Captain Obvious Fly’s

Momma Kliff used to say there are many benefits to experience but there are some drawbacks as well. Along with experience comes a certain amount of snarky largely created by the been there done that syndrome. For example we all know that CGM is a truly transformational tool this is not and should not be news. However there are still people who seem astonished when, yet another study comes out and proves what we already know.

Take a look at this from our friends at Onduo –

“In a presentation at the 13th International Conference on Advanced Technologies & Treatments for Diabetes (ATTD) held in Madrid, Spain, Onduo revealed results of a satisfaction survey completed by 594 members who wore a CGM from March 2018 through July 2019.

An overwhelming majority of survey participants (95% or greater) reported that the use of CGM helped increase their diabetes knowledge, including the impact of eating and taking medications. Survey respondents also reported being highly satisfied with the ease of use of the CGM device and its positive impact on self-management. In addition, Onduo CGM users had a significant improvement in hemoglobin A1c (A1C), with an overall decrease from 7.7% to 7.1%. For those with a higher starting baseline (A1c >9.0%), A1c decreased significantly by 2.6%.”

Just as an FYI the CGM these people used was Dexcom.

The good news for Onduo other than having the good sense to work with Dexcom is they unlike the other digital diabetes players are targeting patients with Type 2 diabetes. See Onduo knows as we do that life is getting much easier for insulin using patients. That systems like the Control IQ and the coming of Tyler will make life much easier for insulin using patients. While these patients may benefit from coaching non-insulin using patients, a far larger market, will benefit more.

Onduo is also proving something we’ve been saying for years, namely that CGM is NOT just for insulin using patients but ALL patients with diabetes. While insulin using patients need this information to properly does their insulin, non-insulin using patients also need this information. As the Onduo survey notes these patients use the information to see how their diet impacts their diabetes and how their meds work or don’t work.

This is great news not just for Dexcom but also Abbott as both companies have noted that insulin using patients are just the tip of the CGM iceberg. That the Type 2 non-insulin patient population is much larger and fertile ground for continued adoption of CGM.

Given that Onduo is building their platform with CGM we also give them an edge over Livongo and OneDrop who continue to use conventional finger stick monitors. It should be noted that Livongo does have agreements with Dexcom and Abbott, but their platform is not built around CGM. We should further note that both Livongo and OneDrop will have an uphill battle once Onduo pulls out the big gun and offers their program for FREE. As we’ve said all along it’s just a matter of time before one of these digital diabetes players goes 100% at risk and Onduo, backed by Verily a unit of Google, has the resources to do just that.

In the next Captain Obvious moment check this out-

“Individuals with uncontrolled type 2 diabetes who declined insulin therapy subsequently had worse glycaemic control. These findings highlight the need to improve our understanding of the relationship of this common but poorly explored clinical phenomenon to blood glucose control and ultimately diabetes complications.”

This was the conclusion of a study published in Diabetic Medicine entitled – Predictors and consequences of declining insulin therapy by individuals with type 2 diabetes

Now if we were truly snarky, we’d say that perhaps these patients who declined insulin therapy should be put on a CGM so they can see for themselves how badly they are doing and a change in therapy is badly needed. We could also, if we were really snarky, state that this is one of the dumber studies ever published as no kidding poorly controlled patients who don’t make changes to their therapy regimen have poor glycemic control – ya think.

We could be overly snarky and blame this resistance to insulin therapy not on the patient but the patient’s physician who used the threat of insulin therapy to guilt the patient into taking their meds. It sickens us when physicians say something like “Hey if you don’t start taking your meds, I’m going to put you on the needle.” And yes this happens all the time.

But let’s not be snarky and look on the bright side as all the digital diabetes players will use a study like this to prove why their services are badly needed. They will say with coaching these patients will either become compliment with their therapy or transition to insulin therapy. This could happen but in the real world there are multiple reasons patients don’t transition to insulin therapy, perhaps the biggest being they really don’t understand it and therefore are afraid of it.

It also doesn’t help that to the patient, the person that matters here, moving to insulin therapy is viewed as a personal failure. Hence the reason why every GLP-1 TV ad goes out its way to mention this ISN’T insulin. This may seem a little whacky that patients don’t have a problem injecting a GLP-1 but have some major issues injecting insulin but it is a fact. It also dispels the notion that the reason more patients don’t use insulin is because insulin injections are painful, which they are not.

From our perspective what this proves is something we’ve known since day one most companies don’t understand what goes on in the real world. That they don’t listen to the people that matter most, the patient. They keep thinking clinically when they should be thinking strategically. Everyone in the diabetes world hates when we say this, but the fact is diabetes is not just a chronic disease it is also a lifestyle. We don’t need any more evidence that insulin therapy works or that CGM is a transformational tool. What we need is for all these companies to understand what these patients go through each and every day. To get out of the clinic and into the real world.