Please tell us something about your background in medicine and in business, and how you came to focus on diabetes.

The decision to go into medicine was an easy one. My father is a nephrologist, my mother is a pediatrician, and my younger brother went on to become an oncologist. In total in my extended family there are more than 20 physicians. From an early age, I would hear about interventions, medication and healthcare in general, so when the time came to go to university, medicine was the natural choice.

Initially, I was drawn towards surgery, but it was not possible for me to get a job in that field in my hometown. So I joined Novo Nordisk as a Medical Sales Representative for the south-east of Serbia, focusing on diabetes care and growth-hormone therapy. After 10 years in different sales positions, I moved to the company’s clinical department and was involved in multiple phase 3 and phase 2 research projects. During this time I also obtained an MSc in endocrinology.

In early 2017, I joined Sanofi Medical Affairs and from the position of Medical Operations Lead South East Europe I moved to Brighter in mid 2020.

Dragan Zdravkovic

Working in sales must have really taken you out into the field, right?

Exactly. In my early roles, it was great getting to know all the physicians and nurses across Serbia involved in diabetes management and growth-hormone deficiency, understanding their daily challenges and supporting them in finding the best solution for patients.

I realized then how much of an impact you can make through that kind of work. For example, I noticed that most of the juvenile patients who started with growth-hormone therapy were from major cities and very rarely from small towns. So I initiated a nationwide project to raise awareness about growth disorders, the necessity of timely diagnosis and a unified approach to treatment.

Novo Nordisk supported the Serbian scientific community and top national pediatricians in establishing the first ever national consensus for growth-hormone therapy. We ended up helping thousands of children – more than I could ever have reached working as a clinician. To me this is a great example of how pharma can support the scientific community and people in need of treatment.

“The goal of Medical Affairs is to understand the unmet needs and how our offering can support the scientific community in improving health outcomes.”

Is providing this kind of support part of your Medical Affairs role at Brighter?

Yes, that’s correct. Medical Affairs serves as the bridge between the health industry and the wider medical and scientific community. We are the medical face of the company. Every innovative company involved in the health sector has an interest in close collaboration with top national and international medical experts, scientific societies and patient association groups. The main contact for establishing, maintaining and improving these relations is Medical Affairs.

Our role is to provide relevant scientific and clinical support for products and medication, to generate adequate clinical research and place it in the right context, and to provide real-world data validation. Understanding the unmet needs in the specific field of interest and how the offering from the company can address these needs and support the scientific community to improve health outcomes – these are the final goals of Medical Affairs.

As with any innovative health-tech company, Brighter is very interested in how the scientific community and patients perceive our offering.

You’ve been working in the field of diabetes for more than 18 years now – what can you tell us about the changes you’ve seen and the challenges that remain?

Both the scientific community and pharma companies across the globe are putting great effort and resources into R&D for novel drugs, devices and digital solutions to address the challenges in diabetes management.

Over the past 20 years, diabetes therapy options have moved from NPH insulin, vials, syringes, metformin and sulfonylureas, on to the first and second generations of insulin analogues in disposable and reusable pens. We’ve also seen the discovery of completely new classes of medications like GLP-1 RA, SGLT 2 inhibitors and DPP4 inhibitors, as well as the development of insulin pumps, closed-loop options and Continuous Glucose Monitoring (CGM) devices.

Yet still we face many challenges in diabetes management. These include lack of awareness about the condition, too many undiagnosed patients, clinical inertia, inadequate insulin titration, the serious issue of therapy non-adherence, lack of access to medication, affordability – the list goes on.

These challenges have a huge impact on the overall health of people with diabetes, as well as on health expenditure. The 2019 figures from the International Diabetes Federation (IDF)1 indicate that today more than 460 million adults are living with diabetes. By 2045, this number is expected to rise to 700 million. In terms of expenditure, the IDF estimates that diabetes treatment cost at least USD 760 billion dollars in 2019. That’s some 10% of total global healthcare spending on adults.

Despite the range of good therapy options available, we still have a huge number of patients with poorly regulated blood glucose who develop complications. I believe that clinical inertia and therapy non-adherence are two of the major contributors to this issue.

“At Brighter, our goal is to provide physicians with the right data at the right time. We aim to put them in the driver’s seat of the data-centric clinical decision process, and empower them to have an even more significant impact on health outcomes in diabetes management.”

Why did you choose to work with Brighter and what are your thoughts on the company’s offering?

I was drawn towards Brighter because I believe the company has the power to address some of the unmet needs in diabetes care.

Imagine if a physician treating diabetes could have access to data about the real injected insulin dose – not just the prescribed dose – and that this would be time-stamped and linked to glycemic value, food consumption, physical activity and other variables that influence blood-glucose levels.

Now imagine if an insulin-treated patient could have a single device for injecting insulin, measuring blood glucose and storing disposables, and that this device would record and time-stamp all treatment events so this data could be shared with a physician.

I believe that Actiste® Diabetes Management as a Service is aiming to provide all these benefits and more. As a physician, I am eager to research, analyze and publish the potential impact of Actiste® on clinical inertia, therapy adherence and behavioral change.

“In the years to come, we will be able to study how effective we have been in addressing the unmet needs in diabetes care.”

So you think there is a lot more potential to use data in diabetes care and in assessing clinical impacts?

Absolutely! In the past few years, both the FDA2 and EMA3 have highlighted the importance of generating real world evidence (RWE4). In other words, the actual validation of any medication or device in everyday clinical practise, apart from validation in clinical studies and regulatory processes. We need to reveal the actual impact on health outcomes in real-life settings and then feed this data back into considerations around usage, availability, pricing and more. This of course goes for Actiste® too.

At Brighter, our goal is to provide physicians with the right data at the right time. We aim to put them in the driver’s seat of the data-centric clinical decision process, and empower them to have an even more significant impact on health outcomes in diabetes management.

With the current diabetes offering from Brighter, we are aiming to address some of longstanding unmet needs in diabetes management, and in the years to come we will be able to study how effective we have been in doing so.

  1. IDF Diabetes Atlas Ninth edition 2019 https://diabetesatlas.org/en/
  2. FDA https://www.fda.gov/science-research/science-and-research-special-topics/real-world-evidence Accessed on 15th Feb 2021
  3. EMA Annual report 2016 https://www.ema.europa.eu/en/documents/annual-report/2016-annual-report-european-medicines-agency_en.pdf Accessed on 15th Feb 2021
  4. Sherman, Rachel E., et al. “Real-world evidence—what is it and what can it tell us.” N Engl J Med 375.23 (2016): 2293-2297. DOI: 10.1056/NEJMsb1609216

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