Like Sands Through the hourglass

Like Sands Through the hourglass

There are times this wacky world of ours is like an old-fashioned soap opera, something like Peyton Place or Days of Our Lives. Although these shows have faded from day time television they did back in the day offer some great plot twists and plenty of good old-fashioned drama. We thought about this when some subscribers reminded us that Sanofi (NYSE: SNY) funded a clinical trial for Common Sensing which used …. wait for it … Dexcom (NASDAQ: DXCM) sensors.

Back on October 16, 2016 MobiHealthNews posted a story which stated;

“Common Sensing, a Cambridge-based company developing a smart connected insulin pen cap, announced that it will test its device in a clinical trial in collaboration with Joslin Diabetes Center, Sanofi, and Dexcom.

The study of 125 subjects will be conducted by Joslin and funded by Sanofi. Patients will be given a Gocap from Common Sensing, a cap that fits on to a disposable insulin pen and can detect data on when the injector is used and how much insulin is left in it. They will also have a Dexcom CGM.

“In the Joslin study, [our device is] being given out with a CGM,” James White, president and cofounder of Common Sensing, told MobiHealthNews. “So, you’ll be able to see someone injecting a dose and, for every minute after that, see how their glucose changes, measured by that CGM. No one’s ever seen that before for disposables, so we’re really excited.”

Now we have no idea how this study turned out or even if it was completed. Yet the fact that this study exists shows how screwed up our wacky world is. Did Sanofi not just strike a deal that combines Common Sensing with OneDrop, this after having Common Sensing already familiar with the Dexcom sensor. Is Sanofi, a part owner of Common Sensing, also partnered with Verily who is in turn partnered with Dexcom. If you are sitting there scratching your head and thinking this is just a little crazy you are not alone.

We have contended that the ultimate goal of the Sanofi/Common Sensing/OneDrop trio is to develop a system that helps patients more effectively dose their insulin. This will accomplish two important goals; fewer incidences of severe hypoglycemia and better outcomes. Fewer incidences of severe hypoglycemia is the money ball here as these events create emergency room visits and these visits are expensive and payors want to avoid them.

Why do you think every insulin company makes such a big deal when an insulin shows fewer incidences of hypoglycemia? What is this about? If you said outcomes go sit in the corner. If you said money you get a gold star. Someone must pay for all these way cool whiz bang toys that work with way cool whiz bang apps which help patients dose insulin which has basically become a commodity.

Now just to show we have nothing against OneDrop we reached out to some distinguished experts in diabetes and asked what we thought was a simple question; how many fingersticks does it take to gather enough information so that a dosing algorithm can work. After a little wrangling over which type of patient and what their therapy option was the consensus was three fingersticks per day was the minimum amount of information. This is great news for OneDrop the only problem being most patients even insulin using Type 2 patients don’t test that often.

See our belief is that CGM not only delivers more and better data it is also more patient friendly and therefore will actually be used by the patient. The success of the Libre proves our point it may not be a true CGM but patients seem to love it because it so easy to use. Now think about the Dexcom/Verily slap it on turn it on 14-day sensor which will cost the same as test strips, a system that is real CGM with all the bells and whistles no handheld device readings sent directly to a smartphone which means no need for the patient to enter any numbers into the way cool app.

See what we are getting here it’s called making the patient’s life easier. Instead of creating more steps CGM eliminates steps. Sure, the OneDrop meter will get the information yet the fact is the system creates more not less work for the patient which basically means only the most dedicated and motivated patients will use it, which unfortunately is not the market Sanofi wants to target.

I hope we’re not going to fast here because there are even more reasons why making the patients easier is important.

The biggest market by far is Type 2 patients as they outnumber Type 1’s by a huge margin. With insulin becoming a commodity insulin therapy, which is already well accepted, is about to get cheaper. With 80% of all patients being treated by primary care physicians and not diabetes specialists these PCP’s need some help. They need help making insulin therapy easier for their patients and these systems do just that.

Let’s be honest here most patients understand how to use an app as most have a smartphone. It does not take an advanced degree from Harvard or Yale to use an insulin pen. Nor do you need an advanced engineering degree from MIT to use the Dexcom/Verily slap it on turn it on sensor. With those two components in place the app does the rest of the work and let’s be more honest patients trust their apps more than they likely trust their doctor.

But wait it gets even better when you open your eyes and see the bigger picture as what else do these systems do? They provide information as to whether the patients is being … wait for it … adherent. What’s the biggest obstacle between better outcomes and patients, therapy adherence.

Open your eyes even wider and you might notice that since all this information is being sent to the cloud cost can be driven out of the system as the system knows when you need more sensors or insulin. Items which can be delivered directly to the patient.

Listen we know that we have thrown a lot at you but see where this can go, why this is so important. See everyone talks about driving cost out of the system but most just talk and can’t see the forest for the trees. Most fail to see that the shortest distance between two points is a straight line, they are so fascinated with whiz bang and way cool they have lost sight of this. Most continue to over complicate the patient’s life, making them do more work not less.

Yes, we do harp on the fact that CGM is not just for insulin using patients but for all patients. That this one piece of technology could forever change how patients manage their diabetes. Yet what seems to get lost what creates all the noise so to speak is this debate on accuracy when the reality is CGM or what CGM is transforming into MAKES THE PATEINTS LIFE EASIER. IT CHANGES THE PATIENT EXPERIENCE.

Yes, we like to have some good-natured fun with our new friends at OneDrop but the fact is their toy is not just outdated it’s more not less difficult for the patient to use. Now if our chardonnay drinking friends would use the OneDrop coaches and the Dexcom CGM that has serious potential. But then again, they really don’t need OneDrop for that as this is something they could easily do on their own. The fact is coaching will become less and less important over time as the system should only get better with the more data.

What everyone needs to remember are just a few simple facts;

1. This is all about money.

2. The biggest most lucrative market are patients with Type 2 diabetes.

3. The keys to the kingdom will belong to any company who changes the patient experience and makes their lives easier.

And yes, it is that simple.