Freeing the World from Type 2 Diabetes
Despite significant advances and innovation in the care of diabetes in recent years, the number of cases continues to rise. There is a need for increased investment in locally adapted projects capable of expanding preventive treatment and other interventions capable of improving outcomes.
The views expressed are those of the author and do not necessarily
reflect the position of Re:solve Global Health.
In a recent FGH talk organized in collaboration with the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA), speakers Niels Lund, Vice President for Global Prevention & Health Promotion, Novo Nordisk and Cities Changing Diabetes, Robert Heine, Distinguished Lilly Scholar, Lilly Diabetes, Eli Lilly & Company and Honorary Professor of Diabetes at VU University Medical Center in Amsterdam and Ruchika Singhal, vice president of global health at Medtronic LABS discussed how partnerships with local stakeholders and health systems could be used to build innovation and improve capacity.
Q: What has Medtronic LABS learned from replicating/scaling innovations across countries? What were the enablers and/or obstacles others should know?
A (RS): Each country has a unique set of stakeholders, and the health systems are at different stages of maturity. The solutions we implement have to be adapted at least a little bit to fit the needs by country. We need “tailoring” vs. producing standard sizes!
Willingness to listen, learn and adapt is crucial for scaling healthcare innovations, because health is local. A one-size-fits-all approach will rarely work in this space. We build local teams that work closely with the existing health systems and stakeholders to implement solutions that integrate and strengthen the local ecosystem, as opposed to promoting interventions that are usually solely technology focused.
Q: You explained that at Medtronic LABS, effective diabetes care is primarily approached as a way of augmenting the capacity of existing health systems, both in terms of people and technology. Can you provide insight into how you approach the development of group-based models for public health systems that are patient-centred?
A (RS): We have dedicated design and innovation teams that develop patient engagement curriculum localized by regions and communities. Our patient engagement specialists work closely with local patient advocacy groups and community health workers (CHWs) to train peer educators on the curriculum and set up patient support groups in all the communities that we work with. We partner with the local health facilities to enable regular patient group meetings and clinical support at those meetings. As our teams engage with patients and CHWs, we continually engage them in feedback to iterate and refine the model. It’s an integrated, on-the-ground, continual, human-centered design approach!
Q: During the webinar, you mentioned how the Cities Changing Diabetes Network is looking to identify what drives risks beyond the biomedical domain, extending into community-based models for optimizing health care delivery. What role do pharmaceutical companies working toward diabetes prevention and care play in facilitating community-based innovations? What value can they bring to these efforts, particularly public—private partnerships?
A (NL): In the case of Novo Nordisk, we have for almost a hundred years been working in the field of chronic disease, in particular diabetes. We therefore have a deep understanding of these diseases, the underlying risk factors (biomedical, social and cultural), their impact on people, the health system and the economy – both in high and low resource settings. On the more practical level, we have strong project management experience, that can help drive public-private partnerships forward.
Q: During the webinar, you briefly mentioned that there are alternative funding opportunities for diabetes prevention and treatment opening to the market. Can you elaborate on how we can innovate within health finance to optimize resources and solutions for diabetes prevention and care?
A (NL): We are working to explore ways to unlock new forms of financing by looking at the prevention and care of chronic disease, e.g. diabetes, as a social investment – in other words, an investment not just in the avoidance of costs to the healthcare system, but also as an investment that can bring people back into being more productive at work, or perhaps even allow them to join the workforce. The following project has been developed and funded with these perspective in mind: CCD_Case_Aarhus diabetes impact bond_DEC 2021.pdf (citieschangingdiabetes.com). While the investment case is fully owned and driven by the municipality of Aarhus, we have been instrumental in facilitating and developing the case.
Q (From audience): Could you give examples of success in reducing obesity in any of the 41 cities? There are tons of good initiatives but are they leading to measurable declines in obesity and/or actual increases in physical activity?
A (NL): Change in the prevalence of diabetes and obesity often require interventions of decades and are affected by many factors other than the initiatives and interventions that we support. Hence, it is very difficult to measure, let alone establish, a cause-and-effect relationship between intervention and outcome. Instead, we look at where we see behavioural changes and/or policy change that are easier to identify in the shorter run. A collection of relevant cases where we have seen behavioural and policy change as a function of the intervention are available here: Case catalogue (citieschangingdiabetes.com)
Q: In the webinar, you said, “It all comes down to trustworthy relationships with partners and organizations that have the same ambition in mind: to help the millions of people living with diabetes that we have failed collectively.” Who are the innovative or unconventional stakeholders those in the NCD and healthcare space need to partner with to accelerate progress?
A (RH): There are many important organizations active in low- and middle-income countries (LMICs) with the ambition to advance care for the many people living with non-communicable diseases (NCDs). Most of these organizations work in isolation and may not have committed to a long-term effort to create a sustainable impact on the health care system. Pharmaceutical companies have launched valuable short-term projects, but unfortunately not with lasting and sustainable impact. True impact can only be achieved when there is a commitment of the sponsor to achieve the desired goal irrespective of time and budget. For many organizations this is too high of a bar to commit to.
An additional challenge that needs to be acknowledged is that many organizations and companies have their own agenda and priorities and want to be recognized for their contributions. Also, we need to recognize that there is a lack of trust in the long-term commitment of pharmaceutical companies and other commercial organizations. The challenges in most LMICs are too great for most organizations to tackle by themselves.
We therefore collectively need to accept that to be successful, we need to establish coalitions with shared responsibilities, leveraging the specific capabilities and expertise of each organization. This will require (re)building trust and long-term commitment. With the launch of the NCD compact and the recognition of the great urgency to act, this is the right moment to initiate these discussions. We can do so much more collaboratively if we care enough to start doing something about it.
Q: Can you provide an example of an innovative initiative for integrating care in LMICs, and briefly explain why this approach is unique and creative?
A (RH): There are two examples I can share. The first is a collaboration with UNICEF that Lilly recently announced to help improve health outcomes for 10 million children and adolescents living with chronic NCDs through 2025. Lilly has committed funding to support UNICEF’s work to address NCD risk factors, strengthen health systems, and enhance the ability of healthcare workers to care for patients in Bangladesh, Malawi, Nepal, the Philippines and Zimbabwe.
The UNICEF collaboration draws on Lilly’s experiences from our long-standing partnership with the Life for A Child program (LFaC), which supports young people with diabetes in under-resourced countries. In 2021 Lilly announced an expansion of this partnership, allowing LFaC to reach approximately 150,000 young people in 65 countries over the next 10 years. Both these transformational collaborations leverage the unique expertise and capabilities of each of the partners: LFaC, UNICEF and Lilly.
Another valuable approach is leveraging projects that have been developed for other purposes and diseases. In Eldoret in Kenya, for example, a health care system was developed for the treatment of HIV and tuberculosis (more information can be seen here. Lilly and the Lilly Foundation provided support and funding to the AMPATH consortium, a network of North American universities partnering with academic health centres in LMICs, to expand its successful approach to more diseases, including diabetes, hypertension, and cancer.
These examples illustrate that working together and learning from each other’s experiences can enable the creation of apparently simple solutions with sustainable impact.