ADA 2010 Initial Impressions

ADA 2010 Initial Impressions

If there was a reoccurring theme here at the 2010 ADA annual conference other than attendees watching World Cup soccer or the hot and steamy Orlando weather it had to be that many of the exhibitors and attendees have forgotten there are real people with diabetes. People who are living their lives WITH diabetes and not FOR diabetes, people who have lives to live and don’t spend every waking moment managing their diabetes.

Walking the exhibit hall Diabetic Investor couldn’t help but think that things have become pretty lame when companies are more concerned with being bought out by a bigger player than by putting the patient first. A prime example of this are the many insulin pump companies, or more appropriately the many OmniPod wannabes, who believe they can take on market leader Medtronic (NYSE:MDT), Animas – a unit of Johnson and Johnson (NYSE:JNJ) and Insulet (NASDAQ:PODD) the makers of the OmniPod.

While several of these companies have cool systems that work with smart phones or have slick iPhone like operating environments, none of them put the interest of the patient ahead of their desire to be bought. Collective these companies seem to have forgotten that while Medtronic has stumbled recently they still control 65% of the market and the insulin pump market is not large enough nor growing fast enough to support new competitors offering nothing more than slick looking systems that do exactly the same thing as the systems already on the market. As Diabetic Investor has noted many times before building an insulin pump is not the hard part. The hard part is running an insulin pump company. A company that must operate like an airline open 24 hours a day, 365 days a year.

Perhaps Diabetic Investor has it all wrong but someone then must explain how all these companies will gain traction in an already over-crowded marketplace. The reality when it comes to insulin pump sales is that in almost every office that promotes insulin pump therapy the office promotes Medtronic and either Animas or Insulet. If the patient is looking for a conventional pump the choice is either Medtronic or Animas, wireless technology remains the domain of Insulet. Even if these new systems where overly great, which they are not, will patients, educators and physicians feel comfortable recommending a new unheard of company over three well established players with years of insulin pump experience.

Diabetic Investor will examine many of these newcomers in our more detailed ADA wrap up issue but it’s pretty safe to say that Medtronic, Animas and Insulet should be more concerned with running their organizations well rather than about possible competition from these newcomers.

Before we leave this subject Diabetic Investor believes it’s about time for Medtronic to grow up and stop acting like a jealous child when it comes to their existing competitors in both insulin pumps and continuous glucose monitoring. Hanging around the Medtronic booth a person could have become rich if they were given a dollar every time a Medtronic sales rep slammed or down talked the competition. A ritual that took place with far too frequent regularity and on more than one occasion involved bald face lies. Is it any wonder the once mighty MiniMed name has been tarnished to the point where there are now physician’s offices who will no longer allow Medtronic to set foot in their offices. If Medtronic has a serious weakness it’s their unprofessional, some would even say unethical behavior of their sales team. Diabetic Investor has free piece of advice for the good folks at Medtronic stop all the trash talking and get to work on your much hyped yet still not unseen, much delayed patch pump.

Believe it or not there was actually some good news in the conventional blood glucose monitoring space and not from the usual suspects. One of the more crowded booths at the show was that of Intuity Medical and their all in one device which they are now calling the Pogo. In an ironic twist of fate the Intuity booth was located directly across from AgaMatrix, normally a hotbed of activity yet for this year’s shows was eerily quiet. (Diabetic Investor doesn’t expect this silence to last too long as AgaMatrix will soon have some major news of their coming soon, stay tuned.) Getting back to the Pogo, this neat little device is the next logical step in glucose monitoring as it combines all the tools – meter- test strip and lancing device into one nice neat little package. While Diabetic Investor does not see the Pogo making Intuity the next Therasense, the product does have a place in the market and should do fairly well when it hits the market. Diabetic Investor suspects eventually Intuity will mimic Therasense in one respect as they will likely be owned by one of the big four in the future.

 Sticking with BGM, sorry for the play on words, many thanks to Bayer for their study that showed that the majority of patients don’t test their glucose levels not because of the so-called pain associated with testing, rather that these patients have no idea what these numbers mean or how to use them to help manage their diabetes. Seems to us we have heard this somewhere before but it’s nice to see a study that confirms something Diabetic Investor has been stating for years.

On the other side of the coin, Roche once again proved they are the worst run diabetes company to occupy this planet with their booklet that basically states that all meters have problems with interfering substances and using the much condemned PQQ enzyme is really ok. Diabetic Investor has no idea who runs the Roche PR department but we suspect it’s the same firm BP uses. One just might think with every other major BGM company moving away from GDH-PQQ, Roche would follow suit. Had Diabetic Investor not seen this booklet with our own eyes we wouldn’t have believed it, honestly we just can’t make this stuff up.

But why stop with medical devices, Roche has proved they are equally inept at drug development. While Roche officials insist taspoglutide is merely delayed 12, more likely 18 months, the reality is this is a dead drug and will never see the light of day. Perhaps this experience will teach the company not to tell everyone that a drug is the greatest thing since sliced bread and soft-soap without providing any data confirming these statements. All along Diabetic Investor knew there was a reason the company did not release any real data as had they done so everyone would have seen what Diabetic Investor suspected, that taspoglutide was nothing special.  

Given their panache for opening their mouths and inserting their feet, isn’t it about time Roche learned that it’s better to be thought a fool than to open your mouth and remove all doubt.

One company that has real data and a damn good drug is Amylin (NASDAQ:AMLN) and their partners Lilly (NYSE:LLY) and Alkermes (NASDAQ:ALKS). While Diabetic Investor has never doubted Bydureon the data presented at this conference plus an actual demonstration of how the drug is delivered should remove any doubt Bydureon is a blockbuster waiting to happen. While the current delivery system is not ideal, it is not overly complex and should not prevent physicians from prescribing the drug. There will be some training involved but as we have noted all along the drug is TAKEN JUST ONCE A WEEK AND TAKEN IN THE PRIVACY OF THE PATIENTS HOME. The real fun will come when the Bydureon pen gets here, once that happens- watch out as Bydureon could change the paradigm for treating type 2 diabetes.

Speaking of type 2 drugs, Diabetic Investor believes we are quickly approaching the point of diminishing returns with several of the oral medications under development. Universally these drugs seem to have less than robust A1C lowering capabilities when used alone and as studies have shown they are not free from serious adverse events. The reality is GLP-1 therapy offers a more compelling profile for the treatment of type 2 diabetes and nothing seen or heard at this conference would cause Diabetic Investor to change our view on this.  This is not to say that there are not some good drugs out there or that oral medications have seen their better days, that would be impractical and frankly out right stupid. As good as we believe GLP-1 therapy is the stark reality is it is not a wonder drug that should be used by every patient. Rather based on the data we have seen so far few of these new compounds look much better than what’s already available.

These are just some of our initial thoughts on the conference and we’ll be publishing much more detailed updates in the days to come including a special ADA issue. One thing is clear however, if the people in that exhibit hall don’t get back to putting the patient first, patient outcomes will continue to suffer. Diabetic Investor more than anyone understands diabetes is a business and we do not live in la la land. Yet, it’s clear that companies who put the patient first will be winners. Building a company just so that someone else will buy it has no place in diabetes; we have more important things to worry about.