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Mary Caffrey
Coverage from the first of 3 Peer Exchange™ discussions from the Diabetes Stakeholders Summit.
“Framing in terms of adherence, as you did, I think really is the issue,” Gabbay said. “Medicine only works if people are adherent to it.”

Selecting the Right Therapy

“So, with all these medication improvements, what are the key challenges?” Scanlon asked.

Hodorowicz framed her answer in terms of the AADE7: 7 evidence-based behaviors identified by the American Association of Diabetes Educators, which include medication. A challenge with newer therapies is that patients are not referred for education on proper use, and physicians often do not have time to teach them in a 10- to 15-minute appointment. “It’s not a good situation,” she said.

Gabbay agreed that diabetes educators are underutilized. “I think it’s a big issue, and it’s more than just reimbursement, because even in places where there is reimbursement, they’re still underutilized,” he said. “Providers may not realize the benefit, and also, I think patients probably don’t like the term ‘education.’ ”

Each panelist offered final thoughts, starting with Bloomgarden. “Every one of us who tries to treat people with diabetes feels that this is a human being who’s struggling with this disease,” he said. “We really can help people by using these newer treatments. And, of course, the managed care companies have helped us to make it available. Even though we grumble a lot, without the insurance companies supporting the patients’ use of this, we could never do it. So it’s a challenge.”

“We can individualize care much more effectively based on what the needs of the patient are,” Gabbay said. “We talked about a number of factors to consider: hypoglycemia, weight gain, and other comorbidities.” In terms of cost, transparency would be an important first step. “That said, I think there’s so much improvement that can be made in diabetes care, and we have so many more tools to be able to do it now than ever,” he said.

“Insulin has to be—in all its forms, in all its devices to inject it—for the patient, affordable; accessible per the payer and the mail order pharmacies; and appropriate—individualized for patients’ unique lifestyle needs, metabolic needs, [and] complication needs,” Hodorowicz said.

“We need to be sure that it’s being utilized as frequently as it needs to be,” Snow said. “For type 1, that’s easy, in a way, because it’s absolutely essential for life. But, for so many folks with type 2 who clearly have a need to move beyond the therapy they’re on to achieve the level of control that they should, insulin is still almost 100 years later a wonderful drug—and needs to be available for those folks, so they can achieve that control and stay healthy.” 

1. American Diabetes Association. Standards of medical care in diabetes—2017, glycemic targets. Diabetes Care. 2017;40(suppl 1):S48-S56. doi: 10.2337/dc17-S009.

2. Garber AJ, Abrahamson MJ, Barzilay JI, et al. Consensus statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the comprehensive type 2 diabetes management algorithm—2017 executive summary. Endocr Pract. 2017;23(2):207-237. doi: 10.4158/EP161682.CS. 

3. Gabbay RA. Discussions of high costs for new therapies raise questions about an old one: insulin. Am J Manag Care. 2016;22(SP13)SP472.

4. Costs in the coverage gap. Medicare website. www.medicare.gov/part-d/costs/coverage-gap/part-d-coverage-gap.html. Accessed June 23, 2017.

5. Caffrey M. Novo Nordisk asks FDA to update Tresiba label on hypoglycemia. The American Journal of Managed Care® website. www.ajmc.com/newsroom/novo-nordisk-asks-fda-to-update-tresiba-label-on-hypoglycemia. Published May 31, 2017. Accessed June 23, 2017.

6. Marso SP, McGuire DK, Zinman B, Pratley R, Buse J. Cardiovascular safety of insulin degludec versus insulin glargine in patients with type 2 diabetes at high risk of cardiovascular events (DEVOTE) trial results. Presented at: American Diabetes Association’s 77th Scientific Sessions; June 9-13, 2017; San Diego, California. https://professional.diabetes.org/webcasts/browsebyname?title=DEVOTE. (Subscription required.)

7. Caffrey M. Rival Sanofi, Novo Nordisk insulin combinations gain FDA approval. The American Journal of Managed Care® website. http://www.ajmc.com/newsroom/soliqua-sanofis-entrant-in-insulin-combo-battle-gets-fda-approval. Published November 22, 2016. Accessed June 23, 2017.
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