Patients with diabetes care a lot about everything from price to choice-and you should too.
Sheri Colberg, PhD, FACSM
Kaveh Safavi, MD, JD
Experts say healthcare executives should bear several factors in mind when dealing with diabetes and some of the issues surrounding the condition.
Here are five areas diabetes patients care about.
1. Expense of new medications
While a host of newer medications can abet weight loss-often a primary concern for people with diabetes, of course-a number of them also are quite expensive. That hampers patient compliance if they’re required to pay out-of-pocket, or have high co-pays, says Sheri Colberg, PhD, FACSM, professor Emerita, Exercise Science, research professor (self-supported), Old Dominion University in Norfolk, Virginia.
Related article: Glucose Monitor Advances Could Vastly Improve Diabetes Management
One in four people taking prescription drugs report difficulty affording their medication, while recent Kaiser Family Foundation opinion polling found bipartisan support for government action to lower prescription drug costs. In 2016, per capita retail prescription drug spending burgeoned at a slow rate (0.6%)-particularly compared to the previous two years when new specialty drugs entered the market. Looking ahead, the CMS projections suggest growth in per capita drug spending will be moderate through 2026.
2. The role of technology in diabetes care
Self-care of chronic conditions is a major area where virtual health can be leveraged to help patients remain medically stable, according to Kaveh Safavi, MD, JD, head of Accenture’s global health practice. Adults with diabetes can use sophisticated mobile technology to effectively manage their lifestyles and conditions, reducing the need for in-person encounters.
Sophisticated analytics can track, trend, and assess patient- and medical device-provided data, such as blood glucose levels, Safavi says. The same technology can prompt and suggest a personalized self-management plan-and that plan can evolve as the patient’s health status changes.
Digital health solutions to manage diabetes are rapidly changing from simply tracking blood sugar values to far more comprehensive capabilities such as supporting clinical decisions, enabling behavioral changes and proactively managing the condition.
With the increasing use of smartphones and Internet, there’s an opportunity to use digital tools for training people with diabetes to self-manage their disease. A number of mobile applications and websites are available to help patients to improve their diabetes care.
3. Rebates can help raise level of adherence
Since insulin is rebated at around 70%, passing rebates to patients at the point of sale will make a big difference in their ability to adhere to medication treatment regimens and keep them out of the hospital where the bulk of their costs occur, according to Jesse Bushman, senior director, Health Policy and Advocacy at the Juvenile Diabetes Research Foundation.
Plans can put insulin on a “preventive medicines” list so that it is not subject to a deductible. This helps those in HDHPs maintain medication adherence early in the year and stay out of the hospital, says Bushman.
The cost of insulin has more than tripled in recent years-from $231 to $736 a year per patient between 2002 and 2013. The increase reflects rising prices for a milliliter of insulin, which climbed 197% from $4.34 per to $12.92 during the same period. Meanwhile, the amount spent by each patient on other diabetes medications fell 16%, from $600 to $502.
Based on a nationally representative survey, the mean price of insulin increased from $4.34 per milliliter in 2002 to $12.92 in 2013. The estimated expenditure per patient for insulin in the United States in 2013 was greater than all other antihyperglycemic medications combined. Another factor contributing to the rise in expenditures on insulin was increased treatment intensity.
4. Device selection
Patients like to have choice in the devices they use (continuous glucose monitors [CGMs], pumps, artificial pancreas systems), says Bushman. These devices-regardless of manufacturer-are driving significant improvements in the glucose control of those who use them. To encourage the largest number possible to use the devices, it’s important to provide choice in the available device-adding to the importance of broad coverage of items like CGMs and pumps, he adds.
Choice is also important in both the adoption of pump technology and continued wear. Data from T1D Exchange Registry demonstrates the variability of pump use by brand and by age range. The insulin pumps of younger patient populations vary more widely among brands. The younger populations may also opt for some of the features available in other brands, such as waterproof or tubeless options, or those available in a sleek touch-screen interface.
The T1D Exchange Registry also collected evidence from members of its community which stated the importance of choice. On a recent Question of the Day, 99% of respondents stated that features and usability factors were either somewhat important (4%), important (15%) or very important (80%) to pump choice.
5. Lifestyle management upgrades
It’s possible for people with type 1 diabetes to have an insulin resistant state similar to those with type 2, essentially giving them “double diabetes.” In almost all cases, lifestyle management improvements can help with managing blood glucose levels and insulin resistance for this reason, says Colberg.
In the early stages, it appears that both prediabetes and type 2 diabetes are somewhat reversible with lifestyle management and weight loss. However, if people return to their former lifestyles, both conditions return-meaning that they are more likely just under control rather than reversed.
Studies of patients with type 1 diabetes and a family history of type 2 diabetes have supported the notion that this combination might promote both microvascular and macrovascular complications of type 1 diabetes.
Chuck Green has covered healthcare for more than 10 years.