It was only a matter of time

First a big congratulations to Andy Reid and the Kansas City Chiefs, kudos as well to the 49ers who had one heck of a season. With football now over we can turn our attention to the cornfields of Iowa, New Hampshire and beyond as the race for the Democratic Presidential nomination heats up and people actually start voting, imagine that democracy in action. Another race which is heating up is the race to get Tyler to market.

Just as a way of quick review we define Tyler as a connected insulin pen(s), CGM and app working in consort. The CGM collects the glucose data, the connected pen(s) collect insulin dosing data and the insulin dosing algorithm which is part of the app makes insulin dosing recommendations. In our opinion and others Tyler has huge untapped potential and could forever alter the insulin delivery system landscape.

When the data begins to flow it will show when used as designed patients using a Tyler will achieve better outcomes than conventional insulin therapy. At JPM during their breakout sessions the executives at Novo Nordisk did note that their connected pen which is available overseas was seeing some great results. Something that really surprised no one as there is growing body of empirical evidence that Tyler works.

Tyler also offers another advantage, he’s cheap or should we say he’s a hell of a lot cheaper than an insulin pump and any of the way cool whiz bang hybrid closed loop insulin delivery systems. Given the popularity of disposable insulin pens here in the US all three of the insulin companies Lilly, Novo and Sanofi have invested in what we call connected cap covers – devices which are placed on a disposable pen that record the dose and send that information to an app. We have said from day one the insulin companies should control the Tyler market and the toys, the connected pen or connected cap cover will be given away for free.

Novo basically confirmed this was going to be their strategy when their connected cap cover comes to the US sometime next year. Lilly seems headed down this same path as they too have a connected cap cover at the FDA and we are told but have yet to see have a fully disposable connected pen under development, Sanofi if it matters also has connected cap covers. All three of the insulin companies see Tyler as way to protect their insulin franchises given that insulin is now a commodity. The insulin market will transform from a battle over which insulin works best to which insulin delivery system works best.

Tyler will also likely be a boost for Dexcom and Abbott as in these days of interoperability all the apps will collect glucose data from either the G6 or Libre2.

While the insulin companies have been moving at glacial speed getting Tyler to market one key component has been missing, clinical evidence proof that Tyler works. Well by the looks of things that missing piece to the Tyler puzzle will soon be in place. Later this month at ATTD in Madrid and likely at ADA in June expect to see not just clinical evidence but also more sessions on the benefits of Tyler. Lilly already is sponsoring a symposia at ATTD entitled Insulin Dosing Metrics A Call to Action Getting Prepared to Leverage the Potential of Connected Insulin Pens. Expect to see a lot more of this at ADA and future diabetes conferences.

This body of clinical evidence combined with symposiums such as what Lilly is doing at ATTD will lay the groundwork for getting Tyler covered by payors and adopted by physicians. The insulin companies know that payors want data back to back up the coverage decisions they make and also know that physicians too need data before making recommendations to patients. About the only people who won’t need convincing that Tyler works is the insulin using patient.

Tyler, like the hybrid closed loop insulin delivery systems, makes insulin therapy simple as most of the heavy lifting is done by the system. This is not to say the patient does nothing rather many of the steps taken by the patients today will be eliminated. We’ve said it before and will say it again it won’t be long before insulin therapy becomes simple and easy for almost any patient.

The commercialization of Tyler will also have several notable impacts on not just the insulin pump market but also many of the way cool whiz bang patient coaching platforms. Given its low cost and what will be solid improvements in patient outcomes we suspect that payors will favor Tyler over more costly insulin pumps. They will still cover insulin pumps but will design reimbursement to favor Tyler.

The patient coaching platforms have a problem as they become somewhat irrelevant when a patient uses a Tyler. Why would any patient need both?

It has taken way too long to get Tyler to market as quite frankly he should have been here already. Be that as it may the pieces are beginning to fall in place for his arrival. An arrival that will have broad ramifications throughout our wacky world. Best of all his arrival will help the people that matter most, the insulin using patient and that my friends is a very good thing.