Michael Castagna, PharmD, MBA sees the need for a larger focus on patient outcomes to better address the diabetes epidemic occurring in the United States. The CEO of Mannkind Corporation, Castagna delivered his comments during a keynote address at the American Pharmacy Purchasing Alliance’s PharmCon meeting held recently in Orlando, FL.

“There’s all these new drugs. There’s all these great things happening,” said Castagna. “But when you really take a step back, and look, you say ‘despite the billions and billions of dollars spent, have we made a difference in outcomes?’”

Diabetes is a leading driver of hospitalization costs. “And yet, we don’t see a lot of innovation happening,” he said. “We’re not getting good outcomes for what we’re paying.”

The average patient spends just 40 minutes a year with a physician, Castagna told the audience. There are 23 million individuals with diabetes in the United States, and about 40 new treatments have arrived on the market in the last decade, but outcomes have barely improved, he added. “Seventy percent of the people on insulin today are not at goal,” he said. “Insulin doesn’t work fast enough.”

The issue is personal for Castagna, who told the audience that his father had passed away from complications of diabetes. He said a problem with treating diabetes is that patients are often waiting until they need insulin to take it, rather than preventing the need in the first place. “We save insulin to the very last second, and replace what you’re missing—unless you’re Type 1, then you get it right away,” he said. “Every time we eat, our sugars go up. Why are we not controlling mealtime insulins first?”

Mannkind, Castagna said, is working on an insulin product that works faster to more closely mimic the body’s natural insulin production and pancreas function. The company currently markets Afrezza, a man-made insulin powder that is inhaled to control blood sugar in adults with diabetes and is designed to be administered at the beginning of a meal. “We wait too long to get people back in control (of diabetes),” he said.

Although drug prices are a concern for Castagna, he said continuous glucose monitoring systems are showing promise for helping patients to better manage their condition by providing frequent blood sugar readings without requiring finger sticks. They also help illustrate the mealtime problem that exists with traditional diabetes treatment, Castagna said.  

“I believe [these systems] will transform the care of diabetes,” said Castagna. According to the CEO, new technology in diabetes will provide feedback, in areas currently missing, that will allow patients to better assess their bodies' actions and reactions.

Individuals with diabetes often see their glucose levels fluctuate throughout the day with highs and lows, which both make a patient feel lousy. However, there are new outcome goals emerging, according to Castagna. One goal is to maintain a more steady blood sugar level, eliminating those dramatic highs and lows, and helping to prevent damage to organs, including kidney and pancreas.

Pharmacists can also help address the need for better patient outcomes by taking a more active role in improving adherence. “You guys have the patients right in front of you every day,” said Castagna.

He suggested that pharmacists working in chains or large retail stores better leverage the in-house clinics to provide care related to diabetes. Independent pharmacists, he said, can provide more personal care and communication to patients with diabetes. Providing education and teaching patients about diabetes, treatments, and dosing can also help, he added.