Innovation in monitoring, injection, disposal benefit diabetes patients
It often can seem like tackling diabetes is like fighting the mythical hydra — cut off one head and two more grow back. As patients with diabetes continue to grapple with perennial problems like blood glucose monitoring, safe injection, and disposal of the sharps they create every day, their ranks continue to swell. Though underlying causes are difficult to address, a number of different companies are coming through with ways to make management easier for patients.
The Centers for Disease Control and Prevention peg the number of Americans with diabetes at 30 million — with Type 2 diabetes comprising between 90% and 95% of all diagnosed cases. It also notes that over the past 20 years, the number of adults diagnosed with diabetes has more than doubled as the population ages and becomes more overweight or obese.
And, by all accounts, it’s a daunting condition to be diagnosed with. Daily insulin injections and multiple blood sugar readings, plus monitoring it in a way that can serve as a resource for both patients and their physicians can prove to be overwhelming.
“Most diabetes patients see their physician quarterly or maybe semiannually. In between those office visits the person with diabetes has to manage their disease on their own,” said Brahim Zabeli, CEO at Smart Meter, which makes the iGlucose cell-enabled blood glucose monitor. “Since insulin was discovered in the 1920s, that’s the way patients have had to treat themselves — pretty much self-managed.”
The iGlucose meter is looking to take some of the guess work out of tracking blood sugar readings. Using cellular network technology, the iGlucose meter automatically transmits readings to the iGlucose personal web portal and the company’s virtual health coach — the latter of which offers automatic feedback on readings. Zabeli noted that, most importantly, readings can also be shared with healthcare providers and enables them to provide support to patients in a way that’s never occurred before.
Smart Meter, Zabeli said, is looking to be ahead of the curve that he anticipates to be picking up steam as more companies develop connected insulin pens and other smart monitoring equipment.
“The profound change in this space is one we’re all experiencing in various facets of our lives and it has to do with connectivity,” he added. “It means that the patient is not going to be alone in managing their diabetes. We’re moving away from a world of self-management into chronic care management whereby patients will have the ongoing support of their healthcare provider. By having visibility to the patient's readings, that healthcare provider will be in a terrific position to provide that support and intervene if necessary.”
Big names in the diabetes space also are getting into connected health offerings — among them BD Diabetes Care. Last year, the Franklin Lakes, N.J.-based company rolled out the BD Diabetes Care app in an effort to offer a resource to patients with diabetes. The app was built with input from patients, healthcare providers and pharmacists, said Stacy Burch, vice president of marketing and commercial excellence at BD Diabetes Care.
“This is a great tool for helping patients to self-manage their disease,” Burch said. “It can extend the pharmacists’ reach by reinforcing proper injection technique, suggests healthy foods, and provides content curated by healthcare professionals in alignment with the latest American Diabetes Association practice recommendations. As more things are changing to digital, it’s a way to have a grounding in tools that may help health care providers and pharmacists help patients.”
Burch said the app is set to be relaunched in November with new features for a more enriching user experience “It’s a great opportunity for pharmacists to offer support to their patients because it’s like an extension of them,” said Claire Levine, senior manager strategic customer marketing at BD Diabetes care. “It provides education focused on helping patients take action. From proper injection technique and medication-adherence tips to lifestyle and disease management, it’s all here. It’s like giving the pharmacist time back and allows them to offer additional value without having to spend a lot of time with the patient.”
Sticking Points
When patients inject as frequently as those with diabetes do, companies take particular interest in making the experience as painless as possible. According to BD Diabetes Care officials, one easy thing pharmacists can do to engage with patients is talk to them about injecting with shorter needles.
“Pharmacists are in a unique position to help make a difference by talking to patients about is using a clinically recommended needle length,” Levine said, noting that the BD Nano Pen Needles, at 4 mm by 32 gauge, is an ideal size for patients using pen injection devices, and 6-mm-by 31-gauge BD Veo Insulin Syringes are the recommended size for patients using a vial. She also said studies show that patients with diabetes on insulin who received structured injection technique training, including changing to a shorter needle length saw a 1% reduction of HbA1c over 6 months from baseline. “Many people are still using longer needles which is not medically necessary to get through the skin. For many people, we find out that very often patients are not using the shortest needle available — because no one told them that there is a shorter needle available. They’re using what they’re using because that’s what they started on and no one had the conversation with them since.”
Another company focused on injection comfort is Owen Mumford, whose Unifine Pentips and Pentips Plus pen needles include the company’s proprietary DiamondPoint and OptiFlow technologies to reduce delivery force and improve drug flow, respectively. The products also come in needles as short and thin as 4 mm by 33 gauge. The Pentips Plus product also is notable because it contains a built-in removal chamber for the pen needle. It allows patients, who may not have access to sharps disposal, to safely remove and contain used pen needles until it can be disposed of safely.
Indeed, sharps containment and disposal that removes used needles from the waste stream are a constant requirement for patients with diabetes who use sharps on a daily basis. Stericycle’s 2019 Access to Care & Sharps Disposal in the Diabetic Community survey found that 25% of diabetic patient respondents said properly disposing of needles and lancets was one of their biggest concerns, and 27% had not talked with their physician about proper needle disposal and might not be aware of proper disposal methods. The survey also found that 85% of respondents said an at-home disposal kit would help them manage their condition better.
For at-home injections, one of the companies looking to integrate disposal is UltiMed. The company’s pen needles, which come in a range of sizes, are available in the UltiGuard Safe Pack, which both dispenses the pen needles and features a built-in sharps container for the used needles.
“As we looked at the market, we compared the amount of pen needles and insulin syringes sold into the retail market to the amount of sharps containers that people actually proactively purchase and found a huge gap,” said Jim Erickson, president of UltiMed. “We saw that gap and said, ‘Is there a way we can give people sharps containers free whenever they buy our products?’ and we came up with the solution of packaging our product within a plastic box, which happens to be an approved sharps container.”
Erickson said that because pen needles are reimbursed by insurance companies, the packaging is, too, making it so that patients who purchase the UltiGuard Safe Pack end up getting a sharps container as a value add. He also said that the company offers co-branding with chains so that patients can purchase the Safe Pack with a trusted name attached to it.
BD also offers sharps disposal solutions, including the BD Sharps Disposal by Mail product, and the BD Safe-Clip by Mail offering — a needle clipper that can hold roughly 1,000 needles and then be mailed out for disposal once full. “Through these products, patients can have the appropriate puncture-proof container at their home to help ensure that they are going to dispose of their needles appropriately,” Burch said.
Pharmacists, given their role as a frequent resource for patients with diabetes who may see them more than their primary care provider, can play a role in patient education regarding safe disposal, said Meg Moynihan, Stericycle’s director of strategic marketing. She said that many patients don’t consider the downstream dangers of improperly disposed of sharps.
“Raising awareness around the safety concerns is the first critical role that pharmacists play,” Moynihan said. “And I think the second is translating that into meaningful action and really encouraging their patients to look around for options available to them for disposal of sharps, which could be something as simple as containers for sale in the pharmacy or disposal receptacle of some kind provided by the pharmacy.”
Beyond providing information about safety, pharmacists may soon be playing a more central patient monitoring role. Smart Meter’s Zabeli said that one of the company’s customers has pharmacists managing patients with diabetes under the direct supervision of a physician. He noted that a proposed Center for Medicare and Medicaid Services rule for 2020 would allow reimbursable remote monitoring under “general supervision” of a healthcare professional, which he said would open up the opportunity for more pharmacists to be involved in the reimbursable service, though it would largely be among clinical pharmacists.
BD also is aware of the importance of the pharmacist, who Levine characterized as a front-line member of the patient’s care team at a critical point in the patient journey.
“The pharmacist is the last point of contact setting them on a positive journey moving forward before the patient goes home and is on their own,” she said. “One of the main reasons why BD’s focus has always been with our retail channels and the pharmacies is because they played such an important role in the treatment paradigm.”