Finding a multidisciplinary approach to diabetes care
An integrated wellness team approach to diabetes care can help patients not only improve their condition, but also lower their prescription costs, according to new research presented at the American Association of Clinical Endocrinologists’ 21st annual Scientific and Clinical Congress in Philadelphia.
Researchers led by Gary Evans, director of research at Northeast Florida Endocrine and Diabetes Associates, developed a multidisciplinary program that enrolled adult patients with Type 2 diabetes. Patients were counseled in nutritional, fitness and behavioral elements of diabetes management in a customized 16-week curriculum, while their doctors monitored body mass index, weight, HbA1C levels and diabetes medication dependence. Medications were reduced as needed to lower the risk of low blood sugars.
Evans and his fellow researchers found that participants decreased their doses of insulin and oral medication by about 46% and 12%, respectively; reduced their 30-day prescription costs, on average, by nearly $143 per month; and decreased their body mass index by 3.07 and HbA1C by 0.7%. The researchers noted that HbA1C was reduced by an average of 1.3% for patients with a baseline HbA1C of 8% or more.
“The multidisciplinary program creates a time frame that gives patients time to absorb the information, revisit strategies for management and engrave the behaviors into their minds,” Evans said. “Covering those key elements is what it takes for patients to grasp and embrace the strategies to be successful and improve their condition. It is our hope that the success of this curriculum will create a pathway for intensive wellness programs to be recognized as medical benefits for diabetes patients by insurance companies. The only way to be successful with long-term goals is to affect a lifestyle change.”
COPD spurs drug development
Taken together, asthma and chronic obstructive pulmonary disease — which includes chronic bronchitis and emphysema — affect nearly 50 million Americans, or about 15% of the total U.S. population, according to statistics from such organizations as the Centers for Disease Control and Prevention. And combined, the two diseases cause more than 100,000 deaths per year. Fortunately, however, there is a wide range of treatments available for both, many of which work for both diseases.
According to the Pharmaceutical Research and Manufacturers of America, an industry group for branded drug companies, the number of people living with COPD — which, according to the National Institutes of Health, includes 13 million who have it but don’t know it — has spurred a large amount of drug development around the disease. A PhRMA report released in February found that more than 50 drugs currently are in clinical development for treating COPD, ranging from pharmaceutical drugs to stem-cell therapies that attack the biological mechanisms behind the disease. Decision Resources, a market research firm, predicted that the COPD market will grow from $8 billion in 2010 to $13 billion in 2020 in the United States, France, Germany, Italy, Spain, the United Kingdom and Japan.
Some new drugs for the condition already have hit the market. In October 2011, the Food and Drug Administration approved Boehringer Ingelheim’s Combivent Respimat (ipratropium bromide and albuterol sulfate), which is delivered in a propellant-free inhaler that uses a slow- moving mist to deliver the same active ingredients as the Combivent Inhalation Aerosol. The company expected to launch the drug in the middle of this year. In November, generic drug maker Mylan bought rights to a drug delivery platform made by Pfizer that would allow it to manufacture and commercialize generic versions of GlaxoSmithKline’s Advair Diskus and Seretide Diskus (fluticasone propionate and salmeterol).
Meanwhile, despite growth in the COPD market, the asthma market is expected to decrease slightly and remain basically flat. According to another Decision Resources report, the asthma market in the same seven countries the firm used to measure the COPD market is expected to decline from $14.6 billion in 2010 to $14.4 billion in 2020. In contrast with the plethora of new drugs for COPD, the asthma market will see increased competition and generic erosion. For example, Merck’s Singulair (montelukast) had sales of $3.3 billion in 2010, but that figure is expected to drop to $2 billion in the United States, Europe and Japan due to generic competition.
Drug Store News recently talked with COPD Foundation founder and president John Walsh about the organization’s new leadership. In March, the COPD Foundation took over leadership for Drive4COPD, which aims to screen people for chronic obstructive pulmonary disease, a collective term for emphysema and chronic bronchitis, which the group estimates to affect 24 million Americans who may have it but don’t know it.
DSN: What led the COPD Foundation to take over Drive4COPD?
John Walsh: We’d been a founding partner of the campaign since it was launched in February 2010, and very active in helping to promote the campaign and working closely with Boehringer Ingelheim and other partners to expand the outreach for the campaign. We thought it was most naturally appropriate for the campaign to be operated from the foundation or another not-for-profit so that there could be a much broader appeal for stakeholders within the COPD community to participate, and that includes any pharmaceutical company, biotech company or any regular corporation not involved with pharmaceuticals, as well as all the professional societies related to treating COPD and patient-advocacy organizations.
DSN: How would you characterize BI’s relationship with it? I understand they’ll be funding it still.
Walsh: Yes. So Boehringer Ingelheim is going to continue to support the campaign and participate on our steering committee. And as far as the governance of the campaign is [concerned], they’re still involved and actively supporting in the sense of providing resources to move the campaign forward. So Boeheringer Ingelheim remains committed to the success of the campaign …
DSN: Now that the COPD Foundation is in charge, what kinds of changes will be made to how it’s run?
Walsh: We’ve organized a steering committee for appropriate governance. The steering committee reports up to our board of directors so we will be completely transparent as to what moneys are expended for what activities, and we will be aggressively pursuing additional funding to support the activities of the campaign. The campaign — as you’ve seen it with the pinwheel logo and the Drive4COPD affiliation with NASCAR — is going to remain intact. We’re going to take the campaign one or two steps further not only by making certain that the 12 million people in America that are symptomatic but not diagnosed, so essentially at risk, identify their risk level for COPD.
And … through the simple five-question pop screener that you can take at Drive4COPD.org, we want to not only make sure that people take the pop screener and identify their risk level, but we’re [also] going to work very hard in trying to track the individual that’s at risk and make certain they get properly diagnosed. And if they’re diagnosed, [we want to] make certain that they’re aware that we’re a resource for them to learn more about living with COPD, to help them with their families and issues related to being diagnosed with COPD.
DSN: What are some major upcoming plans that you have?
Walsh: We’re in the process of finalizing an employer toolkit, which we will launch in the next few months. The employer toolkit is essentially a toolkit that will be available on the Web, as well as in hard copy, that will have a cost calculator. Corporations will be able to log on and, by the skill level and industry and geographic location, be able to quantify how many people in their organization might be at risk for COPD and what the actual cost for having COPD is. We’re going to be working very closely with the wellness directors and the [human resource] departments to make certain that we get the simple population screener — the risk screener — in their annual health risk assessment in their wellness programs. We’re also going to be working with state respiratory societies to get respiratory therapists in there with the spirometry testing for individuals with COPD and be there as a resource to both the employer and the employees as they’re diagnosed.
DSN: What are some things that retailers, especially pharmacy retailers, can do to participate in the campaign?
Walsh: We’re going to be reaching out very aggressively to all the pharmacy retailers to invite them to partner with us in this campaign. Flu season in the fall is a perfect example where we’d like to piggyback with the flu shots and the flu-shot campaigns. Everybody with COPD has a high risk level for influenza, [and we want] to make certain that [pharmacists] take advantage of getting all the patients that they have on products that treat COPD to get their flu shots. Also looking at [things that exacerbate] frequent infections to work with the pharmacists and have them help identify somebody who might be at risk. Obviously [we want to be] able to distribute at a point of sale the information to access the five simple questions and get as many Americans as possible to identify their risk level, and be there as a resource whether it’s on our website or on our information line, (866) 316-COPD. They can take the screener over the phone or on the website, identify their risk level, and know whether or not they need to make certain to get to their healthcare professional.