Cyber Monday

Now that we live in the interconnected age, we can add some new traditions to our old ones – in the past the Friday after Thanksgiving was and still is known as Black Friday – now in the internet age we can add Cyber Monday to our holiday shopping experience. Yet shopping isn’t the only thing we have on our mind this Cyber Monday check out a few news items that occurred while most of us were watching football and feasting on Turkey;

Per a report by Zack’s;

“Recently, Medtrnic, plc MDT entered into a definitive agreement to acquire nutrition-related data services, analytics and technologies provider Nutrino Health Ltd. This development is part of the company’s efforts to expand its diabetes management business.

While financial terms of the deal remain undisclosed, Medtronic expects this transaction to culminate in third-quarter fiscal 2019, ending Jan 25, 2019, subject to certain customary closing conditions.

Notably, Nutrino is working on the improvement of universal health by enabling artificial intelligence (AI)-led analysis of how nutritional intake will affect a person’s health. The company has created a food database and nutrition data insights platform, collating data from millions of access points and food items globally.”

According to a press release issued this morning;

“In the proof-of-concept study, Dr. Mehta evaluated the safety and efficacy of a physician-driven insulin titration algorithm in adult patients diagnosed with type 2 diabetes who were prescribed V-Go. At weekly intervals, the bolus doses of insulin were titrated based on 2-hour post meal blood glucose averages. Up titration occurred when averages exceeded 170 mg/dl and down titration occurred when averages were below 100 mg/dl. Following initiation of V-Go, the bolus dose was actively titrated (either up or down) for the first three weeks of therapy after which insulin dosing remained fairly stable. Basal doses were adjusted after bolus dosing was optimized. Clinical outcomes were evaluated after four months.

After four months of V-Go use with insulin dose adjustments, 67% of patients achieved an A1C level less than 7.5% compared to 13% at baseline on prior regimens. Moreover, a significant decrease in A1C of 1.6% was found compared to baseline (8.7% to 7.1%; p<0.001) and the prevalence of hypoglycemia decreased to 7% by month four from a baseline of 23%. Mean body weight did not change from baseline to study end.”

Now we don’t want to rain or perhaps we should say snow on anyone’s parade but let’s point a few snarky facts (hey it is Cyber Monday and what better way to honor snarky Alexa who will soon be telling patients how to manage their diabetes while ordering more Tide at the same time, but we digress) – anyway back to the snarky facts – frankly we could care less if Nutrino has the best damn artificial intelligence on the planet without an accurate reliable CGM sensor this way cool whiz bang AI will be wasted – think of it this way – combining great AI with a crappy unreliable inaccurate sensor is like putting low grade gasoline in a NASCAR – the car will drive but it ain’t going to win any races. At some point you would think the folks at Medtronic would wake up and realize that when it comes to diabetes, they aren’t very good at anything beyond insulin pumps. That their moves beyond this core competency have never ended well.

The reality is Medtronic owns the insulin pump space, the space isn’t growing all that much and baring a major misstep the goose will lay lots of golden eggs. Yet as we have been reporting the company just can’t get out of their own way and seem intent on cooking their own goose. All of this was created because the company has once again taken their eye off the ball straying from their core competency. Again, hubris and greed has trumped common sense.

Now in the past the company has always corrected their mistakes first by replacing the management team and then next refocusing on their core competency. Yet this time around even these measures may not help as the FDA could be the hammer that cracks the piggy bank.

And to be honest no one in diabetes will feel sorry for the company when this happens, Medtronic has a very well-deserved reputation as the evil empire. Which is really too bad as their core employees really care about patients unfortunately, we cannot say the same about management. A team which is putting profits over patient safety and then by using fancy semantics thinks the FDA won’t notice. As Momma Kliff used to tell her boys when it came to how she and the Wizard parented; we may be dense at times, but we aren’t dead either so don’t think we aren’t paying attention.

Turning our attention to the Valeritas news when will people understand that trying to turn a dumb patch pump into a real insulin pump is like giving a college football coach a two-year contract extension when the coach has proved about all he’s good at is losing. (Which is exactly what the Fighting Illini have done which proves diabetes is not the only area where things get overly wacky. But again, we digress.)

Folks let get a few snarky facts clear – take an accurate reliable CGM combine it with a good insulin dosing algorithm and it does not matter how the insulin is delivered – pen or pump –  patients will achieve better outcomes. Even better there is no need for ANY physician intervention as the algorithm not only does the heavy lifting for the patient it also learns getting better over time. Listen we have nothing against physicians, but the fact is physicians and office visits cost money and the less interaction between the physician and the patient the better. We don’t necessarily feel this way, but payors sure do, and their feelings matter more.

We have never and still don’t see a need for all these dumb patch pumps. There is NO unmet medical need here. Yet as always this won’t stop these companies from trying to prove these useless products aren’t really useless when truth be told all they want is a greater fool to come along and take this dog off their hands.

As Momma Kliff used to say never underestimate the lengths people will go to make money. Never mind whether what they do adds value or is really needed if they think they can make a buck they’ll put a tutu on a pig and call it a ballerina. When in reality this pig can’t dance.

Happy Cyber Monday everyone.