With 366 million people living with the condition globally, and costing healthcare systems about $465bn annually, it’s no surprise that much of the healthcare world has its eyes on diabetes and the damaging effect it can have both economically and to the individuals who live with it.
These figures are only expected to get higher, as unhealthy diets and sedentary lifestyles become more common across the world, prompting former president of the International Diabetes Federation (IDF) Jean Claude Mbanya to proclaim: “The clock is ticking for the world’s leaders.”
The UK is no exception with the non-profit Diabetes UK suggesting the number of people with diabetes in Britain is expected to rise by 700,000 by the end of the decade.
Increased incidences come at an increased price, and it is expected that the direct cost of diabetes to the NHS will be £17bn by 2035/36.
One man who will have more interest than most in these figures is Peter Meeus, UK managing director of Novo Nordisk – a pharma company that has built its name on diabetes, ever since August and Marie Krogh brought the knowledge of insulin back to Denmark from North America 90 years ago.
“I think diabetes is underestimated,” he says, commenting on the perception of the condition in the UK. “A lot of effort goes into heart disease and cancer, which is a very good thing, but we strongly believe diabetes should get more attention.
A lot of effort goes into heart disease and cancer, which is a good thing, but we strongly believe diabetes should get more attention
“We see good signs in the Department of Health, but there is a need to act sooner and quicker.”
| Career Highlights |
| VP business area UK and Ireland, Novo Nordisk |
| General manager Belgium and Luxemburg, Novo Nordisk |
| Senior brand director Zometa USA, Novartis |
| Senior global brand director diabetes, Novartis |
| Vice president sales and marketing, Novo Nordisk |
| International marketing manager insulin analogues, Novo Nordisk |
| International product manager Activelle, Novo Nordisk |
Forging friendships
Novo is working on ways to address this and, perhaps unsurprisingly, these include collaboration with major diabetes stakeholders, such as Diabetes UK.
“We have been collaborating with them for many years now and will continue to do so,” Meeus says. “Whatever they do to raise awareness of diabetes in terms of prevention, diagnosis and treatment we are also supporting.”
Meeus also highlights education as a major area of Novo’s work in diabetes, noting the company’s efforts with the South Asian Health Foundation at the time of World Diabetes Day to teach the South Asian community in the UK about diabetes.
“We specifically zoomed in on this population because the prevalence of diabetes is six times higher than in the white population,” explains Meeus.
“These people also tend to be based in difficult-to-reach communities and it takes extra effort to reach them. This includes both simple things like having someone who can speak the same language, because these groups don’t always speak fluent English and the language barrier can be a big hurdle.”
Novo’s support in this instance took the form of funding the company’s Changing Diabetes programme.
“We do not always seek commercial interests and we do a lot of activities that serve the diabetes community,” explains Meeus. “As a company that has spent 90 years in diabetes, we think it is our obligation to increase awareness.”
Wake up call
In the UK, there are signs the government sees diabetes as an important healthcare concern, according to Meeus, including the development of a Diabetes Action Plan to replace the current National Service Framework.
“We look forward to that and seeing how we can act as a collaborator to help roll this out and support this,” he says.
This development could see Novo working increasingly with the NHS – a move that fits in with the growing trend towards partnerships between healthcare systems and the pharma industry.
“We strongly believe in partnership with the NHS,” says Meeus. “We always aim for a public-private partnership because ultimately we think it provides better care for patients with diabetes.”
As a company that has spent 90 years in diabetes, we think it is our obligation to increase awareness
These aren’t just words, and Novo has several ongoing projects with the NHS, including a collaboration with Kings Health Partners, comprising Guys and St Thomas’s Hospital and King’s College Hospital London, to develop a system of integrated diabetes care.
Launched in January 2012, aims of the projects with the NHS include the development of clear, costed, evidence based, quality controlled pathways for all diabetes patients, while Novo’s expectations include data on how appropriate use of its products is both cost effective and able to improve patient outcomes.
There’s more to come too, says Meeus: “We have several other projects running across the country and we plan to do this in an even more structured way going forward.”
Understanding the patient
Understanding of diabetes among people living with the condition in the UK is still a challenge, especially when it concerns specific risks, such as hypoglycaemia – a potential side effect of insulin that occurs when glucose levels fall too low, leading to symptoms such as anxiety, blurred vision, difficulty in concentration, confusion and even seizure or coma in severe cases.
“The number of incidences of hypos is under-reported, either because of concerns or patients don’t realise this is a side effect and there are treatments now that can help,” explains Meeus. “Not reporting it is a very big issue.”
Novo has attempted to address hypoglycaemia with the launch of its new insulin Tresiba (insulin degludec), which was approved in Europe at the end of last year and has demonstrated it is as effective in reducing blood glucose levels as is its rival Lantus from Sanofi, yet carries less risk of hypoglycaemia.
Tresiba has also demonstrated it is just as effective even when patients don’t administer an injection at the same time every day – as per the recommendation for Lantus – with some commentators suggesting this greater flexibility in dosing could improve adherence, which is one of the biggest issues for people living with a chronic disease.
“Over the past 90 years, we are the only company that has really been advancing insulin through many different steps,” says Meeus. “We are not yet another generation because that’s too much of an overstatement, but these are important evolutions.
“Each time you get clinical benefits that are becoming better, and the treatment’s become easier for patients as well. There’s a dual tract that’s evolving there.”
For what it’s worth
Such innovation should be rewarded appropriately, notes Meeus, adding his voice to the number of senior pharma figures who think new medicines are worth their often higher price tag.
For Tresiba, this isn’t just down to the benefit it provides, but also its potential to reduce the estimated cost of £30.4m per year to treat incidences of severe hypoglycaemia in the UK, and the £41.8m cost for moderate hypoglycaemia.
“If you buy something new, the price is always higher,” he says. “But in this case, it offsets a lot of costs that are related to the disease, and you cannot discuss price without discussing the upside you create.”
Several obstacles stand in the way of the uptake of Tresiba in Europe, including the decision from the US FDA to request more data from Novo Nordisk regarding the drug’s cardiovascular safety before it can be approved.
In addition, Meeus highlighted a need to raise awareness among the healthcare community of how serious hypoglycaemia can be.
We see good signs in the Department of Health, but there is a need to act sooner and quicker
It’s another challenge that Novo is working on, says Meeus: “I think through the information we provide about clinical trials in publications, healthcare professionals will be more aware of the need for treatments that can reduce risk of hypoglycaemia and that are given in a device that makes it easier for people with diabetes to live the life they want to live.”
Lead time
In any case, as with any new medicine, uptake in the UK is still likely to take a long time.
“I think the UK is seen as a low uptake market if you compare it to other European countries,” says Meeus.
“There is always a step towards those people who want to use the newest treatments, and that gradually spreads towards more use.
“I think it’s important that we want to see commercial success, because we use commercial success to reinvest in R&D and the communities we work in. But it is also important that we give clinicians the time to work with the product so they can see for which patients they would like to use it and to see the benefits and then gradually expand from there.”
As for the future of diabetes treatments, Tresiba is just the start of medicines becoming more and more personalised towards specific individuals, according to Meeus, and Novo will remain a major player.
“There will be more and more treatments available for specific patient needs,” he says. “I think it’s important that healthcare professionals have more choice to address specific needs of patients.”
On top of this, education cannot be forgotten, and governments need to continue doing more to communicate the importance of diabetes awareness to the public and providing them with suitable medicines.
“Authorities in general will invest more time in terms of creating diabetes awareness and diagnosing people with diabetes, and they will also be open to providing people with diabetes the products that they need – both existing products and innovative products that provide benefit over existing therapies.”
Further afield
The future will also see companies working more in developing regions, such as Africa, where Novo’s Changing Diabetes programme is also running. This support includes offering medicines at a discounted price.
Meeus explains: “In developing countries we offer 20 per cent of the price we ask in developed countries. We have programmes to provide insulin free for children – I think we have reached 10,000 children with diabetes.
“We co-founded and continue to support the World Diabetes Foundation, which provides assistance for projects that are focused on diabetes care, but may not have the means to do so. This can be a diabetes clinic or a programme to support diabetes footcare for example.
“There are a lot of activities ongoing because we believe strongly we should support these efforts through Changing Diabetes,” he concluded.
