Digital Opinion Leaders in Diabetes
The Worldwide HCP Social Media Study Daniel Ghinn, Creation Healthcare @EngagementStrat Tweet with: #CPDiabetes

Diabetes in 2013-14 The global
burden and threat of NCDs constitutes a major public health challenge that undermines social and economic development throughout the world… World Health Organization, Global Action Plan for the Prevention & Control of Noncommunicable Diseases 2013-2020 By the end of 2013, diabetes will have caused 5.1 million deaths and cost USD 548 billion in healthcare spending. Without concerted action to prevent diabetes, in less than 25 years’ time there will be 592 million people living with the disease. Most of those cases would be preventable. International Diabetes Federation, IDF Diabetes Atlas, 6th Edition, 2013 Diabetes is a huge and growing problem, and the costs to society are high and escalating.

Learning from Healthcare Professionals A
distilled view of public social media conversations 70M+ websites Full Twitter ‘Firehose’ feed All major social media >100,000 verified healthcare professional (HCP) sources covering websites & social media

8,189,534People connected to HCPs in
the study 47,875HCPs connected to diabetes conversation 205,889HCP Tweets & posts about diabetes 19,068HCP authors in study 189,402HCP Tweets about diabetes 16,896HCPs Tweeting about diabetes Big Data: impact of Healthcare Professionals

Most conversation is about Type
2 Diabetes n=27,017 Type 1 29% Type 2 64% Gestationa l 5% Others 2% Most HCP conversation about diabetes does not refer explicitly to a diabetes type, but implies Type 2.

>300 HCP Roles

Physician, 11,435 Dietitian, 10,951 Nutritionist,
10,099 Emergency Medicine Physician, 9,079 Nurse Practitioner, 7,882 Endocrinologist, 7,714 Registered Nurse, 5,184 Pharmacist, 5,171 Family Medicine Physician, 4,322 Psychologist, 3,477 Naturopath, 3,254 Cardiologist, 3,087 Surgeon, 2,636 Preventive Medicine Physician, 2,478 General Practitioner, 2,470 Top 15 HCP roles by share of voice of >300 HCP roles in study

>200,000 posts; 19,000 HCPs in
>125 countries n=16,896

HCP networks within networks
n=16,896

Most influential endocrinologists – virtual
network

Relationship mattersRelationship matters A virtual
professional network connected by diabetes

HCP: Activism for patients Partha
Kar is also the most engaged HCP by peers in diabetes Endocrinologist, General Physician, Clinical Director, UK Activating

Multi-dimensional data Place Roles Topics
& issues Time

Time & role: what the
data tells us Roles Time

Global diabetes timeline The story
told by HCPs in social media May 2013 Apr 2014 14-Nov-2013 World Diabetes Day 3,000 2,000 1,000 All HCP conversation

Global diabetes timeline: Roles Endocrinologists
May 2013 Apr 2014 14-Nov-2013 World Diabetes Day 300 200 100 17-23 Jun 2013 Fall in diabetes- related deaths All HCP conversation Endocrinologists

News: Fall in diabetes-related deaths
“Good news: the risk of dying early due to diabetes has been greatly reduced! … The treatment helps!” 17-23 June 2013 Physician, Researcher & Writer Norway Optimistic

News: Fall in diabetes-related deaths
– sceptics? 17-23 June 2013 General Practitioner & Blogger UK Questioning Sceptical

News: Fall in diabetes-related deaths
– sceptics? 17-23 June 2013 Medical Public Health Consultant UK General Practitioner UK Jobbing General Practitioner UK

Global diabetes timeline: Roles Endocrinologists
May 2013 Apr 2014 14-Nov-2013 World Diabetes Day 300 200 100 17-23 Jun 2013 Fall in diabetes- related deaths 8-14 Jul 2013 Roche halts trial of diabetes drug All HCP conversation Endocrinologists

News: Roche halts trial of
diabetes drug 8-14 July 2013 Endocrinologist USA Frustrated

News: Roche halts trial of
diabetes drug – mixed reactions 8-14 July 2013 Family Med Physician, Asst Dean Med Ed USA Internist & Medical Writer USA Indifferent Concerned

Global diabetes timeline: Roles Endocrinologists
May 2013 Apr 2014 14-Nov-2013 World Diabetes Day 300 200 100 17-23 Jun 2013 Fall in diabetes- related deaths 8-14 Jul 2013 Roche halts trial of diabetes drug All HCP conversation Endocrinologists

May 2013 Apr 2014 24-30
Jun 2013 T1D Vaccine trial results Global diabetes timeline: Roles Leadership roles 14-Nov-2013 World Diabetes Day 120 80 40 17-23 Jun 2013 Fall in diabetes- related deaths 8-14 Jul 2013 Roche halts trial of diabetes drug All HCP conversation Endocrinologists Leadership roles

News: Type 1 Diabetes Vaccine
24-30 June 2013 Medical Doctor Kuwait Cardiologist & Editor-in-Chief USA Licensed naturopathic physician USA Optimistic Positive Excited

May 2013 Apr 2014 24-30
Jun 2013 T1D Vaccine trial results Global diabetes timeline: Roles Leadership roles 14-Nov-2013 World Diabetes Day 120 80 40 17-23 Jun 2013 Fall in diabetes- related deaths 8-14 Jul 2013 Roche halts trial of diabetes drug All HCP conversation Endocrinologists Leadership roles

May 2013 Apr 2014 24-30
Jun 2013 T1D Vaccine trial results Global diabetes timeline: Roles Neurosurgeons 14-Nov-2013 World Diabetes Day 17-23 Jun 2013 Fall in diabetes- related deaths 30 20 10 19 Jul – 4 Aug 2013 Projection on US diabetes by 2020 8-14 Jul 2013 Roche halts trial of diabetes drug All HCP conversation Endocrinologists Leadership roles Neurosurgeons

Projection on US diabetes by
2020 29 July – 4 August 2013 Neurosurgeon; Medical Correspondent USA Alerting

May 2013 Apr 2014 24-30
Jun 2013 T1D Vaccine trial results Global diabetes timeline: Roles Neurosurgeons 14-Nov-2013 World Diabetes Day 17-23 Jun 2013 Fall in diabetes- related deaths 30 20 10 19 Jul – 4 Aug 2013 Projection on US diabetes by 2020 8-14 Jul 2013 Roche halts trial of diabetes drug All HCP conversation Endocrinologists Leadership roles Neurosurgeons

May 2013 Apr 2014 24-30
Jun 2013 T1D Vaccine trial results Global diabetes timeline: Roles Registered Nurses 14-Nov-2013 World Diabetes Day 17-23 Jun 2013 Fall in diabetes- related deaths 19 Jul – 4 Aug 2013 Projection on US diabetes by 2020 8-14 Jul 2013 Roche halts trial of diabetes drug 200 100 19-25 Aug 2013 Study finds pumps > injections All HCP conversation Endocrinologists Leadership roles Neurosurgeons Registered Nurses

News: Insulin pump better than
injections? “According to this article the insulin pump is more effective than the injection therapy, I prefer injections.” 17-23 June 2013 Medical Doctor & Diabetes Patient, Colombia Questioning

May 2013 Apr 2014 24-30
Jun 2013 T1D Vaccine trial results Global diabetes timeline: Roles Registered Nurses 14-Nov-2013 World Diabetes Day 17-23 Jun 2013 Fall in diabetes- related deaths 19 Jul – 4 Aug 2013 Projection on US diabetes by 2020 8-14 Jul 2013 Roche halts trial of diabetes drug 200 100 19-25 Aug 2013 Study finds pumps > injections All HCP conversation Endocrinologists Leadership roles Neurosurgeons Registered Nurses

May 2013 Apr 2014 24-30
Jun 2013 T1D Vaccine trial results Global diabetes timeline: Roles Dieticians 14-Nov-2013 World Diabetes Day 17-23 Jun 2013 Fall in diabetes- related deaths 19 Jul – 4 Aug 2013 Projection on US diabetes by 2020 8-14 Jul 2013 Roche halts trial of diabetes drug 500 300 100 26 Aug – 2 Sep 2013 Study: Fruit juice vs raw fruit 19-25 Aug 2013 Study finds pumps > injections Dieticians All HCP conversation Endocrinologists Leadership roles Neurosurgeons Registered Nurses

Studies: Fruit consumption & risk
of Type 2 Diabetes 26 August – 1 September 2013 “I am surprised that the authors are surprised that eating fruit helps diabetes but drinking fruit juice aggravates it” General Practitioner, UK “…we feel that this statement needs clarification, since the authors do not specify (a) whether the participants consumed 100% fruit juice or juice sweetened with fructose corn syrup (b) the volume of fruit juice consumed and (c) the type of fruit juice that caused this effect.” Associate Professor of Research, USA “Comparing apples and oranges with risk of incident diabetes without due consideration of the possible confounding effects of household income on the relationship runs the risk of generating erroneous conclusions.” Epidemiologist, Australia Questioning Affirming Questioning

May 2013 Apr 2014 24-30
Jun 2013 T1D Vaccine trial results Global diabetes timeline: Roles Dieticians 14-Nov-2013 World Diabetes Day 17-23 Jun 2013 Fall in diabetes- related deaths 19 Jul – 4 Aug 2013 Projection on US diabetes by 2020 8-14 Jul 2013 Roche halts trial of diabetes drug 500 300 100 26 Aug – 2 Sep 2013 Study: Fruit juice vs raw fruit 19-25 Aug 2013 Study finds pumps > injections Dieticians All HCP conversation Endocrinologists Leadership roles Neurosurgeons Registered Nurses

May 2013 Apr 2014 24-30
Jun 2013 T1D Vaccine trial results Global diabetes timeline: Roles Primary Care / GPs 17-23 Jun 2013 Fall in diabetes- related deaths 19 Jul – 4 Aug 2013 Projection on US diabetes by 2020 8-14 Jul 2013 Roche halts trial of diabetes drug 26 Aug – 2 Sep 2013 Study: Fruit juice vs raw fruit 19-25 Aug 2013 Study finds pumps > injections 120 80 40 14-Nov-2013 World Diabetes Day 13-19 Jan 2014 Google announces Smart Contact Lens Primary Care / GPs Dieticians All HCP conversation Endocrinologists Leadership roles Neurosurgeons Registered Nurses

Google announces Smart Contact Lens
13-19 January 2014 Internist USA Paramedic Canada Emergency Doctor USA Endocrinologist USA Optimistic Optimistic Engaging Interested

May 2013 Apr 2014 24-30
Jun 2013 T1D Vaccine trial results Global diabetes timeline: Roles Primary Care / GPs 17-23 Jun 2013 Fall in diabetes- related deaths 19 Jul – 4 Aug 2013 Projection on US diabetes by 2020 8-14 Jul 2013 Roche halts trial of diabetes drug 26 Aug – 2 Sep 2013 Study: Fruit juice vs raw fruit 19-25 Aug 2013 Study finds pumps > injections 120 80 40 14-Nov-2013 World Diabetes Day 13-19 Jan 2014 Google announces Smart Contact Lens Primary Care / GPs Dieticians All HCP conversation Endocrinologists Leadership roles Neurosurgeons Registered Nurses

May 2013 Apr 2014 24-30
Jun 2013 T1D Vaccine trial results Global diabetes timeline: Roles Bariatric Surgeons 17-23 Jun 2013 Fall in diabetes- related deaths 19 Jul – 4 Aug 2013 Projection on US diabetes by 2020 8-14 Jul 2013 Roche halts trial of diabetes drug 26 Aug – 2 Sep 2013 Study: Fruit juice vs raw fruit 19-25 Aug 2013 Study finds pumps > injections 14-Nov-2013 World Diabetes Day 13-19 Jan 2014 Google announces Smart Contact Lens 31 Mar – 6 Apr Bariatric Surgery vs Intensive Med Therapy Dieticians All HCP conversation Endocrinologists Leadership roles Neurosurgeons Registered Nurses Bariatric Surgeons Primary Care / GPs 40 20

Bariatric surgery for diabetes 31
March – 6 April 2014 Medical Oncologist, Clinical Pharmacologist Australia Activating

Bariatric surgery for diabetes Wider
global conversation over time Consultant Psychiatrist, UK *?&^$! * Medical Doctor, India Pharmacist, AustraliaClinical Psychologist, UK Affirming Challenging Challenging

Multi-dimensional data Place Roles Topics
& issues Time

Time & topics: what the
data tells us Topics & issues Time

Global diabetes timeline: Topics by
complication type HCP conversation about all diabetes topics May 2013 Apr 2014 30 Sep – 6 Oct 2013 Story: Exercise as good as drugs for treating diabetes 26 Aug – 1 Sep 2013 WHO includes diabetes in top-10 causes of death worldwide Cardiovascular Death Feet Kidney disease Mental health Neurology Pain Sexual dysfunction Sight Stroke 600 400 200

WHO places diabetes in top-10
causes of death worldwide “[After an] increase in obesity, diabetes is among the top 10 causes of death in the world. In Chile it’s the 7th cause: 1.2 million diabetics.” Dean, Faculty of Medicine Chile Alerting

Global diabetes timeline: Topics by
patient age group May 2013 Apr 2014 HCP conversation about all diabetes topics 300 200 100 Adults Elderly Pregnancy Teens Young children 10-16 Jun 2013 Study: Taking walk reduces risk of diabetes in elderly 9-25 Aug 2013 Phthalate increases risk of diabetes in young children 13-19 Jan 2014 US Preventative Services Task Force (USPSTF) backs universal diabetes screening for pregnant women

USPSTF backs universal diabetes testing
for pregnant women “Interesting that the US Preventive Services Task force now recommends what has been the standard of care for years.” Healthcare Professional CMO & Pediatric Surgeon, USA Gastroenterologist USA Dietician, USA 13-19 January 2014 Supportive Frustrated Cynical Interpreting

Diabetes testing for pregnant women
- Japan obstetrician and gynaecologist Japan “Doctor Song Mingyuan said that there were some gynaecologists who didn’t do their jobs properly, such as not conducting examinations for gestational diabetes, and it’s true. We recently got someone from a place like this, which does so little pregnancy examinations, it’s ridiculous. For blood samples, all they do for early stage examinations is check for infectious diseases and do a red blood cell count, and then for mid stage examinations, they just check for casual blood glucose. And then they just go home. Come on, seriously, stop it.” 13-19 January 2014 Frustrated

Multi-dimensional data Place Roles Topics
& issues Time

Place & topics: what the
data tells us Place Topics & issues

Geography matters Diagnosis Management &
treatment Monitoring & testing Prevention & risk Reversal Canada n=1,782 India n=396 Japan n=696 Spain n=1,834 UK n=4,070 USA n=31,978 Venezuela n=4,545 Australia n=1,010 Key topics around prevention, diagnosis & management vary by country

Venezuela: Interest in prevention &
risk? “U.S. scientists have discovered a common genetic variant among Mexicans and other Latin Americans appear to increase the risk of type 2 diabetes, reported today in the journal "Nature".”Internist Venezuela Alerting

Diabetes in multiple dimensions HCPs
bring their local experience to the global conversation Many HCP roles interact with unique perspectives Topics can answer business & systems questions Time illustrates how stories develop

How to scope a study
Therapy area What topics, therapy area and/or indication would you like to study? 1 Brand & comparative products Do you want to study mentions of your brand and/or comparative products? 2 Region What region, country or state do you wish to study? Would you like to see insights at a regional, or individual country detail level? 3 Include patients? Along with your HCP study, would you like to include a study of patients & consumers? 4 Market factors Are there market factors we should be aware of, or do you have existing insights? Such as new data; product launch; competitor activity; changes in policy? 5 Your goals What do you hope to gain from the study? E.g. discover customer needs; plan messaging; develop advocates; measure results 6

What next? Dive deeper: Questions
about this study? daniel.ghinn@creationhealthcare.com www.creationhealthcare.com