A couple months ago, I had a very interesting evening at a dinner in London with the Medtronic Board of Directors, members of the Executive Committee, senior leaders, and physicians from some of the most prestigious hospitals in the United Kingdom (UK), as well as members of the National Health Service.
The dinner was set up to be an open dialogue on what needs to be done to overhaul healthcare in the UK. The reality is in the UK, the healthcare budget continues to get squeezed, with required annual savings of 4-5%, which not only puts pressure on the quality of delivery, but also on the ability of the health system to provide universal access.[i] The dinner was an open forum for attendees to speak out about what needed to be done at the government, private sector, and medical community levels in order to address the issue.
Attendee comments were very interesting. “We need to focus more on outcomes”; “We are sitting on massive amounts of data we need to use in order to demonstrate the effectiveness of various treatments”; “We need to have more evidence-based medicine”; “We need more innovation from industry to help drive better quality and lower costs.”
The discussion got me thinking about the state of diabetes in the UK; across the country, there are more than 400,000 people with type 1 diabetes.[ii] If you look at all of the data – and there is a lot of it – there is clear and indisputable evidence that pump therapy provides the best glycemic control and lower HbA1C levels for patients.[iii] There is also clear and indisputable evidence better glycemic control and lower HbA1C levels lead to fewer micro-vascular complications in patients with diabetes, which ultimately means fewer incidences of diseases such as retinopathy, cardiovascular disease, peripheral circulatory issues, and neuropathy.[iv] However, in the UK, pump therapy is used by only 10% of the population![v] Even the government’s own organization for comparative effectiveness research, NICE recently announced that pump therapy is cost-effective, and has recommended that it should be used approximately twice as much as it is today.
It seemed strange with all of the discussion about data, innovation, focusing on outcomes and evidence-based medicine – from the people who influence healthcare in the country – there is a clear contradiction in what is actually prescribed to patients. Here is an example of where we have all the data and evidence that a therapy that exists today improves outcomes and lowers costs, yet the therapy isn’t widely adopted. Why?
Part of the answer came from a pediatric endocrinologist that was sitting at my table. At one point, she stood up and said, “We need to really understand the nature of the patient-physician relationship. With diabetes, in order for me to help my patients, a large part of what I do is psycho-social. This requires time. Anything that enables me to have more time with my patients to address the psycho-social aspects of the disease ultimately helps. The things that take away from my time with my patients are not helpful. This is where I need Medtronic’s help.”
For me, her comments were striking, and suggested Medtronic Diabetes needs to think differently about clinical innovation. For type 1 diabetes, we have historically defined clinical innovation as the steps required to get to an artificial pancreas. However, this physician was saying we need to think more expansively. Clinical innovation, at its core, needs to improve the care a physician provides to their patients. For a device in an acute setting, it’s all about better features that drive better clinical outcomes. However, in a post-acute, chronic disease setting such as diabetes, it needs to be more than that.
This isn’t simply about prescribing a pump with increasingly sophisticated algorithms. It is also about innovation that enables the physician to spend more time coaching, guiding, and supporting their patients as they manage their disease over their lifetime.
Medtronic can address this. We can do it more through better tools and analytics, physician support, education, and patient services. These tools will be critical not only for patients with type 1 diabetes, but also for patients with type 2 diabetes. There are aspects of this that tie to the product, as well as to services that we can provide. More time for the physician to care for their patients is an aspect of what “more freedom” is all about.
IMPORTANT SAFETY INFORMATION
Medtronic Diabetes insulin infusion pumps and associated components are limited to sale by or on the order of a physician and should only be used under the direction of a healthcare professional familiar with the risks associated with the use of these systems. Successful operation of insulin infusion pumps requires adequate vision and hearing to recognize alerts and alarms. Insulin pump therapy is not recommended for individuals who are unable or unwilling to perform a minimum of four blood glucose tests per day. Insulin pumps use rapid-acting insulin. If your insulin delivery is interrupted for any reason, you must be prepared to replace the missed insulin immediately. For more information, please visit www.medtronicdiabetes.com/importantsafetyinformation.
[i] Department of Health’s settlement at the Spending Review 2015. 25 November 2015. https://www.gov.uk/government/news/department-of-healths-settlement-at-the-spending-review-2015
[ii] Daily Hansard – Westminster Hall. Type 1 Diabetes (Young People). 30 April 2014 : Column 247WH http://www.publications.parliament.uk/pa/cm201314/cmhansrd/cm140430/halltext/140430h0001.htm
[iii] NICE Published Guidance http://www.nice.org.uk/guidance/dg21
[iv] The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977–986
[v] Llewellyn S, Procter R, Harvey G, et al. Health Services and Delivery Research, No. 2.23. Southampton (UK): NIHR Journals Library; 2014 Jul. http://www.ncbi.nlm.nih.gov/books/NBK259885/
Tags: clinical innovation
, diabetes care
, healthcare cost
, holistic diabetes management
, Integrated Care