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CVS Caremark’s MinuteClinic to start treating diabetes

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On August 4, CVS Caremark announced the expansion of its MinuteClinic to treat chronic diseases including diabetes, coronary heart disease, and hypertension – very good news for patients in our view! MinuteClinic is a part of CVS Caremark that provides walk-in healthcare for the treatment of common illnesses. Currently MinuteClinic only offers diabetes screening for $40, which consists of either a blood glucose test or an A1c test. MinuteClinic does not allow co-pays to cover this screening because it does not want the screening to replace an annual examination. We look forward to seeing what diabetes treatments MinuteClinic will provide, and are hopeful that MinuteClinic’s efforts can help with earlier diagnosis and treatment of diabetes. Really, where we think this could be the most helpful is where patients could ask basic questions of the pharmacist about various treatments – not, of course, as a substitute for seeing their doctor or educator, but as a supplement. We also would love to see CVS Caremark subsidize the cost of a diagnostic a little more than they already are.

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8/6/09 1:22 PM

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Sotomayor Becomes First Justice with Type 1 Diabetes

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On August 6th, the Senate confirmed Judge Sonia Sotomayor as the 111th justice of the Supreme Court in a 68-31 vote. This makes her the first Hispanic, third woman, and first person with type 1 diabetes to serve on the court. While Sotomayor’s confirmation is no surprise--we considered her a shoo-in from the start--we are still overjoyed to have a Supreme Court Justice with diabetes. We hope Sotomayor will help raise awareness of diabetes and waylay many of the common misconceptions that the general public has about type 1 diabetes.

Read Jim Hirsch's article regarding Sotomayor in diaTribe 16 in which he explains how he got involved in the White House's efforts to handle the fallout. Click here to continue

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7/31/09 2:46 PM

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The accuracy of blood glucose monitoring: no need for alarm

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We recently read an article in the New York Times about the accuracy of blood glucose monitors and whether the official accuracy standards for the devices need to be changed. This is an important issue, to be sure — millions of people with diabetes manage their diabetes treatment and dose their insulin based on the numbers from glucose monitors — but it’s also important not to let one article shake your faith in one of the most important tools we have in the struggle with diabetes.

The Times did a good job of presenting a “worst-case” scenario about the accuracy of meters, but in our view, the article overstated the problems and didn’t take into account how important meters are for good control.

Let’s talk about the numbers. Current standards from the International Organization for Standardization (IOS) require that nearly all (95%) of results from a glucose monitor have to be within 20% of the actual glucose value — as the Times reported. Later in the article, however, it cited a study of five common glucose monitors, saying that “results varied by as much as 32 percent.” What was not stated clearly in the article was that these five meters were never compared to the actual glucose value, only to each other — and that the 32% number was from the worst comparison between two meters (out of 10 possible combinations), and ONLY when the meters were used with old strips, and ONLY in the 70-100 mg/dL range. In contrast, the average variability between meters (with old or fresh strips, and across all glucose ranges) was about 9%, and the variability using only fresh strips was about 6%.

So what’s wrong with the Times article? While the accuracy of blood glucose meters is clearly a serious concern, it’s important to take the time to fully understand the data and to anticipate the reaction of people with diabetes upon learning that their meter is (potentially) off by 32%. We were alarmed that the results of Morgan DiSanto-Ranney’s high school science project could lead to her father testing less — as inaccurate as meters are, people with diabetes are certainly better off with them than without them. How can you figure out where to go with blood glucose if you don’t even know where you start? A recent literature review in JAMA evaluated large, recent trials showing that testing with a glucose monitor helps to improve control, which in turn reduces the complications of diabetes.

In addition, the Times missed out on the chance to give people with diabetes some really valuable information: for example, that meters are more precise when used with fresh test strips, that it’s very important to make sure patients test when their hands are clean (logical information that you would think would be unnecessary to convey, but studies have also shown problems on this front in “real life”), and that all meters are not created equal (one of the meters, dubbed meter “E”, seemed to perform worse than the others, and was one of the two meters in the comparison producing the 32% difference).

People with diabetes (and people in general) don’t have the time to follow up on every statistic in an article. We count on the media to represent issues fairly and consider the context of each article’s argument. In this regard, we believe the recent Times article on the accuracy of blood glucose monitoring fell short of the mark. Blood glucose monitoring is an important tool in diabetes management, and it will continue to be useful regardless of whether or not accuracy standards are changed.

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