The Big Interview questions – Ascensia’s James Richardson
James Richardson is a Pharmacist and an expert in Pharmaceutical Medicine according to the Swiss Association of Pharmaceutical Professionals.
He is presently the Medical Lead for BGM Mature Markets at Ascensia Diabetes Care. Additionally he mentors MBA students at Durham University, UK. Previously he was an Officer in the British Army.
From your perspective, what immediate impact has COVID-19 had on people with diabetes?
I think the pandemic has affected many people, not just those with diabetes. Following the measures, such as social distancing and staying at home, or having concerns about being made redundant or furloughed has led to a lot of anxiety. For those with diabetes, this sort of anxiety can impact blood glucose levels.
There’s also the fact that routine diabetes appointments have been missed because access to hospitals has been limited. Even day-to-day care has changed for people with diabetes, with standard screening appointments for complications often being put on hold, which can lead to the risk that they are not spotted early enough.
For example, it’s not uncommon for people with diabetes to be advised not to cut their own toe nails, so prior to COVID-19, a chiropodist would come over and do that for them. But, now we’ve been trying to work around these issues and find a safe path to accessibility, but in a controlled manner. I think that’s what people initially have found difficult and quite stressful.
I recently did an adhoc analysis of data collected from our CONTOUR® DIABETES app, which is connected to our Bluetooth enabled BGM devices, I noticed there was a 15 per cent increase in the number of people triggering critically low blood glucose levels between January and May. Now, that could mean that people were testing more over that period, or connecting more often to the app. Whatever the reason, we saw a significant increase during the main period of lockdown.
What impact will COVID-19 have on the long-term management of diabetes post the pandemic?
Quite a bit I think. So far, we’ve seen the infrastructure for communication with healthcare professionals change quite radically. A lot is now done over the phone and apps are being used more than ever. These are useful as they can produce blood glucose reports, which can be sent via email or a portal such as Diasend by Glooko to a person’s doctor. This allows them to look at their patient’s readings and give them appropriate guidance. I think lockdown has forced us to adapt, which is not always a bad thing.
But, having said that I still think there will always be a place for face-to-face communication. Being in the same room as someone gives you a better understanding of that person and gives you the important non-verbal clues about their health and mental state that might be missed if the consultation is over the phone.
Take conditions, such as diabulimia. If asked by their doctor, people may not wish to talk about about the topic. However, they might start to open up to a nurse in a waiting room because it’s not in front of their doctor and the pressure has been relieved slightly. It’s a lot easier to bend the truth and tell the healthcare professional what they want to hear over the phone or via email.
And when it comes to conditions relating to eyes and feet, people with diabetes will always rely on a thorough in person check by the relevant healthcare professional.
What impact has COVID-19 had on Ascensia Diabetes Care?
First and foremost, our goal during the COVID-19 situation has been to make sure that our patients have access to all our products throughout the entire lockdown period and we have, to date, successfully managed to do that. We can’t help people unless our product is in their hands.
We’re a global company and a lot of our products are manufactured in Japan. Since many passenger planes have been grounded, which typically carry a fair bit of cargo, getting our products from A to B, at least in the early days when this started, was more challenging. Having spoken to colleagues in our supply chain management team I’ve heard they sometimes had to rebook a shipment up to seven or eight times before it successfully left for its destination. And as demand is high, costs have increased significantly.
These are some of the things that have been going on in the background at Ascensia that healthcare professionals and patients may not be aware of. But it was crucial we persevered to ensure products were available so people could continue to manage their diabetes consistently.
Then we need to consider that we have a lot of staff who travel round the country in order to meet with doctors and other healthcare professionals. Obviously they’ve not been able to do that during the pandemic, so we’ve had to be creative. In the absence of face-to-face meetings we’ve set up webinars and online training events, which have been pretty successful. We’ve had some excellent feedback and we may continue with some of these approaches in the future. Although I don’t think they will ever completely replace face-to-face appointments, they should be a good addition.
Tell us about how Ascensia has been sharing glucose data via apps and software and what this means for the future?
I actually did a presentation about this at the ATTD in Madrid this year, about how apps are developing. The success of an app is based on two important key elements. Firstly, the app must receive the correct information and provide an appropriate prompt. If it doesn’t, then it’s not likely to work. Our CONTOUR® DIABETES app reacts swiftly if someone is critically low by providing a prompt to the user to take on 15g of carbs within 15 mins and then test again, but not every app is able to do that.
The second piece to the jigsaw is that the app is only as good as the data that is provided to it. The blood glucose number must be accurate, otherwise the app could give the wrong advice. It’s only a combination of these two things that will ensure the user gets a positive health outcome. What we found when we looked at third party data is that not every meter is capable of accurately measuring blood glucose levels when someone is in the lower range. It’s not difficult to be accurate in the high ranges – a lot of meters and CGMs are able to be fairly spot on, but it’s the low ranges that require a lot more work. That’s not helpful to a person with diabetes who is about to get behind the wheel of a car for example. They need to have access to accurate results so they can drive with confidence, knowing that they are safe from hypoglycaemia.
What’s been striking is the increase in new accounts being created on the app since January. So people are obviously seeing the benefits of using the app. I just hope that this continues post COVID-19, now people have the opportunity to see how useful it can be and carry it forward throughout the rest of their lives.
Sometimes there’s a large drop-off rate with apps as people download them, use them for a bit and then stop. That’s generally because they haven’t enjoyed any long-term benefits from using that app, but we have a pretty good retention rate with our CONTOUR® DIABETES app.
What lessons should the diabetes community learn from the COVID-19 global pandemic?
I think we’ve learnt to be a bit more prepared for emergencies in the future. I once came across an article that was directed at people with diabetes about what to do when they go on holiday. It advised having a back-up for their CGM and suggested keeping additional insulin and lancets in different places in case one set was lost. It is something we are well aware of at Ascensia and have worked with people with diabetes to prepare our own back-up planning guide for type 1 diabetes. I think COVID-19 has forced people to think more about access to their meds and diabetes supplies, and perhaps not take it for granted. They’ve had to ask themselves whether they had a back-up plan in case access to insulin or other supplies became sparse.
In terms of consultations, I think we might see a bit more of the telephone triage model. Zoom and other video platforms will also continue to be used for consultations. They’ve become a vital part of lockdown communication because some people have been feeling very isolated. But moving forward, perhaps Zoom and Teams could still be used to access people who need health advice but are not able to be seen in person. I also think there will be big increases in people using the electronic prescription service in the UK, which will alleviate chemist queues.
How have Ascensia’s plans for 2020 changed?
They haven’t changed significantly to be honest. Although we’ve been forced to find different ways of working, our key focus has been to ensure that people with diabetes can access and use our solutions to manage their diabetes. In the current environment, that has meant we are focused on maintaining the supply of products throughout COVID-19 and I’m pleased to say we have been successful in doing that.
We’ve also adopted a remote working environment, which has worked well, but personally I kind of miss the water cooler conversations. Working in an office prompts both social and professional conversations, which sometimes you need to get insights from people who may not be willing to share ideas over email. Over the water cooler people are more willing to tell you what their silly idea is, and then that can develop into something meaningful, and this just doesn’t happen so much outside of the office.
Our plans have also had to change in terms of diabetes congresses because, since the pandemic, all of the main physical, annual diabetes events have gone virtual. These conferences are an essential part of our diaries as they are a hotbed for innovation, sharing ideas and sharing state-of-the-art knowledge and it’s important that we maintain that. The plans haven’t changed, it’s just the way we go about the plans that have.
What are Ascensia’s plans for 2021?
We have big plans for next year, which will not necessarily be changing due to COVID. We will just have to see how things pan out. Our main aim is our commitment to meeting the unmet needs of people with diabetes and for that we’re constantly investing in our R&D and continually innovating the technology that makes our products so effective. We have a new line of BGM meters, which we believe are state-of-the-art.
We will continue to provide a comprehensive BGM product portfolio that gives people with diabetes and their healthcare providers a range of effective, highly accurate and easy to use options. Another area of focus will be on enhancing the experience of our digital solutions by improving the user experience of our CONTOUR® DIABETES app.
Our next priority is to really expand into the CGM side of diabetes management. We’ve been concentrating our efforts into looking at why CGM systems don’t work well in some people. For example, we’ve discovered some people can have a reaction to the adhesive on the tape, so we have spent significant time to mitigate these problems as much as possible. We’ve put in a lot of time and care looking into the chemicals we use in the adhesive. And this is just one example of where we are trying to improve on what is currently available in CGM.
Talk us through a typical day in your professional life?
That has changed quite a lot during COVID. I used to travel extensively for work, but now, instead of travelling to the US. I’m moving from one room to the next. So, my carbon footprint has dropped right off.
I work quite a bit with the R&D team, developing new features with the apps we have, so I spend a lot of time looking at external research papers. I think it’s important I maintain my finger on the pulse of the scientific view on what’s going on out there.
Some of my time is spent on looking at clinical protocols, on how to test or examine products and writing about them. I also do some work with the marketing team when we’ve produced a scientific paper, ensuring the content is understood and written in a more understandable way for people.
I am also part of the Legal, Medical and Regulatory team so when Ascensia wants to put materials out there we ensure it is legally and medically sound and follows any necessary regulations and that we’re putting out the whole truth. That’s important to us as we really believe in having integrity throughout our messages to people. We understand there’s a lot of intolerance if you don’t tell the truth.
What’s your biggest achievement in diabetes care?
That’s an easy one. In February this year, I went to ATTD in Madrid and delivered the first oral presentation that Ascensia has ever been invited to give. The subject was about how BGMs relate to apps and how they can only be effective if they are provided with the right information. I was nervous in the build up to it, I had various board members wanting to listen to the presentation and several changes were made, but I’m privileged that I’m part of a strong team who have a wealth of knowledge between them. So, when we put our heads together we came up with some of the best ideas. It went very well, we had a very packed hall and the audience members were very receptive.
What do you do in your spare time?
When I moved from the UK to Switzerland I wanted to form a new group of friends and the best way to do that was to join the local football team. So, that’s what I did and found myself playing in the Swiss 4th division, although I’m not sure how long I will continue as I’m 37-years-old and there’s only so long I can keep running around after 18-year olds.
I also appreciate the social responsibility the club displays. For example Switzerland contains the largest diaspora of Eritrean refugees in the world. The club was approached by a group of players about the possibility of sharing our training facilities because they could not afford to pay for their own. We ended up sponsoring them to enter a team of their own into the league and kitted them out with some strips and paid their registration fees. Football is one of the things that can cross cultural divides and bring people closer together. We wish Eri Basel all the best for their forthcoming season.