Drug delivery
39% of people with diabetes feel their medication routine affects their ability to live a normal life. Almost two thirds (65%) of those surveyed also noted that their condition negatively affected their physical health, while 46% felt their emotional well- being suffered.
“People spend a lot of time with diabetes in their head,” says Østergaard. “It’s mentally consuming, and it’s not something anyone wants; it's not something that they've chosen, and they will do anything to be rid of it. You spend your time on it because you have to – and therefore you want to make sure it takes up as little time as possible.”
Digital dosage
39% of people with diabetes feel their medication routine affects their ability to live a normal life.
spotted after they’ve lost a great deal of weight and no longer have the strength or energy to get through a school or workday. The diagnosis itself can also be very isolating, catalysing a range of mental health issues for youths yet to develop a stable sense of who they are. Depression is three times more common in people with type one diabetes than the general population.
“If you’re a person with type two, then it’s overwhelming to move from taking a pill a day to having to measure your blood sugar and dose the correct amount of insulin.”
Søren Smed Østergaard, Novo Nordisk 3x 14
Depression is three times more common in people with type one diabetes than the general population.
Journal of Medicine and Life
“If you’re a person with type one diabetes, it’s overwhelming to be thrown into it immediately,” explains Søren Smed Østergaard, Novo Nordisk’s VP of digital health. “And if you’re a person with type two, then it’s overwhelming to move from taking a pill a day to having to measure your blood sugar and dose the correct amount of insulin.” Even in these cases, the impact of the realisation that one has become what Østergaard calls a quote- unquote “real” diabetic is hard to overstate: people with type two are also twice as likely to have depression as non-diabetics. “Then there’s the worry that if you take too much insulin it can be detrimental to your health, and if you take too little you may have complications later in life,” he continues – and even if it doesn’t contribute to clinical levels of depression, diabetes isn’t exactly a confidence booster. “So people get scared. It’s like being a line dancer; if you take a wrong step, the consequences can be severe. And you feel that.” Indeed, in 2012, Novo Nordisk’s second ‘Diabetes Attitudes, Wishes and Needs’ study found that
Novo Nordisk believes digital therapeutics can help with that. Instead of leaving diabetics to the Sisyphean task of calculating the right amount of insulin for each of their injections, Østergaard’s team is currently trialling an app that uses blood sugar measurements and a simple question about recent hypoglycaemic episodes to automatically titrate users to the optimal dose. In Østergaard’s view, this sort of dose guidance solution should be a cheap and effective way to share out and build on the improvements advanced devices like smart insulin pens have brought to diabetes management. According to a 2020 Novo Nordisk-led study into the use of these pens (which record the timing and dose of insulin injections and can integrate them with glucose monitors) by type one diabetics in Sweden, they can increase mean discounted life expectancy by 0.9 years. They can also increase adjusted life years by 1.15 – while saving a combined €45,318 per patient compared with standard care. And that’s without directly addressing the stress and strain of dose calculation. “Digital therapeutics are a lot of things, but what we’re aiming for right now is to make sure that people dose correctly and at the correct time,” Østergaard explains. “People are struggling with complying with therapy, of putting action on their intention, essentially. Maybe maths wasn’t your favourite subject in school, so you’re worried whether you’re calculating your dose correctly, which makes you hesitant to make changes.” Or, in the worst cases, you might try to avoid the hassle by simply skipping doses. “Therefore, you need reassurance, you need support – or at least many people could benefit from that.” Digital therapeutics don’t just simplify diabetes management for patients and healthcare systems, either. Compared to molecules, apps are remarkably easy to develop, and if they’re designed and trialled to ensure they work safely with drugs that have been proven to effectively treat diseases and promote health, they can greatly magnify a pharmaceutical company’s impacts at minimal
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