More than 30 million Americans have diabetes—that’s about 1 in 10 adults—and 90 to 95% of them have type 2 diabetes (T2D). While this disease is well-recognized, its prevalence continues to climb, and certain groups are disproportionately affected. Furthermore, clinical inertia, or the failure to intensify treatment even when goals are not being met, continues to be a huge challenge due to factors such as race, age, access to care and economic reasons.
As an established leader in diabetes, Merck’s objective was to create an unprecedented and far-reaching educational initiative that would draw greater attention to this critical public health issue and the factors that impact T2D outcomes, while activating the community to seek appropriate treatment at the appropriate time. Merck’s unbranded educational program, America’s Diabetes Challenge: Get to Your Goals (ADC) was the clear choice for the platform.
Since its creation in 2014, ADC has made deep inroads into the T2D community, bringing the stories of people living with diabetes and their loved ones to the forefront, while also sharing critical resources to address the most significant barriers in disease management. Through doing so, we learned that to fully unravel the massive T2D ecosystem, we needed to dig deeper into the struggles of managing the disease and help draw a connection to the millions of people in desperate need of help. The key challenges included:
• T2D in Hispanic/Latino and African American Communities: The largest ethnic minority population in the United States, Hispanics are almost twice as likely as non-Hispanic whites to be diagnosed with diabetes, and more than 50% are expected to develop T2D over their lifetimes. T2D is also a significant concern among the African American community, as it’s the fifth leading cause of death in this population. Nearly 13% of all African American adults have been diagnosed with diabetes, and this community is more likely to experience serious long-term health problems from the disease.
• Social Determinants of Health: These conditions and factors affect a wide range of health outcomes, but are not always recognized and often go undiscussed and unaddressed, even though they drastically impact diabetes management. The facts are staggering:
o Over 23 million Americans live in food deserts—low-income communities without access to healthy and affordable food. The risk for developing T2D is two times higher in people with food insecurity.
o Only 12% of American adults are health literate and have the ability to understand information needed to make appropriate health decisions. People with diabetes who also have low health literacy have a harder time understanding their disease, participate less in self-care activities and have poorer glycemic control.
o About 29 million Americans are uninsured. Uninsured people with diabetes have fewer physician office visits and medication prescriptions.
o Among individuals with diabetes, those with lower incomes have a higher rate of forgoing medical care due to cost.
o Approximately 16% of the population lives in rural areas, yet only 10% of physicians practice there. Rural residents experience a 17% higher rate of T2D than urban residents.
• Stigma: While diabetes is a serious chronic illness, there is stigma associated with it. Unlike other chronic conditions, a diabetes diagnosis tends to draw blame. Lack of education about the disease results in shaming those struggling with the condition, and this social stigma negatively impacts the way people feel about and treat their diabetes.
• A1C Goal Attainment/Hypoglycemia: About one-third of adults are not at their A1C goal (the key indicator of blood sugar control/disease management)—putting them at a significant risk for deadly complications. There is also lack of motivation to be proactive in T2D management, especially when it comes to controlling hypoglycemia (low blood sugar); people accept it as a part of living with T2D.
As a company at the forefront of diabetes research and innovation, Merck recognized that it had an opportunity to intersect and engage with critical populations earlier, educate and drive them to visit the doctor earlier and get appropriate treatment earlier in their disease journey by: 1) positively impacting the diabetes epidemic one community at a time, 2) galvanizing at-risk groups in priority markets with culturally relevant content, 3) investing emotionally in target consumers to drive behavioral change around A1C goal attainment, hypoglycemia and treatment plans and, 4) raising awareness of the social determinants of health to equip HCPs to better support the needs of people affected by T2D.
Merck and GCI Health (GCIH) sought to sound the alarm on the diabetes epidemic with a bold vision incorporating a fully integrated communications strategy—one that would ultimately create a groundswell in homes and communities across America.
It was time to change the national perception of T2D in a way that hadn’t been done before. With an innate ability to put a human face on global issues—that might otherwise seem distant or unrelatable—and generate honest and earnest discussions, a documentary was selected as our storytelling centerpiece.
After analyzing the key issues, we engaged Ani Simon-Kennedy, a filmmaker whose mother and grandmother both live with T2D. We then initiated an extensive process to find people living with T2D who could speak to the social and cultural challenges of managing the disease.
Shoots in five cities brought the concept to life. As Shenekqual prepared for her wedding, Stewart headed to Capitol Hill, Niurka provided for her family and Susie searched for the support she needed, Merck and GCIH were behind the cameras capturing their journeys. Additional interviews with physicians and advocacy experts supplemented the powerful stories, and legacy spokesperson chef Leticia Moreinos Schwartz shared her expertise, teaching Susie how to cook healthy recipes for her family. The last piece of the puzzle was to find a narrator for the film—someone with a personal connection to T2D who would help create urgency around the diabetes epidemic and resonate with Merck’s multicultural target demographic.
Acclaimed actress Viola Davis came on board in early 2019 with a hard-hitting personal message that spoke to the generational impact T2D has had on her family, revealing for the first time ever that she was recently diagnosed with prediabetes. Like the film’s subjects, she grew up simply accepting diabetes—or “the sugar”—as a part of life. Speaking out about her experience for the first time, Viola helped bring authenticity to the cause, propel the diabetes epidemic into the national spotlight and generate support for the millions of Americans affected by T2D.
The final result was "A Touch of Sugar"—a documentary that dives into the diabetes epidemic that affects every community in the United States, told through the voices of people united in their struggle with this chronic disease. Along with two versions of the documentary—a short-form and long-form—a third edition of the film was created, "Un Toque de Azúcar," focusing specifically on the Hispanic population, a key demographic for Merck.
With the film now ready for the big screen, Merck and GCIH took a multichannel approach to launch "A Touch of Sugar" and bring the epidemic to the forefront:
• Documentary Premiere Made National Headlines with Celebrity Spokespeople: Over two days, Viola conducted 38 media interviews to discuss the film, her prediabetes diagnosis, the impact T2D has had on her family and the importance of using the film as an educational tool. Chef Leticia participated in an S/RMT in English and Spanish to discuss the film, her personal connection to T2D and how the Hispanic community is disproportionately affected.
• "A Touch of Sugar" Ignited Dialogue during the 2019 Tribeca Film Festival: Launch activities centered around the 2019 Tribeca Film Festival. Tribeca’s national presence and extensive network helped amplify the film’s visibility and deepen engagement with the public. Throughout the festival, the trailer for "A Touch of Sugar" was played before every film screening. More than 120 representatives from advocacy organizations, the media and Merck attended the debut event. Following a red-carpet reception and film screening, Tracey Brown, CEO of the ADA, moderated a panel discussion with Viola, Ani and select people featured in the documentary. The event offered Merck an important stage to establish T2D as an urgent public health issue, strengthen disease advocacy and build corporate equity.
• Extensive Collateral Brought T2D Crisis to Life & Rallied Public to Take Action: Educational materials in English and Spanish expanded on film topics and supported the launch.
• Social Media & Digital Activity Raised Awareness & Sparked Passionate Response: Social media posts were developed for the ADC Facebook page and Merck, spokespeople and Tribeca channels, inspiring communities to address the social determinants of health impacting T2D management. Several new social media tactics were executed, including a Twitter Sponsorship with Entertainment Weekly linked to the Tribeca Film Festival and celebrity whitelisting that put paid promotion behind Viola’s social posts. AmericasDiabetesChallenge.com, and its Spanish counterpart, DesafiandoLaDiabetes.com, were revamped to include information about the film, including the trailer.
Throughout the year, we will continue to activate the community by creating consumer experiences via ongoing grassroots screenings—including town takeovers in priority markets and submissions to film festivals across the country—and digital and media efforts, such as integrations with TV networks. Additionally, national collaborations with the ADA and NHMA will maintain program credibility and ensure access to HCPs.