It doesn’t happen overnight

Recently there has been some rancor in CGM land as many have asked why Tandem decided to work with Abbott when they already have a perfectly good relationship with Dexcom. Rancor which will get louder now that Tandem has released the results from the DCLP3 study which found – per a Tandem press release-

“Over the six-month study period, use of Control-IQ technology led to a higher percentage of time spent in range (70-180 mg/dL), less hyper- and hypoglycemia and better HbA1c levels than use of a sensor augmented pump. No severe hypoglycemic events were reported, and 100 percent of participants completed the study.”

Here are some additional highlights from the release;

Time in range (70 mg/dL – 180 mg/dL) increased from 61 percent at baseline to 71 percent using Control-IQ technology. The control group using sensor-augmented pump therapy alone, remained unchanged at 59 percent (p<0.0001). This mean difference amounted to 2.6 more hours per day spent in the target range.

Time in range at night (midnight to 6:00 a.m.) was 76 percent using Control-IQ technology compared to 59 percent using a sensor-augmented pump (p<0.0001).

Time spent below 70 mg/dL was 1.6 percent using Control-IQ technology compared to 2.3 percent using a sensor-augmented pump (p<0.001). No severe hypoglycemia was reported.

Time spent above 180 mg/dL was 27 percent using Control-IQ technology compared to 38 percent using a sensor-augmented pump (p<0.001).

Statistically significant improvements in HbA1c and reductions in mean glucose were observed.

Now not to dismiss Tandem’s role in these impressive results but Dexcom their partner with Control IQ also deserves credit and actually a great deal of credit as the algorithm used by Control IQ is the TypeZero algorithm which Dexcom happens to own. This begs the question, which is more important, the pump that follows the instructions given it. Or can any pump follow instructions given to it by the algorithm which makes decisions based on data it receives from the sensor.

The pump people will hate us for this but it’s the CGM/algorithm that drives these systems not the pump. Proof of this can be seen with the system Control IQ will likely crush in the market the 670G from Medtronic. While the pump used with this system isn’t as patient friendly as the Tandem pump, nor does it have connectivity like the Tandem pump, but it still does what it’s supposed to do and that is it follows instructions it is given by the algorithm which gets its data from the sensor.

The many issues with the 670G aren’t with the pump it’s the sensor. As we have noted many times when the damn thing works the results are pretty impressive. The problem is the damn thing doesn’t work well which is why this statement from the study is particularly damning for Medtronic as – “The median time the Dexcom G6 CGM was in use was 97 percent”.

But let’s get back to the Tandem Abbott deal and explain that this makes perfect sense from several angles. Libre is doing quite well, Libre2 will eventually be here and interoperability is the big thing these days. Abbott wants to sell more sensors and Tandem doesn’t want Dexcom to have them by their cojones which is where they have them today.

Yet there is downside to this deal that no one seems to get, the impressive results for the Control IQ didn’t happen overnight and took years of hard work. Signing deals are the easy part getting two organizations to work together now that takes talent and lots of patience. With both companies located in San Diego there was not just physical proximity between Tandem and Dexcom but lots of cultural similarities as well. This cannot be dismissed as corporate cultures play a pivotal role.

To say that Abbott and Tandem have different cultures is like saying the Washington Nationals are on a role. Abbott is about as button down conservative as it gets, while Tandem is California cool. Will these two dramatically different cultures peacefully coexist, that’s an excellent question. Whether they play well together or not it will take time before we see anything of substance from any of Abbott’s recently announced partnerships.

Although we have to admit we are waiting to see how long it takes Abbott to figure out that Sanofi is the worst partner in diabetes. We’re putting the over/under at 18 months before this partnership is over without producing a single system.

We suspect Abbott is trying to hook up with Insulet too and again we can’t blame Insulet if they say let’s play together. Insulet really has nothing to lose as they also understand the interoperability game. Yes, the Horizon works with the Dexcom sensor and will be launched with that sensor. And just as the Tandem/Abbott system will take time to develop so too would any Abbott/Insulet system.

The takeaways from all these deals by Abbott are this-

1. Libre2 is delayed, may not get the iCGM designation meaning the launch will likely be pushed back to 2020 about the same we should be seeing the G7 from Dexcom. We’ve said it before and will say it again G7 may not kill the Libre2 but it sure as heck will give it a serious battle.

2. Abbott knows that insulin using patients use more sensors than non-insulin using and that companies like Sanofi and Tandem reach these heavy sensor users. In many respects the CGM business isn’t that different from the SMBG business in that everyone wants the insulin using patients. Yes non-intensively managed patients use sensors just not as many or as often as intensively managed patients. One statistic that always stood out before CGM came along was that insulin pump patients although less than 10% of the total patient population accounted for almost 25% of all the test strips sold.

3. Abbott has made a major investment in Libre manufacturing capacity and wants to protect this investment.

4. Bigfoot overpromised and under delivered which heightened the need for more deals.

When it comes to partnerships even with Abbott’s recent push the edge goes to Dexcom for the simple reasons they have more of them and have been at it longer. Abbott is just getting started and being the battleship corporate bureaucracy they are these partnerships will likely move at glacial speed. Still we have to wonder being from the Chicago area what they will bring to the meetings with our chardonnay guzzling friends from France. Portillo’s, Deep Dish Pizza maybe a couple cans of Old Style. Talk about two different cultures.

Anyway in the grand scheme of things the biggest takeaway of all is with these results is Medtronic should be afraid, very afraid. That Golden Goose is starting to feel the heat and could soon be an ugly duckling.