Moving in opposite directions

Moving in opposite directions

Last week as a banner week for diabetes devices as the American Association of Clinical Endocrinologists (AACE) issued two consensus statements one for insulin pumps the other for continuous glucose monitoring systems. While the statement on insulin pumps was more like a condemnation of insulin therapy outlining the many issues with insulin pumps and how pump patients are trained and supported. The statement on CGM was more forgiving and supportive of this new and improving technology.

As the authors indicate; “That said, the technology itself is far from perfect; its accuracy and lag time errors due to interstitial fluid delays cause frustration for patients and clinicians alike. CGM devices could also be designed to be more comfortable and convenient. Added to these concerns, endocrinologists face a more fundamental issue: limited reimbursement for both the technology itself and for health care professional’s investment of time and resources. It is for these reasons that CGM use has not been as widespread as some would have predicted.”

On the flip side they note; “Still, we must appreciate that CGM technology is not only novel, but it can improve the lives of patients who incorporate it into a comprehensive DM management plan.”

From its inception Diabetic Investor has always seen CGM technology playing a limited role in diabetes management. Not because we did not believe in the technology rather because who would be using the technology. There is no question that a non-insulin using type 2 patient would not use a CGM as these patients don’t even test their glucose levels using a conventional monitor. We also expressed doubts that CGM technology would move beyond insulin pump and patients following multiple daily injection therapy. While we still believe this, the future for CGM continues to get brighter as the technology improves physicians are finding more ways to use. And let’s not forget that Diabetic Investor sees hospital based CGM systems as the hidden value of the technology.

Still these two statement made by AACE show the sharp contrasts in two technologies both of which are supposed to improve patient outcomes and make diabetes management more patient friendly. While Diabetic Investor would not go as far to state that insulin pump technology has failed, there is too much clinical evidence showing insulin pump therapy is very effective, rather insulin pump companies have failed. This failure can be summed up best by the way these companies treat the people who use their devices and those who sell their devices. Instead of putting the interest of the patient ahead of profits, these companies are killing the goose that once laid the golden egg. Back in the day before being taken over by Medtronic (NYSE:MDT), MiniMed understood and proved that it is possible to put the patient first and make a nice profit at the same time.

Let’s hope CGM companies learn a lesson from their insulin pump counterparts and remember that there is a real live person who’s wearing their device. That is better to view their customers with admiration rather than disdain. From what we have seen so far Dexcom (NASDAQ:DXCM) under the expert tutelage of Terry Gregg, is setting the standard for CGM. From his days running MiniMed, Mr. Gregg has always understood this is not a business about technology but a business about helping patients better manage their diabetes.

While Medtronic may hold a larger share of the CGM market, this really has more to do with their huge installed insulin pump user base rather than having a better technology than Dexcom. Based on numerous patient and physician interviews plus data provided from Healthy Outcomes, Dexcom is the leader in CGM and with their relationships with Animas and Insulet (NASDAQ:PODD) could well overtake Medtronic for market share leadership.

Let’s just hope whoever buys Dexcom, and this is going to happen, doesn’t do to CGM what Medtronic did for insulin pumps.