The Future of Managing Type 2 Diabetes

Peter Salgo, MD: With all this, I’ve got to tell you, there’s a lot of noise out there. We’ve covered a lot of ground. But from somebody who’s not an endocrinologist and is not frontline treating outpatients with diabetes, what this sounds like is, great, there is some new stuff that’s really terrific. If you were to project out, oh, let’s say 10 years, the type 2 diabetes formulation, type 2 diabetes landscape, what does that look like?

Helena W. Rodbard, MD: It looks amazing because looking back 10 or 20 years ago, even 10 years ago, we could have never imagined that we would have so much to offer to our patients. We also know that there is a huge pipeline. Why? Because there is a huge need worldwide. So there are lots of people [who] are very interested in developing newer and better drugs. So projecting forward, I think it’s a message of hope. I really think there’s going to be more to offer.

Om P. Ganda, MD: I think we’ve made tremendous progress in the care of people with diabetes. I think there’s more to come, but we are now much more in a better position to treat our patients in [a] much better way without causing hypoglycemia, without causing weight gain—which happened with TZDs [thiazolidinediones] and sulfonylureas. And we are actually making their life better by reducing the cardiovascular risk that these people have, particularly those who have been studied in these trials with preexisting cardiovascular disease. So I think we’re looking for the day when we can prevent these complications by using these drugs earlier once they’re approved for that purpose.

Peter Salgo, MD: The population that is prime for type 2 diabetes is exploding. People are getting older. The American population is getting older. These new drugs are not free. These guys are excited about these new drugs. Somebody is going to pay for it, and as the number of people who need these drugs increase, how are we going to afford this?

James T. Kenney, RPh, MBA: Well, it’s part of the challenge we face every day trying to manage the formulary. Because again, we’re only talking about diabetes. We’re not talking about orphan disease, gene therapy, CAR-T [cancer antigen receptor T-cell therapy, and] all these other therapies that are coming along that are extremely expensive.

Peter Salgo, MD: Well, they’re not any diseases we have to worry about. This is a diabetes panel.

James T. Kenney, RPh, MBA: Absolutely. It’s a diabetes one.

Peter Salgo, MD: The heck with those diseases.

James T. Kenney, RPh, MBA: Well, the exciting part is [that] there will be some generics that will launch over the next few years that will offset some of the newer drugs that are coming to market. And that will create some inexpensive combinations, which will help the providers treat their patients more efficiently. And I think [for] the disease itself, we’re just continuing to learn and expand, and—I agree with the physicians on the panel here—it’s remarkable what we’re seeing with the results. We focus a lot of attention with our providers on lowering hemoglobin A1C [glycated hemoglobin]. We see it on the commercial side if we’re doing NCQA [National Committee for Quality Assurance] accreditation and we’re getting our HEDIS [Healthcare Effectiveness Data and Information Set] scores down or if we look at the star ratings for our Medicare population, there’s a lot of attention on getting patients to goal and driving things down. And I think with the expansion of new drugs and a better understanding of disease, if we can get primary care to really accept and appreciate the guidelines as well and treat these patients more aggressively, then maybe our endocrinologists can do some other creative things.

Peter Salgo, MD: I’ll ask you for a 1-word answer. [Are you an] optimist or [a] pessimist going forward?

James T. Kenney, RPh, MBA: Optimistic.

Peter Salgo, MD: That’s great to hear. You know, it’s been a terrific discussion and we’re kind of at the end of it, time-wise. But this is a discussion we’re going to keep having over the years as more and more products come out. But before we end the discussion, what I’d like to do is open up the floor, ask each of you to give 1 last thought you may have for our viewers. And why don’t we start with you, Dr. Ganda.

Om P. Ganda, MD: Well, diabetes is a [dreadful] disease, we know that. And we are very, very fortunate that in the past 15 years, we have made a lot of progress. We can’t lose sight of the fact that there are almost half a billion people with diabetes on this earth, and this number is going to rise even further. So this is a huge challenge. We also know that we spend about 230% higher on the care of people with diabetes, speaking of the cost, compared [with] those without diabetes. So it’s a huge challenge. And I think preventing the complications is really going to be the goal going forward. We cannot see all these people developing diabetes and developing complications.

Helena W. Rodbard, MD: I would leave them with a message of hope. I really think that we’ve come such a long way, and there is still a lot more that is coming our way. When a patient is diagnosed with diabetes and they come to my office, the first thing they can think about is somebody [who] they knew [who] had 1 of those dreadful complications of diabetes. So I have to tell them that diabetes now is a different disease. It’s totally different [from] what their mother or grandmother might have had. We have all kinds of resources, but I don’t let my patients off the hook. I said, this is going to be a team effort, so I’m going to do my part, but I expect you to do your part, starting with lifestyle modification. But it’s a message of hope.

Peter Salgo, MD: You’ve got the last word.

James T. Kenney, RPh, MBA: Well, I think we need to collaborate with our physicians to try to develop a formulary and a benefit design that meets the needs of the patients, the providers, the health systems. Because clearly, we can’t cover everything and anything that comes down the line. And ideally [we will] find that right mix of products for each individual patient. There are unique subsets of patients out there. [We need] to help build the formulary to get the best combination to treat those patients.

Peter Salgo, MD: All right. Well, I want to thank all of you for being here today. I want to thank you, on behalf of our panel, for joining us too. I hope you found this Peer Exchange discussion to be useful and informative. I’m Dr. Peter Salgo, and I’ll see you next time.