A Look Back At EASD -ADA
As we were getting ready to disembark the plane when it arrived in Lisbon I asked a long-term consultant to the diabetes industry why he comes to EASD. “I like to come here because what they have here will show up in our county in two years” was his response. Given what we witnessed at EASD there isn’t much to look forward to in 2019. Yes, there was a vast collection of whiz bang way cool cloud enabled toys and by golly there is a host of newer better drugs that do amazing things. And we must admit after attending ADA which was like a morgue it was nice to attend a conference seemed happy, smiling and upbeat.
Now we suspect this update attitude at EASD had much to do with Lisbon which is one beautiful city. However, when it comes to our wacky world the sad fact is with all the new way cool whiz bang toys, way cool apps and even cooler drugs when it comes to improving patient outcomes we are like hamsters on a wheel going nowhere in a hurry. The fact is for most patients with diabetes and not just insulin using patient’s outcomes are not improving.
Looking back at both ADA and EASD and giving it some serious thought the reason for this lack of improvement in outcomes can be traced to one fact; when it comes to diabetes management the needs of the patient are secondary to the goals of the companies in our wacky world. A disproportionate amount of attention is being paid to insulin using engaged patients and not enough attention is being paid to regular folk with diabetes.
As we noted when we were in Lisbon you couldn’t swing a dead cat without hitting a patch pump or CGM company. Each company also had their own version of a way cool app which is supposed to help these patients more effectively manage their diabetes. Yes, there are an abundance of toys to play with and yes, the drugs we have are getting better but none of this makes a damn bit of difference if patients do not play with the toys or take their meds.
It’s about time for this industry to realize a few facts;
1. STOP TRYING TO CHANGE A PATIENT’S BEHAVIOR INSTAED CHANGE THE DIABETES MANAGEMNET EXPERIENCE.
2. Although we did not see them at EASD as we did at ADA the folks in Silicon Valley stand a better chance at changing things then the old guard.
3. As much as we hate to keep saying this but it’s clear that the business of diabetes interferes with the management ofdiabetes.
Now this does not mean there is no hope maybe we are just cockeyed optimists but some trends do offer hope.
1. It’s clearer than ever that CGM will become the standard for glucose measurement this is a very good thing and has the potential to forever change diabetes management for ALL patients with diabetes.
2. While an artificial pancreas sure sounds way cool reality is beginning to set in with many realizing what we have said all along as way cool and whiz bang as this toy can be we are still a long way from a real artificial pancreas and this is a limited market.
3. The goal of technology is not to be way cool, the goal is get patients ALL patients to take their meds and thankfully some are beginning to see this.
Taking this into account here is are some companies we see benefiting from these trends.
Dexcom (NASDAQ: DXCM) and Abbott (NYSE: ABT) have established themselves as the leaders in CGM, with Medtronic (NYSE: MDT) playing catch up.
Although they were not officially in attendance there is no question that Intarcia with their exenatide micro-pump has the potential to alter the GLP-1 landscape.
The insulin market as we knew it is transforming with biosimilars forcing Lilly (NYSE: LLY), Novo Nordisk (NYSE: NVO) and Sanofi (NYSE: SNY) to rethink their future insulin projects and we see this as a very good thing. All three, after being hit over the head with a baseball bat, now understand that payors will not pay a premium for incremental performance improvements, either their new insulin’s offer REAL and sustainable improvements otherwise forget about it.
Try as they might to adapt the death march continues for conventional BGM companies like Roche, Johnson and Johnson (NYSE: JNJ) and Ascensia. Now JNJ has already made their decision to exit diabetes yet who they sell too will impact Roche and Ascensia. The good news for Roche and Ascensia is like the insulin companies they have awakened from their slumber and recognized they must change to survive, the bad news is it may be too late.
Believe it or not we do see a glimmer of hope for all the way cool whiz bang cloud enabled conventional systems provided they can PROVE their systems benefit ALL patients and not just insulin using patients. The value here isn’t in the toy that gathers the information as CGM will take care of that. No, the value here is they have the potential to change the diabetes management experience. It’s quite possible that companies like Apple, Amazon and Google will prefer to buy rather than build their patient experience platforms.
Perhaps the best news of all is that the transformation that is underway in our wacky world unlike past transformations has the potential to improve patient outcomes, that outcomes will translate into profits and that is a very good thing for everyone.