A false narrative
When Tandem made the decision to convert to a pay as you go model we noted that 2026 would be a throw away year for the company. While this move was desperately needed to remain competitive it also bought them time. Looking at their earnings yesterday and reading through the transcript of the call then looking at the streets reaction this strategy seems to be working. Rather than acknowledge that...
When pigs fly and elephants stand on coffee tables
It never ceases to amaze me just how much the street fails to understand the dynamics of the insulin pump market. This morning Insulet releases earnings which were nothing short of spectacular especially when compared to their competitors. The company raises guidance and actually beat street estimates so naturally shares are getting hammered down over 10% today. Granted this has been a very tough year for MedTech as all the pump...
Will AI come to the rescue?
When it comes to the future of insulin pumps the ultimate platform the Holy Grail would be a slap it on, turn it on and then forget about its platform. No entering any meal information no taking selfies of a meal no worries about exercise or activity. Just fill it with insulin and off you go. Many seem to believe that as CGM performance improves and insulin dosing algorithms become...
Adapting to a changing dynamic
As the CGM market matures it’s time to accept certain facts. The days of 20%+ quarterly growth are likely gone. While the market remains robust future new patient adds will come with a higher acquisition cost combined with lower sensor use per patient. The largest untapped market will be general health and wellness. Patient retention has become a more important metric. Scale continues to drive profitability. Thankfully Dexcom who reported earnings...
At Last
In a few weeks our wacky world will be gathering in New Orleans for the annual ADA money grab otherwise known as Scientific Sessions. Quite frankly the relevance of this event has been declining for some time now. What used to be a must attend event has become somewhat of a yawner. We have no reason to believe this year will be any different. This is perhaps somewhat ironic as the...
Running the playbook
Looking at the results released by Beta Bionics yesterday and reading the earnings call transcript two things are obvious this company is on the right track and the stock is a bargain at these levels. It’s also obvious to me someone who has been around this wacky world of ours for 30 years now they are running the playbook pretty well. The key here won’t be the Mint their version...
Correction
Yesterday I stated “The real news today came when Abbott CEO Robert Ford noted that the dual sensor which measures glucose and ketones is on track for approval in the second half of the year. Bigger news is Ford finally quantified the market potential for this sensor stating he sees a market of 1 million possible patients. Now I don’t want to cast aspersions on Mr. Ford but I want to know what he’s smoking.”
Here is the exact quote “You are going to have about 5 million SGLT2 users that are not using the product who will now benefit from having continuous ketone monitoring.” Now I still believe Mr Ford is smoking something as the reason these patients are not currently using a CGM is not because it does not measure ketones, it’s because they do not value the data as insulin using patients do.
I dare Mr.Ford and his team to gather up say 25 patients using an SGLT2 and ask them what a ketone is. Ask them when and how often it should measured. Ask them what a good and bad number is and then what action steps do they need to take based on this data. Now if they can get past the blank looks on these peoples faces for they have no clue what a ketone is, ask them if they know what a CGM is and what it does. Here you will get near universal responses as yes these patients know what a CGM is and know what it does.
But here’s the kicker ask them why they aren’t using a CGM. Is it because it does not measure something they don’t even know how to define our is it because they do not value the information it provides. Not one patient in that room will say “I’ve been thinking about using a CGM but have been waiting for one that measures ketones and glucose before getting started.”
Seriously folks think about this from the perspective of a patient in the real world not the fantasy world Mr. Ford seems to live in. Ask anyone who was in the BGM business and ask them how much luck they had getting non-insulin using patients to use their product. Heck CGM should be adopted as these patients can no longer claim finger sticks are painful.
The reality hasn’t changed as these non insulin patients haven’t changed. Patients who yes would benefit from using a CGM but not immediately as insulin using patients do. Insulin using patients can and do change their behavior from using a CGM and they do so almost immediately.
This is not the case for non-insulin using patients who tend to tune out from the data after the newness factor wears off as the data is not creating any action steps. In fact it’s creating more questions then answers. A non-insulin using patient can only control when or if they take their meds. They cannot change them without getting a new script from their doctor, who isn’t using this data either. The majority of these patients are being treated by PCP’s who lack the time and knowledge base to do anything other than diabetes management 101.
PCP’s who are already telling these patients they should measure their glucose regularly knowing full we’ll this plea is falling on deaf ears. PCP’s who unless they have been in cave for the past 10 years know what a CGM is and what it does. PCP’s who only have a slightly higher awareness of what a ketone is and what role it plays in diabetes. PCP’s who merely can write a script for a CGM knowing that the patients insurance company will choose which one they actually use. Non-insulin using patients do not walk into their doctors office and demand to be put on the Freestyle Libre.
This dual analyte sensor is nothing more than snake oil wrapped in a nice cool looking bottle. Type in SGLT2 Ketones and Google AI, states
SGLT2 inhibitors increase ketone body production by reducing plasma glucose and insulin while raising glucagon, shifting metabolism toward fat oxidation. This moderate increase is believed to provide an alternative fuel source for the heart and kidneys, contributing to cardiorenal benefits, but can rarely cause euglycemic diabetic ketoacidosis. Rarely cause DKA.
The ADS says ketones should be checked every 4 to 6 hours when glucose levels exceed 240-300. Which sounds great until you consider that non-insulin using patients are the least frequent testers of glucose levels, have no clue what a ketone is or does and if they did test and got a number exceeding 240 they would likely shrug it off. This may friends is the real world.
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