When technology and treatment come together

As much as we state diabetes and better outcomes is not about the toys in the toy chest. That’s it’s not so much about collecting all the damn data but knowing to do with it that counts. There are times when technology combined with data analytics creates knowledge which in turns leads to better outcomes.

Take a look at the conclusion drawn from a recent study entitled; State of Type 1 Diabetes Management and Outcomes from the T1D Exchange in 2016–2018 which was published in DIABETES TECHNOLOGY & THERAPEUTICS:

“In summary, recent data from the T1D Exchange registry demonstrate that only a minority of adults and youth with T1D meet ADA goals for HbA1c. Glycemic control has not improved overall between 2010–2012 and 2016–2018 and in fact appears to have worsened particularly in adolescents. CGM use has substantially increased in recent years and CGM use is associated with lower HbA1c levels.”

Just for clarity sacks we think the authors should have clarified a bit further stating that when a patient understands what do to with the data the CGM provides it is the most transformative piece of technology ever invented for patients with diabetes. It also points to what we have been saying as the study states this as well it does not matter how the insulin is delivered, pen or pump. The fact is the pen, or the pump is just a piece of hardware.

Like most things in our wacky world this is both good news and bad news. This is very good news for Dexcom and Abbott but not so good news for Medtronic, Insulet, Tandem and the many interconnected pen companies. In a crazy way this could turn out to be good news for the insulin companies. Allow us to explain why.

As we know all the insulin companies are working on their versions of a Tyler while Lilly has taken the extra step of developing their own insulin pump. Unlike Dexcom and Abbott who want to sell as many sensors as possible all the insulin companies want to do is sell more insulin. So, while it may seem crazy to the established insulin pump companies these insulin companies could very well GIVE AWAY the insulin delivery system making money from the continual sale of insulin.

Let’s be honest about this it doesn’t cost $5,000 to make an insulin pump and the supplies are made for pennies too. Nor does it cost a fortune to make a connected pen, whether it is a durable pen or pen cap cover. The real cost comes in supporting these systems which under the right circumstances can also be mitigated. As we have stated in the past an insulin company could mitigate these patient support costs in several ways.

They could transfer this cost by distributing their pen or pump through the pharmacy, basically the pharmacist or staff in the pharmacy would be the de facto support option. Walgreens and/or CVS may take on this responsibility as they retain the patient who in turn gets all their stuff from the pharmacy.

Another option particularly with the new sensor augmented smart pumps is that the technology do that job. As we keep stating with sensor augmented pumps the system does all the heavy lifting therefore all the patient really needs to do is set the system up, turn it in and let it do its thing. Although we do not know this for a fact, but it makes sense that Lilly could sell their pump pre-filled which takes away one step so that all the patient needs to do is insert the infusion set and attach it to the pump. As we have seen with G6 applicator this process of infusion set insertion can become quick and painless.

The other option of course is the insulin company could charge for support. As we noted the other day the patient could be given multiple support options. Free support via the web or app, a nominal charge for phone support and higher charge for concierge like support.

Considering that none of the insulin companies are tied to the past they are not beholden to the idea that patient support must come from a human on the phone. It also helps they haven’t a clue what the device world is really like anyway so as Momma Kliff used to say there are times when ignorance is truly blissful. A visionary insulin company, ok we know that is an oxymoron, could be innovative, again we know this is wishful thinking, and bring a new and fresh approach, and no we are not taking advantage of the fact that pot is legal here in California.

The reality is a bold insulin company, and no we haven’t started drinking today, who only wants to sell more insulin could wreak havoc in the insulin delivery world by giving the hardware away for free or at such a low cost that no established insulin pump company not even the Evil Empire could compete on price. They could end the hopes and dreams of every “smart” pen company by doing the same thing with their own “smart” pen that just so happens is pre-filled with their insulin. Imagine that.

By the way if it hasn’t dawned on anyone yet Dexcom and Abbott could do this too. They already own the most important piece of the system, the sensor. It’s even better for Dexcom as they also own TypeZero which just happens to be the best insulin dosing algorithm on the planet. Although Abbott doesn’t yet have an insulin dosing algorithm, they do have a relationship with Bigfoot who does and also has a “smart” pen and insulin pump. With the coming of biosimilar short-acting insulin what’s to prevent Dexcom and Abbott from doing what the insulin companies could do. The difference being the goal – all Dexcom and Abbott want to do is sell more sensors.

This idea of giving away the hardware for free isn’t new but until now market conditions plus technology made the idea untenable. The fact is hardware has become a commodity and in a commodity market all that matters is cost. What matters now is systems and in a diabetes management system its results that matter.

This morning we talked about Apple and Google two giant tech companies who have made the deep dive into the diabetes pool. Two companies whose main businesses are doing quite nicely even without diabetes. These two companies rule the smartphone/smart device world with Apple owning the premium segment, Google owning the remainder of the market. It could turn out with that Dexcom and Abbott could end up in the same place.