Lilly Gets “Real”

Lilly Gets “Real”

According to a press release issued by Lilly (NYSE:LLY) this morning- “Eli Lilly and Company (NYSE: LLY) today announced it is conducting the first major international, prospective observational study designed to understand the real-world obstacles that people with type 2 diabetes face that prevent them from reaching their ultimate treatment goals.

Many people with diabetes who take daily insulin resist a progression of insulin therapy that could help them reach their ideal blood sugar target. The MOSA1c (A Multinational Observational Study Assessing Insulin use: Understanding the challenges associated with the progression of therapy) study will seek to determine why that is by gathering data on insulin use, interactions between people with and treating diabetes and other factors involved in the progression of treatments used to manage diabetes.

Despite treatment, many people with type 2 diabetes do not reach blood glucose (HbA1c) goals after initiation of insulin therapy, exposing them to an increased risk of serious complications. These results are consistent across studies and geographies.”

Only Lilly, a company that is supposed to be a leader in diabetes care, would need to conduct a study to find out what everyone else already knows. The reason most patients with Type 2 diabetes using insulin therapy do not achieve better control is due to that fact insulin therapy isn’t all that easy. As we have noted in the past even when these patients receive some education on how to properly dose their insulin, unfortunately a rare occurrence, there are a host of factors beyond insulin that impact overall outcomes.

This is one of the reasons Diabetic Investor believes so strongly in the potential for GLP-1 therapy options. Unlike insulin, patients using a GLP-1 do not need to monitor their glucose levels, they don’t have to worry about what they eat, when they eat and most importantly they don’t have to worry about hypoglycemia. Unlike insulin GLP-1’s offer a simple and consistent dosing regimen, a regimen which is performed once or twice a day depending on which GLP-1 the patient is prescribed. With the coming approval of Bydureon, which only needs to be taken once a week, this dosing regimen will be even more patient friendly. But there’s more – unlike insulin using patients who typically experience weight gain after initiating insulin therapy, patients initiating GLP-1 therapy typically see weight reduction or at minimum no change in their weight.

The simple fact is GLP-1 is a far more patient friendly therapy option and one that does not require hours of training.

In the real world, somewhere where Lilly has never been there are also a host of non-medical factors as to why insulin using Type 2 patients are not seeing better outcomes. Several studies have shown that these patients often skip or fail to dose their insulin as prescribed, not a surprising fact to Diabetic Investor or anyone else with a working brain cell that has bothered to talk with these patients. Besides all the calculations these patients need to perform before taking their insulin there is what Diabetic Investor likes to call the diabetes vanity factor. In the real world these patients don’t want everyone else to know they have diabetes and don’t like administering their insulin in public. Many mistakenly believe the reason patients don’t take their insulin as prescribed is due to the so-called pain factor. Although Diabetic Investor would never state that insulin injections are pleasant, it’s actually more painful to monitor glucose levels. Thanks to advanced insulin needle technology, needles have become smaller, thinner and lubricated making an insulin injection far less “painful”.

If Lilly is really interested in learning why these patients aren’t doing better with their insulin therapy Diabetic Investor has a simple suggestion, have all the executives in the diabetes unit pretend they are insulin using Type 2 patients for a month. Have them monitor their glucose levels, calculate carbs, understand factors like insulin to carb ratios, insulin on board, duration of action, target glucose levels and constant worry about hypoglycemia. Have them carry around all the stuff a patient has to carry around each and every day of their lives.  Have them perform their everyday tasks and see how they feel when they have to take their insulin while they are in a public place.

Diabetic Investor has said it a thousand times; managing diabetes is 24x7x365 job with no days off and it would be interesting to see these executives who have absolutely no clue as to what it’s like to actually live with diabetes have to deal with all that real patients deal with even if it’s just for a month- talk about an eye opening experience. See how they feel when complete strangers who see them taking insulin ask them questions about their diabetes or offer their condolences to them just because these uninformed people see diabetes as a death sentence.

The simple fact is Lilly is grasping at straws here and looking for answers as to why their insulin franchise is going down the tubes.  The harsh reality which they refuse to accept is that the market for short-acting insulin has become a commodity market where price is more important than performance. They have never understood the real needs of the people who actually have to use the product they make. They have lived in an ivory tower world ignoring the changing dynamics of the insulin market and when they finally realized their franchise was headed for the toilet their efforts to fix the problem where too little and too late.

Rather than understand and adept to change they fought change at every turn and when they did have a chance to revitalize their diabetes franchise with Bydureon they foolishly choose to protect their dying insulin franchise and do one of the dumbest deals of all time. A deal that is typical Lilly – a series of me-too, late to market drugs that will merely hasten Lilly’s demise in diabetes.

Diabetic Investor would like to know which genius at Lilly thought this study, no matter what conclusions are drawn, would result in greater insulin sales. And quite frankly for a company that was supposed to be a leader in diabetes management the fact that they are doing this worthless study shows how desperate they have become. Once again Lilly has proven that when it comes to diabetes they are clueless, they just don’t and for whatever reason can’t get it.

The sad fact is this once proud and distinguished company through a series of missteps, poor management and even poorer decisions has fallen to third tier status. Diabetic Investor can’t say were surprised as we have chronicled this demise for some time and have watched in amazement as they have an uncanny knack for doing the absolute wrong thing at the worst possible time. Barring a major overhaul and complete departure from current business practices the situation is likely to go from bad to worse-  like or it not that’s what in store for Lilly in the real world.