Looking back at the American Association of Clinical Endocrinologists (AACE) conference that wrapped up yesterday Diabetic Investor is sensing that the diabetes world is getting set for yet another seismic change. A day did not go by when someone asked what Sanofi-Aventis (NYSE:SNY) is up to. An equally popular question was, why anyone hasn’t bought Insulet (NASDAQ:PODD). It’s also becoming clear that many of these physicians believe Novo Nordisk (NYSE:NVO) got the short end of the stick when it came to the FDA’s decision to give Victoza® a black box warning. And not surprisingly Diabetic Investor couldn’t find anyone who felt there was any hope for the conventional glucose monitoring market, for most of these physicians continuous glucose monitoring is where it’s at.
Looking at these observations individually one can’t help but think that everyone is watching Sanofi-Aventis trying to anticipate their next move. Will they buy Abbott’s (NYSE:ABT) or Roche’s diabetes device unit? Will they enter the insulin pump market by acquiring Insulet? And try this one on for size, what would happen if they bought Medtronic’s (NYSE:MDT) insulin pump unit. Diabetic Investor maintains that Sanofi is just getting started and whatever moves they make will change the landscape in the diabetes device market.
One of the companies watching Sanofi very closely is Novo Nordisk. Sanofi has stated on more than one occasion they are gunning for Novo and wants to overtake the company for worldwide dominance in the diabetes market. In a wide ranging interview with Jerzy Gruhn President and Sr. Vice President- North America for Novo, it doesn’t appear the company will stray from their core competences. While it’s possible that we might one day see a Novo insulin pump, Mr. Gruhn indicated the company has no desire to enter the BGM market.
Speaking on Victoza Mr. Gruhn noted the company is happy with sales at this point but for obvious reasons would not comment on what the FDA will do with Bydureon. As we noted earlier many believe Victoza did not warrant a black box warning and see the FDA being overly cautious. These same endo’s said they would have no problem prescribing Victoza and as Diabetic Investor has been stating all along they see GLP-1 therapy as a game changer. The general consensus was that Bydureon does not deserve the same black box warning slapped on Victoza but these same endo’s believed anything is possible given the current ultra-conservative environment at the FDA. Just as the black box would not stop them from prescribing Victoza it would not prevent them from prescribing Bydureon. Like Diabetic Investor they believe once-daily administration trumps twice daily and once-weekly will trump once daily.
Moving to the insulin pump market no one can figure why Roche bought Medingo or why no one has yet to buy Insulet. Watching these events very closely is Catherine “Katie” Szyman, Senior Vice President and President, Diabetes at Medtronic. Like everyone else Ms. Szyman is watching to see what Sanofi will do next. Although Ms. Szyman would not comment on when we might see the Medtronic patch pump, she did indicate the company is working diligently to bring this product to market. While the subject was never discussed Diabetic Investor came away from the interview believing that if the right offer came along Medtronic would consider selling this unit to Sanofi.
In a sign of just how bad things have become in the conventional glucose monitoring space LifeScan, a unit of Johnson and Johnson (NYSE:JNJ) was touting their new lancing device. No you are not reading this wrong the US market leader in BGM is actively touting a new lancing device, as if this new “more comfortable” lancing device will somehow increase testing frequency or lead to more meter placements. The fact is all of the BGM companies are in the same sinking ship and no one, so far, has figured out that if they don’t change their thinking it’s just a matter of time before the ship sinks entirely.
On the other end of the spectrum it was gratifying to hear that more endo’s are seeing the benefits of continuous glucose monitoring (CGM). Although Diabetic Investor did not hear anything to change our belief that CGM will never become the standard of care, we do see more endo’s recommending CGM. The bottom line here is that endo’s understand how to effectively use all this data to improve patient outcomes. Some even believe that CGM should be used for their non-insulin using patients as method to measure therapy effectiveness. While this was not the norm it does show that physicians are finding more, not less, ways to utilize CGM with their patients.
Although this year’s conference was much better than last year’s overly dull conference, Diabetic Investor came away less than impressed and concerned that AACE may be losing relevance. While there were several excellent presentations the conference lacked any true buzz or excitement. The exhibit hall was a virtual ghost town and several noted endo’s skipped the show entirely. When it comes to diabetes and conferences the ADA’s Scientific Sessions is the big enchilada with AACE becoming merely an appetizer.