For more than 30 years, Roche has been committed to helping people with diabetes live lives that are as normal and active as possible. Marcel Gmuender is the Global Head of Roche Diabetes Care, a global leader for diabetes management systems and services.
What is the role of the new Integrated Personalised Diabetes Management (iPDM)?
Healthcare systems and the way diabetes is treated are evolving rapidly. We at Roche Diabetes Care believe that data is on the one hand an important lever to improve therapy outcomes and on the other hand allows for four crucial aspects in diabetes management: personalization which contributes to more targeted therapy adjustments; prevention of secondary complications and disease progression; prediction of critical situations (as e.g. our very sensitive hypo warnings we have built into our new Accu-Chek Insight CGM system); and participation and an enhanced doctor patient interaction, contributing to an improved motivation and adherence
Our approach to a structured and Personalised Diabetes Management addresses the main challenges people with diabetes, their caregivers and healthcare professionals face every day. Market feedback has shown that single, stand-alone therapy solutions lack in bringing the majority of people with diabetes to their individual therapy target. Therefore, integrated and interoperable solutions are the key to success in optimally managing diabetes and achieving better therapy outcomes. We see this as a vast opportunity to improve the lives of people with diabetes, support them in their daily routines and contribute to freeing their minds off of some important therapy aspects they have to deal with 24/7. I am confident that we are on the right track with our strategic approach and we will continue to drive and market innovative solutions to facilitate integrated Personalised Diabetes Management and support sustainable care. Doing so, we are working with governments and payers and are partnering with industry and healthcare professionals to help reduce the burden for people with diabetes, their caregivers and healthcare systems and prepare healthcare structures worldwide for the future.
“Integrated and interoperable solutions are the key to success in optimally managing diabetes”
What are the main advantages brought by this system?
International studies have demonstrated that each part of this approach fosters improved outcomes. We have strong evidence that following the six steps of the Personalised Diabetes Management cycle and implementing the structured feedback loops into daily therapy routines is not only allowing for a better glycemic control but also enables a better doctor-patient communication. We also see short-, mid- and long-term health-economic benefits stemming from iPDM. A study recently conducted in Spain was revealed that iPDM in combination with our emminens system resulted in a reduction of 12% in total diabetes treatment cost. Currently, we have a study program underway that is evaluating the therapeutic and health-economic benefits of the entire PDM cycle in a diabetologist and GP setting. We expect the study results to become publicly available in 2017.
Moreover, involving wireless and interoperable technologies and using solutions like our Accu-Chek Connect app and online diabetes management system have shown to make consultations more efficient – be it in the doctor’s office or remotely. Such solutions save time for people with diabetes and healthcare providers but at the same time hugely increase their motivation, adherence and confidence in therapy as well as their peace of mind as they don’t have to make every therapy decision on their own but can rely on their physician when needed. For healthcare professionals, diabetes centers and hospitals e.g. the modules of the emminens system allow for an optimal handling of patient contracts, logistics and large amounts of therapy-related data and most importantly to guide them step-by-step through the structured and integrated Personalised Diabetes Management process.
High quality data, lower costs and more analyst information. What is the next technological step going to be like?
We will certainly continue with our chosen path of integrating our devices into holistic solutions supporting Personalised Diabetes Management. We have just introduced our new Accu-Chek Insight CGM system at the EASD congress in Munich. Taking this technology to the next level and combining it with our insulin delivery systems as well as further smart mobile solutions will be our next development steps in focus. Furthermore, we are looking into options to offer even simpler solutions to obtain, handle and interpret the important diabetes data in everyday life. Our ultimate goal is that people with diabetes have access to optimal care and can think less of their therapy routines as this is taken care of by our solutions.
Who is the professional in charge of the development of predictive reports and predictive inspection routes: the healthcare expert or the telecom engineer?
We need to work on this in a collaborative approach. We for sure need analytical and algorithm competencies as well as mobile technology and medical expertise to be able to provide the optimal solutions. However, as such a report deals with health information and medical competencies, it will be the healthcare expert.
The new iPDM system needs to be supported by all the key agents of the health sector. Thus, how are you planning to complete this cooperation?
We are working already with governments, health insurance companies, physician and patient associations as well as industry partners to ensure the adequate involvement of all key stakeholders in the implementation of iPDM. In some European countries as e.g. Germany, we have started its implementation in pilot regions together with one of the biggest health insurance companies in this market. The feedback I have received so far from this project is truly encouraging and shows that we are on the right path.
How can these new digital solutions help patients to make better decisions in the management of their condition?
Unlike many other forms of doctor-patient-interaction, I am convinced that digital health will have by far a greater effect on how care is being delivered to people with diabetes. This is due to the following reasons: mobile devices are ubiquitous and individual; mobility by itself implies that the users are part of a network, which radically increases the volume, variety and frequency of information exchange. Already today, patient treatment and remote monitoring solutions constitute almost 60% of the total mobile health deployments in Europe. With solutions like our Accu-Chek Connect or the emminens systems, we facilitate a better overview of the important diabetes data. As a patient, it is not only a number you see but with the help of a mobile app or a PC you can visualize your daily or weekly profile. This helps to more quickly and easily identify where the issues are and determine the appropriate lifestyle or therapy adjustments to get the glucose levels back to the defined target range. Another example is the calculation of an insulin bolus dose to cover a meal or a snack. There are quite a number of factors that need to be considered in such a calculation and we have heard from many patients that this is a topic they often struggle with. The bolus advisor built into our meters and the Accu-Chek Connect app supports patients in determining the bolus dose required to bring the glucose levels back to the target range and at the same time consider the pasta or the banana they are about to eat. These are just two examples for everyday situations in which digital solutions can be of enormous benefit to a person with diabetes, alleviating their therapy routines.
This has been confirmed by clinical studies like the ABACUS or ACCRUES trials and research involving the emminens eDetecta module. This research was able to make evident that the emminens system helped to improve the quality of clinical decisions by supporting correct and much faster glucose pattern detection compared to the manual analysis. In addition, people with diabetes were able to obtain remote consultancy from the healthcare professional via the platform, the eConecta App or a simple text message, which significantly helped to improve doctor-patient interaction during the time between doctor visits.
How can this new model reduce cost in healthcare systems?
Our integrated Personalised Diabetes Management approach implemented by means of the emminens system was already able to demonstrate its health-economic benefits in the Oblikue study conducted in Spain. The results published at the ISPOR meeting last year show that the total treatment costs could be reduced by 12% irrespective of diabetes type 1 or 2. In gestational diabetes the reduction by 14% was even more pronounced. Especially the outpatient visit cost in type 1 and type 2 as well as the by far less emergency hospitalisations in type 2 patients were significant contributors to this result. As said, we have a study program currently underway that is evaluating the therapeutic and health-economic effects of integrated Personalised Diabetes Management in a GP and diabetologist setting. We plan to publish the results from this ProValue Study program in 2017.
Digital health will have by far a greater effect on how care is being delivered to people with diabetes
This new model improves the security, the production and the equipment maintenance. Can we also say that it is more sustainable as well?
I am convinced that it is more sustainable than traditional care models, based on the advantages offered by iPDM involving our digital health solutions: real-time disease management as it provides access to real time data so diabetes can be treated more proactively before the condition can progress; automated workflows ensure adequate data collection, informed decisions and while errors e.g. in data interpretation are minimized; reduced costs due to less emergency hospitalisations and cut down unnecessary doctor visits as many questions can already be answered in remote consultations; improved therapy outcomes due to increased data availability and quality resulting in more informed and more timely therapy decisions. I am confident that with this approach we as a company can deliver not only value in terms of improved therapy outcomes but can also contribute to enhanced and sustainable structures of care.
What is the approach of Roche concerning Diabetes care management for the next ten years?
For the self-management of diabetes by the patient with the help of the healthcare professional it remains of utmost importance to manage the blood sugar levels. This needs measuring tools like continuous glucose monitoring, test strips and potentially new, non invasive systems in the future. We will drive this technical innovation and the corresponding advice systems to manage the disease and the therapy for each individual. Therefore, we will continue to drive device integration, leverage interoperability and digital health solutions as well as provide integrated care concepts to support people with diabetes, their caregivers and healthcare professionals in the daily management of this chronic condition. Doing so, continuous glucose monitoring, its integration with other devices as well as the provision of further integrated Personalised Diabetes Management solutions will be in focus. We are committed to consequently leverage the use of digital health solutions and supporting tools, as this will make it easier to deploy integrated and networked care concepts short-term. With this, we expect to be able to meet the needs of people with diabetes, healthcare professionals and healthcare systems and contribute to a more resource-preserving and efficient deployment of national healthcare budgets.
By Jose L. Cánovas