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Kept In Check

Approximately 382 million people worldwide have diabetes, affecting 1 in 12 adults. By 2035, this figure is estimated to rise to 592 million. Broken down, around 10% of people with diabetes suffer from the type 1 form, with 90% demonstrating type 2 (1,2). This does not even include gestational diabetes, which affects up to 10 in every 100 women in England and Wales during pregnancy (3).

As the prevalence of diabetes continues to grow, so too does the strain on healthcare systems and professionals. In response, healthcare providers, patients and third sector organisations are working together to help manage, treat and ultimately reduce the impact of this condition, through the introduction of multiple novel initiatives.

Prevention and Support


The increase in diabetes presents a challenge on a global scale – one that governments around the world are responding to. The Dubai Health Authority (DHA) has demonstrated its commitment to making changes with the launch of ‘The Dubai Standards of Healthcare for Diabetes Management’, in a move to ensure early detection and unified management of diabetic and pre-diabetes cases. The DHA will also hold several training workshops for more than 700 doctors in 2015, to ensure that all healthcare providers in Dubai follow the same standards of diabetes management.

The intensified focus on meeting the diabetes challenge is evident in the UK too, with NHS England announcing the launch of its new diabetes prevention strategy in March 2015. While the full programme will be rolled out nationally from April next year, it will be piloted in seven areas of England and will target up to 10,000 patients. The strategy aims to reduce England’s ever-growing spend on diabetes treatment, which already stands at some £10 billion annually.

In February of this year, Diabetes UK sought 16 healthcare workers across the UK to become clinical champions to support and improve the care of diabetics. Aided by a package of training materials, the roles are open to anyone working in healthcare that has experience in handling the condition. The success of a similar programme was first seen in 2014, when Diabetes UK enlisted 10 clinical champions for the first time, including several specialist nurses. These recruits have since spearheaded a number of initiatives aimed at improving the care received by people with diabetes.

Self-Management

However, it is not just the healthcare professionals managing the disease that need to be well trained and educated in diabetes management. Self-management plays a critical part in diabetes, where the majority of the treatment is in the hands of the patient. For example, studies show that individualised management using care planning can significantly improve glycaemic control (1). Research has also shown that self-management can lower per patient costs and admissions (2), reducing the pressure on professional time and improving clinical outcomes which, in turn, should lead to positive behaviour, less stress and a better quality of life for people with diabetes (4).

More and more is being done to support and promote the benefits of good self-management. Healthcare providers are offering free workshops and classes to people with prediabetes and diabetes, and even to family and friends of those living with the condition. These classes offer a wide range of support services such as education on medication administration, diet guidelines and blood sugar testing, as well as promoting self-management – with the aim of helping to prevent or limit long-term health complications.

A recent study, conducted by the University of Kansas Work Group for Community Health and Development, evaluated 173 patients from four patientcentred medical homes to determine the effects of a multi-site coordinated care approach that delivered diabetes self-management education (DSME) and diabetes self-management support (DSMS). Results showed that patients with diabetes had decreased glycated haemoglobin after the implementation of a coordinated care approach, along with showing a significant decrease in body mass index (5).

Case Study


The importance of getting a device right for the end-user cannot be underestimated. Once the patient needs have been identified during the design stages, developers should utilise human factors engineering and prototyping to ensure new devices meet these requirements, and are as comfortable and straightforward to use as possible.

Research conducted during the development stage allows companies to understand key design factors of prototype devices that result in tangible patient benefits. For example, experts agree that the most accurate routine when using injection pens is the immediate removal of the pen needle after injection, and replacement with a new needle just prior to the next use (1,6,7). This information was used to drive the design of the Unifine® Pentips® Plus – a pen needle system with a built-in remover.

The main goal of the device was to add incremental convenience when pen needles are used, which supports good injection routine by encouraging more frequent pen needle change. This, in turn, can help to reduce adverse effects such as infection (8), lipodystrophy (9), trauma from needle insertion (10), dose inaccuracy caused by air bubbles entering the cartridge (11,12), needle breakage within the skin (13) and bruising (14).

Guidance on a good injection routine is an important part of diabetes selfmanagement education, and – by offering better devices designed to support the required end-user outcomes – manufacturers can play a valuable role in supporting adherence by healthcare professionals and patients.

Smart Insulin


Along with the developments in supporting self-management, there continue to be technological and drug formulation advancements in diabetes therapy. Introduced earlier this year, ‘smart insulin’ is currently undergoing trials with scientists – it is hoped that it could revolutionise the way diabetes is managed. Instead of repeated blood tests and injections throughout the day to keep blood sugar in check, a single dose of smart insulin would keep circulating in the body and ‘turn on’ when needed.

Smart insulin would therefore enable people with type 1 diabetes to achieve near-perfect glucose control, all from a single injection per day, or even per week. This could greatly aid selftreatment for those living with the condition; 57% of people with type 1 and type 2 diabetes intentionally skip insulin injections, with the primary reason being fear of pain when injecting (15). With the benefits smart insulin can offer, this would dramatically reduce the amount of times end-users would need to inject (16).

Greater Control

While diabetes is placing an evergrowing strain on healthcare systems, it is clear that this has in no way gone unnoticed, with the developments and advancements in education, technology and drug formulations paving the way to help manage the disease and, in turn, reduce its prevalence.

Guiding healthcare professionals and end-users through education and training on good self-management is key to treating diabetes worldwide.

References


1. What is the global economic burden of type 2 diabetes? Visit: www.medicalnewstoday.com/articles/290948.php
2. Diabetes epidemic worldwide. Visit: www.dailymail.co.uk/health/article-2997882/diabetes-epidemic-400-million-sufferers-worldwidenumber-condition-set-soar-55-20-years-unless-humans-change-wayeat-exercise.html
3. Gestational diabetes. Visit: www.nhs. uk/conditions/gestational-diabetes/pages/introduction.aspx
4. Avoiding hospital admissions. Visit: www.kingsfund.org.uk/sites/files/kf/Avoiding-Hospital-Admissions-Sarah-Purdy-December2010.pdf
5. Self-management education, support, improved clinical health outcomes in patients with diabetes. Visit: www.healio.com/endocrinology/diabetes-education/news/online/%7b4a04002f-9cbe-4975-9d97-7952cbb53b0e%7d/self-management-educationsupport-improved-clinicalhealth-outcomes-in-patientswith- diabetes
6. Diabetes Care in the UK: The First UK Injection Technique Recommendations, 2nd edition
7. Evidence: Helping people help themselves. Visit: www.health.org.uk/publications/evidence-helpingpeople-help-themselves
8. Broadway CA, Prevention of injectable therapy leakage after subcutaneous injection, Diabetes Educator 17: p90, 1991
9. Insulin lipodystrophy and lipohypertrophy. Visit: www.ncbi.nlm.nih.gov/pmc/articles/pmc3743397
10. De Villiers FP, Lypohypertrophy – A complication of insulin injections, S Afr Med J 95: pp858-859, 2005
11. Dejgaard A and Murmann C, Air bubbles in injectable therapy pen devices, Lancet 334: p871, 1989
12. Chantelau E, Heinemann L and Ross D, Air bubbles in injectable therapy pen devices, Lancet 334: pp387-388, 1989
13. Annersten M and Frid A, Injectable therapy pen devices dribble from the tip of the needle after injection, Practical Diabetes International 17: pp109-111, 2000
14. Dolinar R et al, The importance of Good Insulin Injection Practices in diabetes management, US Endocrinology 5(1): pp49-52, 2009
15. Peyrot M, Rubin RR, Kruger DF and Travis LB, Correlates of insulin injection omission, Diabetes Care 33: pp240-245, 2010
16. 'Smart' insulin hope for diabetes. Visit: www.bbc.co.uk/news/health-31291722



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Cecilia Mendy is Junior Product Manager, Drug Delivery at Owen Mumford, and is responsible for developing and implementing the company’s global marketing strategy for the Unifine Pentips Plus. She has product management experience in the biopharmaceutical and medical device industries – both at local and global levels – on therapy areas that include rheumatology, vaccines and thrombosis. Cecilia has previously worked with Amgen, Sanofi Pasteur and Innothera. She has a postgraduate degree in International Business, as well as a Master’s degree in Biopharma Marketing and Management from ESCP Europe, Paris.
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