The other side

As we continue to gauge the economic impact of the coronavirus it is worthwhile to look beyond the crisis and speculate as to what life will look like when this crisis ends. Based on conversations with members of the diabetes industry we have reached the following conclusions;

1. On the device side businesses with large installed user bases will weather the storm just fine. Insulin pump patients continue to order pump supplies as are patients using a CGM who continue to order sensors. The area that will impacted most in the device world is new patients adds. With patients unable to see their physician companies like Dexcom, Abbott, Tandem, Insulet and Medtronic will experience slower new patient adds.

It’s difficult to determine whether or not this will create a pent-up demand when these restrictions are lifted, and life gets back to normal or whatever normal becomes. With time on their hands one could argue that patients have had more time to learn about the newer systems that come to market, i.e. the Control IQ from Tandem.

Additionally now that patients have experienced shelter in place unable to leave their homes patients and their physicians are becoming well versed in sharing data via the cloud. Zoom isn’t the only technology that’s experiencing an explosion of new users. We found it noteworthy that Abbott sent out an email earlier this week which stated;

“During these unprecedented times, we are here to support your health, safety and wellbeing. While the FreeStyle Libre 14 day system currently allows you to share data with your healthcare team, our team has been working diligently to improve this process.

Coming soon, you will be able to connect with your doctor directly from the FreeStyle LibreLink app.1 To get ready for this, be sure to ask your doctor for their Practice ID, a code that links your account to their account. When the new feature is launched, we will provide more details.”

Dexcom already has this connectivity. Keep in mind that Dexcom patients went ballistic went the company experienced connectivity issues using the Share feature which is included with the Dexcom app.

As we have noted previously, we anticipate a greater percentage of patients sharing their data with their healthcare team as we move forward. Today this is being forced upon patients but in the future after this over patients will find sharing to be more cost effective saving them both time and money as they no longer have to physically visit their physician.

Looking a little further down the road thanks to algorithms these same patients won’t need physician as the algorithm will perform all the analytics and make recommendations. There is no question the role of the physician will change becoming more like a consultant who confirms the recommendations made by the technology and then writing whatever scripts the patient needs.

Again this change would have happened anyway but thanks to the current crisis this move towards less patient physician physical interaction will accelerate. The technology is already here and thanks to the crisis is now being used as designed. The crisis will eventually go away, but the technology will only get better.

2. Like the device side we don’t see much of a slowdown on the drug side, crisis or not patients still need to take their meds. The one area which likely will be impacted are new drugs like Rybelsus® from Novo Nordisk. With patients unable to see their physicians it’s highly unlikely these physicians would push a new drug, especially one like Rybelsus which has a complex dosing regimen, onto a patient without an office visit.

The area that will obviously change is the increased use of telemedicine combined with increased use of virtual office visits. A move also helped by device connectivity. Although glucose data is not the only data a physician needs it is very helpful. In the future we anticipate a greater share of the blood work needed by physicians to be performed off site as well.

This creates an opportunity for both drug and device companies to provide physicians with the technology they are going to need in the future. Just by way of example Lilly who is already working with Dexcom could develop systems which allow the physician to monitor patients using Trulicity. Yes insulin using patients are the low hanging fruit for this type of technology, but this does not mean patients using a GLP-1 don’t need to be monitored.

The reality for physicians is they will be forced into a world they have not been trained for, virtual medicine. This won’t be much of a problem for younger physicians who are well versed using technology but could be somewhat of an issue for more experienced physicians who are used to seeing patients in their office.

The fact is technology will replace many of the functions once performed in the physician’s office. Training patients on new drugs and devices once done live and in person will move to virtual. Same can said for patient support. Given that the majority of office visits are pretty basic the office visit in the future will become somewhat of a luxury.

We hate to be redundant, but we have long known that technology had the POTENTIAL to change diabetes management. It was never a question to us whether whiz bang way cool could help patients. It was more a matter of getting the patients to play with the toys in the toy chest. Years from now we just may well look back on this crisis as the turning point as it has forced patients and their physician to adapt to all this way cool whiz band technology.