Drug developers and manufacturers often refer to the unmet need of patients when they introduce new products, but what is unmet need and how do we assess it? One way to address this issue is to refer to public health agency reports on causes of mortality and morbidity. Another is to ask what benefits a treatment can confer on patients and others.
Diabetes contributes significantly to cardiovascular disease and stroke (the first and fourth leading causes of death) and to disability due to kidney and neurologic disease and blindness, as well as vascular insufficiency and amputation.
There can also be unmet needs for people with rare disorders or uncommon severe versions of common disorders. Diabetes is a case in point. Many type 2 diabetes patients do reasonably well when they are prescribed and take their medications to control glucose, blood pressure, and lipids. Many patients with type 1 do well with continuous insulin infusions or multiple injections.
However, there are still other patients who suffer the long-term consequences of diabetes. This unmet need is the result of system, scientific and personal issues.
System issues include the high rate of underdiagnosis (which we have discussed in this column before), and the failure to prescribe or follow up on necessary medications. Other system issues go beyond healthcare provision to public health and socioeconomic concerns that impact diet, physical activity and mental health. The National Diabetes Prevention Plan addresses many of these areas.
Personal issues, such as difficulty paying for healthcare and problems implementing life style changes or adhering to medication are also important, and must be accommodated and supported if we are to make further improvements in diabetes outcomes.