Evolution

Evolution

Evolving from being a capital focused business to a value based software model with an integrated medication management platform that drives better outcomes

Enhanced commercial strategy focused on ongoing customer engagement and lifetime partnership

These two points came from the Becton Dickenson (NYSE: BDX) earnings presentation yet they could serve as blueprint to where diabetes management is headed. No BD was not specifically talking about diabetes but this is a company that understands diabetes and could well be more of a player than many think.

As we noted just yesterday the future of diabetes management is changing. It’s beginning to dawn on companies that all the toys in the toy box are essentially commodities. That the future resides in diabetes management systems, systems which include everything a patient needs to manage their diabetes. Systems which can be adapted to the individual needs of the patient. This is the power of software as it’s adaptable and can change as data changes.

Yesterday we spent time speaking to the needs of patients who do not use insulin. While this is by far the largest group of patients and therefore the most lucrative, it is also the most difficult group of patients to engage. Ironically it is this group that payors are focused on yet most of the interconnected diabetes management (IDM) are not. As we noted yesterday one reason for their focus on insulin using patients is these patients are more engaged with their diabetes management.

Still it’s non-insulin using patients that represent the largest market opportunity but also the most difficult group to engage. However, we see help on the way and it’s from another company which reports earnings after the market closes today. Dexcom (NASDAQ: DXCM) along with Google have the slap it on turn it on Band-Aid like sensor a product which will be priced competitively with conventional test strips. A product which has the potential to revolutionize diabetes management. Allow us to explain why-

First and foremost, it’s very patient friendly as we note all the patient has to do is put it on. There is no calibration and readings are sent to the patient’s smartphone. Like the Intarcia exenatide micro-pump the Band-Aid sensor is a stupid elegant solution as the patient really doesn’t do all that much.

Second the data generated from the sensor will yield some astonishing information and not just glucose trends. From this data, the patient’s physician will know whether the patient is taking their meds, whether these meds are working and have strong data they can share with the patient so the patient understands why the physician is doing what they are doing.  This fact cannot be understated.

As we have noted in the past there are several problems with A1c being the lone marker for therapy changes. The test can only be done every 90 days and many patients only test once maybe twice a year. The Band-Aid sensor allows for faster therapy interventions. Physicians will also know if this new therapy is working and not have to wait 90n days or longer to see if this new therapy regimen is working.

The most misunderstood aspect of non-insulin patients is that most people believe they cannot be engaged. That most these patients do not want to be active participants in their diabetes management. That the daily burden of diabetes management is simply too much for patients who do not use insulin. While there is some truth here there is also lots of myths. The biggest problem we see is that no one has taken the time to explain why. Far too often these patients are told what to do and given no explanation as to why they should be doing it. Some of this is a payor related not letting physicians do their job, some of this is system related or what we like to call managing diabetes by the numbers.

Well data can change all of that. What IDM has proven is that patients will respond to messaging. That it is possible to transform data into patient relevant, patient actionable information. The problem is one of time and persistence. With insulin using patients there is almost immediate gratification, this is not the case with non-insulin using patients. Simply put it takes more time to see results and therefore requires more interactions with the patient constantly reinforcing that they are on the right path.

It would be a mistake to believe that just because these patients do not use insulin they cannot become engaged with their diabetes management. They just cannot be treated the same as patients who do use insulin. Nor can the results be judged the same as insulin using patients.

What everyone seems to forget is all patients with diabetes are the same it’s just their therapy regimen is different. We have noted many times the bias shown to insulin using patients, that non-insulin using patients although the majority are treated like second class citizens. Until this attitude changes, until companies begin to understand that non-insulin patients have unique needs nothing will change.

The question isn’t whether or not non-insulin patients can be engaged with their diabetes management. No, the question is will the companies who seek to engage them evolve, will they see beyond the limited horizon of the insulin using world. Yes, it will be a longer and more difficult journey but the payoff is huge and well worth the effort.