Time for a new tune

Time for a new tune

Looking over the many posts on social media related to the AADE one just might get the impression everything in diabetes land is just grand. That all these way cool whiz bang cloud enabled devices which communicate with way cool apps will revolutionize diabetes management. That the much hyped artificial pancreas will soon be here and that it too will revolutionize diabetes management forever. Yes, the diabetes blogging community is singing from the same song book. Therefore, leave it to Diabetic Investor to sing a different tune, a tune that is not blinded by trying to make everyone happy.

It constantly amazes Diabetic Investor how some very smart people can think every new device or drug is great. That these smart people cannot for one moment view things through the prism of reality. That they ignore that as much as they not like diabetes is a business and the business aspects impact outcomes. Yes, it’s an absolute love fest between these people and why not they are all singing from the same hymnal.

Think it’s time for a different tune, a song commonly known as the truth.

Let’s look at the much hyped artificial pancreas. Yes, this device has potential but it still isn’t here and likely won’t be here for a few more years. Now just in case anyone is interested in the truth we have been hearing that this product is right around the corner for years and years. This doesn’t mean it won’t get here but it won’t get here anytime soon. And in spite of what these “smart” people may believe the facts state this will not be a blockbuster product. Keep in mind these are the same people who sang the praises of Afrezza and we all know how that product turned out.

Another misstatement of the truth is that ANY conventional blood glucose meter no matter which way cool app its connected to will be a hit.  A case in point here is perhaps the BEST conventional glucose meter we have ever seen from a design standpoint. Kudos to the folks at OneDrop for finally designing a meter which is WAY COOL.  Only problem is conventional point to point fingerstick monitors are about to go the way of the rotary telephone and land lines. Continuous glucose monitoring is where it’s at and CGM will soon be as cheap as conventional monitors. When that happens say sayonara to conventional monitors no matter how cool they are.

In a nice but misguided move everyone agrees we need more diabetes educators, or do we? Diabetes continues to grow at epidemic rates and the last time we looked there were only about 30,000 or so Certified Diabetes Educators. Well even if that number doubled do the math, simply put there just aren’t enough CDE’s to cover all the patients with diabetes and those about to get diabetes. Yet looked at realistically do we really need more CDE’s. Can not the functions performed by CDE’s be automated? Is it not true that for the majority of patient’s diabetes management isn’t that complex? Or as physicians who treat these people say if they would be compliant or whatever the PC term is now, with their therapy regimen we wouldn’t have the problems we have today.

But we’ll give another reason why we may not need more CDE’s – technology. Take the exenatide micro-pump from Intarcia once inserted in the patient’s body is there any need for a CDE? Or look at the all the once-weekly GLP-1’s once the patient is trained on how to inject, something that can be handled by a nurse or PA, does this patient need a CDE? Think about what will happen when we have an oral GLP-1, will these patients need a CDE? Think about what will happen when “smart” insulin pens are combined with CGM would not the app connected to this system replace the CDE?

Heck we could even make a strong argument that as insulin pumps continue to get smarter that these patients too will not need a CDE.

Let’s be clear here just so there is no misunderstanding – WE LOVE CDE’S AND VALUE WHAT THEY DO. However, we also live in the real world, know how to do simple math and well the numbers just don’t add up.

The most astonishing aspect of how all these people who sing from the same song book miss the point is the very technology they are hyping out of one side of their mouths will end up replacing or making obsolete many of the products and people they tout out of the other side of their mouths.  The fact is these people would rather be cheerleaders than to take a critical eye to what is really going on.  In many ways they remind us of our wine drinking friends in France as they are incapable of holding these people and/or companies accountable. They seem to ignore reality and distort the “facts” to fit their view.

Folks diabetes is a serious chronic disease state which continues to grow at epidemic rates around the globe. This disease has serious healthcare and economic consequences. And while there has been some improvement in diabetes management the facts tell us that the vast majority of patients are still not properly controlling their diabetes. It is not just foolish but out and out stupid to ignore how the business of diabetes influences the management of diabetes.

Listen Diabetic Investor isn’t into Kumbaya moments; we are not going to sit around the campfire singing that everything is great as the fire rages around us.  It should come as no surprise but Diabetic Investors beats to the tune of a different drummer.