Team:Lethbridge/HP Pharmacy
Medical Professional Perspective
Doctor-Patient Relationships for Diabetics
we had the opportunity to interview.
When discussing the doctor-patient relationship with medical professionals, we learned that doctor-patient relationships are very unique to each person to provide the most effective medical care possible. Personalized medicine is a necessity in diabetes care as to be able to achieve optimal glycemic control, prevent or delay complications as long as maintaining the quality of life. This includes the need to adapt a prescription regimen as necessary. According to (Bridges and Smith, 2016), the relationship and regular follow up are essential to prevent acute or chronic complications from arising due to deregulation of blood-glucose levels.
We had the opportunity to discuss with Dr. Sofia Bakopoulou regarding the interaction she has with patients as an endocrinologist. Medications such as insulin are prescribed at different stages of the disease and specific factors as complexity of regimen, side effect profile of medication, impact on weight and hypoglycemia , cost , access and availability can impact the choice of treatment. As a result of our discussion with her, we learned how doctors prioritize medication for their patients and how they modify the regimen needed to maintain the best standard of care following the current guidelines: “Part of my job is to discuss with the patient the current possible strategies in term of medication, individualize treatment goals and create a management plan., A patient-centered approach and a shared decision making strategy by taking in careful consideration patient’s factors and preferences , enhances the patient’s engagement and optimizes adherence in the regimen. Mutual agreement on regimen changes is essential to avoid clinical inertia.
Dr. Bakopoulou also described the importance of medications, specifically insulin, whereafter living ten years with diabetes, many of diabetics type 2 are reliant on prescribed insulin. As well, endocrinologists, depending on the country’s health system, have also to take in consideration the cost when they prescribe insulin that meets the needs of their patients. With insulin costs on the rise and the fact that many of diabetics are likely to rely on insulin prescriptions in an more advanced stage of their disease, we felt it vital that we focus on manufacturing insulin in a way that is inexpensive but also very modular. We feel our project Algulin has the potential to meet the needs of doctors and patients where microalgae provides an oral alternative that requires no protein purification. As well, it provides an opportunity to formulate and innovate on further insulin alternatives that may make them more fast acting and long-term. A goal of ours will be to design new constructs in the future in parity with microalgae production. All of this is with the intent of democratizing insulin supplies while providing an oral insulin that can meet the needs of health care professionals and most importantly, their patients."
Healthcare Aides
We learned also that healthcare aides are essential to vulnerable patient’s navigation of diabetes management. Necessary for the care of young and elderly (Berget et al, 2019), health care aides reduce anxiety of diabetes administration by helping maintain their prescriptions and make the appropriate dosages. When speaking with a health care aide in Lethbridge, we learned healthcare aides are limited in their direct contact with medicine dosages and are prohibited from injecting medicine on behalf of their client. Contrarily, they are allowed to measure doses of oral medication. This further confirmed that oral insulin would be a much better alternative to injectable insulin since children would benefit most from a health care aide’s assistance in drug monitoring and drug administration. This is especially true since 80% of diabetic children are type one diabetics, which require more strict monitoring of their medical regimen.
Pharmacy-Based Distribution
we had the opportunity to interview.
In order to understand how drugs are sold in pharmacy and if a pharmacy could be a reasonable production center, we had a discussion with Elizabeth White, a pharmacist in Ontario. Elizabeth taught us that in order for Algulin to be considered compoundable, made and distributed in a pharmacy, it must be a distributable powder. Compoundingis a fairly common task done by pharmacists where certain drugs for certain patients must be personalized to meet their unique needs. We believe Algulin could be a compoundable form of insulin where a complete photobioreactor optimizes recombinant microalgae growth and its pairing with a red fluorescent protein can allow for dosages based on the fluorescence to insulin ratio. In order for it to become a distributable powder, we decided to attempt a biomass drying protocol that preserves protein content.
We also discussed the recent phenomenon of American diabetics “caravaning to Canada” to purchase insulin at about 10% of the cost (Reuters, 2019). Elizabeth raised concerns over maintaining insulin supplies in Canada if the trend continues since drug supply instability in Canada is often a problem. In fact, Canadian provinces have since began to raise similar concerns (Edwardson, 2019). With no intention of raising the opinion that American diabetics do not deserve more affordable insulin, the preservation of supplies to maintain diabetics’ health in Canada and elsewhere is important. This confirmed to us that our project, aimed at democratizing insulin is incredibly important to maintaining an inexpensive, widely distributable drug to treat the symptoms of diabetes. The root cause of the problem however, is drug price regulations and given the uniqueness of our insulin and manufacturing techniques, our project is patentable and would allow for low cost maintenance to meet the supply for those who need insulin. We hope to continue to develop Algulin so that it may be a sustainable product to maintain a reasonable supply.
Public Health and International Scale
(taking a selfie with team member, Jesse).
“If diabetes were a country, it would have the third largest in population behind China and India. There are two major issues for patients: injections are painful, and they’re terribly afraid of hypoglycemia.” This is a statement made by Dr. Steve Ferzacca, an anthropology professor at the University of Lethbridge who has experience studying diabetes in Indonesia and among American Veterans. On an international point of view, Dr. Ferzacca provided a very encouraging insight where in his opinion, “Every single person would take an oral insulin over an injectable if it were available.” Most importantly however, he was convinced that a low cost, oral insulin would be immensely important for assisting lower income diabetics around the world, especially in under developed nations where formal medical practice is not readily conducted.
One of our biggest takeaways from interviewing Dr. Ferzacca was the benefit he predicts of not having to refrigerate the oral insulin. This is one of the biggest challenges in maintaining supplies of protein therapeutics worldwide and especially in locations with energy instability. This interview and the pharmacy interview really cemented the need to dry the algae, expressing insulin for open distribution.
References
Berget C., Nii P., Wyckoff L., Patrick K., Brooks-Russel A., Messer L.H. 2019. Equipping School Health Personnel for Diabetes Care with a Competency Framework and Pilot Education Program. Journal of School health. 89(9): 683-691.
Bridges H., Smith M. 2016. Mediation by illness perceptions of the association between the doctor–patient relationship and diabetes related distress. JHP. Vol. 21(9): 1956–1965.
Edwardson L. Aug. 13, 2019. Protect Canada's insulin supply from U.S. buyers in search of bargains, advocates urge. CBC News
https://www.cbc.ca/news/canada/calgary/canada-insulin-supply-protection-1.5244359
Reuters T. June 29, 2019. American caravan arrives in Canadian 'birthplace of insulin' for cheaper medicine. CBC News.
https://www.cbc.ca/news/canada/london/insulin-prices-united-states-canada-caravan-1.5195399