Dumb it down

Dumb it down

One of the more irritating aspects of diabetes management is the disconnect from the people who are supposed to be helping patients better manage their diabetes and the patient themselves.  This is not a new phenomenon and goes along with what we see as bias towards insulin using patients. Although 95% of the patient population does NOT use insulin it’s amazing how much attention these patients receive. Some of this attention is deserved but the fact is just because a patient does not use insulin does not mean in any way that are immune from the same complications when they fail to manage their diabetes.

This is why we have never believed in a one size fits all diabetes management system, while it should seem like common sense the needs of the non-insulin patient are vastly different than those of an insulin using patient. Yet it’s surprising how many seem to believe that only insulin using patients are interested in managing their diabetes. This isn’t just foolish it’s also very bad business as we noted earlier 95% of the patient population does not use insulin. This is like designing systems which only work with iPhones when Android systems now run 65% of the smartphones, oh wait this is happening already – sorry we didn’t mean to digress.

Now we know this bugs the crap out of many of the diabetes snobs out there, that distinguished group of patients who look down upon non-insulin patients as if they are somehow superior because they use insulin, but when it comes to helping non-insulin patients dumber is better. Yes, any company that really wants to help these patients would be wise to dumb down diabetes management making it simple and easy.

This is one reason we see the GLP-1 market continuing to grow and why we think systems like the exenatide micro pump from Intarcia are so valuable. GLP-1 is the dumbest therapy there is, there is no need to monitor glucose, there is little risk of hypoglycemia, it’s a fixed dose, proven glucose control and the added bonus of weight loss. With three once-weekly GLP-1’s on the market, with once-monthly coming along with an oral version from the folks at Novo Nordisk (NYSE: NVO) there is no question this market will continue to grow. But we’ll go one step further.

Outcomes based reimbursement also favors GLP-1 usage and really favors systems like the one from Intarcia. While we won’t say that GLP-1 usage guarantees patient compliance they sure do make compliance easier. Even better with the low risk of hypoglycemia GLP-1’s score on another level, they don’t send patients to the emergency room.

Let’s be honest here even with all the advantages of GLP-1 therapy the fact is physicians still favor pills. This fear of the needle is not just from the patient side, primary care physicians who treat 80% of the diabetes population, also fear the needle. This perception is slowly changing but it does exist.

The biggest shift will come when physicians are also reimbursed for outcomes as quite frankly swallowing a pill may not be “painful” numerous studies have shown that patient compliance on oral therapy isn’t that great. Think of it this way a patient can inject once a week – or not all with the Intarcia pump – or swallow a handful of pills each and every day. Keep in mind that the majority of patients aren’t just taking pills to manage their diabetes. Is it any wonder that patients sometimes forget to take their pills?

Yes, we are strong believers in diabetes management systems but we are stronger believers in making diabetes management simple.  Looked at realistically and honestly the majority of systems being developed are being designed for the insulin using patient. And to be even more honest the main goal isn’t necessarily better control but to keep these insulin using patients out of the emergency room, better control is just a nice byproduct. This is why Sanofi (NYSE: SNY) and Novo focused so much on lower hypoglycemic events for their new long acting insulin’s – they know what an emergency room visit cost and payers hate additional costs.

The reality is diabetes is not and never has been a one size fits all disease. Diabetes management systems need to acknowledge this fact. Even better it also must be acknowledged that no matter how patient friendly any system is that simple, yes, dumb solutions work best.