Who gets the payoff?

Before we give our initial thoughts on the conference it’s time to start a fund for that poor dead cat. Walking around the exhibit hall, which continues to shrink, guess what we see? Toys and more toys, apps and more apps. About the only thing we don’t see is BGM yep a show which used to be dominated by BGM is now a show dominated by CGM. That poor dead cat.

What we’re beginning to wonder is who gets the payoff with all this whiz bang way cool. More specifically will someone please explain why we need 6000 different apps that all do basically the same thing the same way. Then explain to us when a patient will find the time in their busy day to enter all this information these apps need so they work. Next explain why a patient who won’t experience any tangible benefits from all this damn work will continue to use these apps. What happens after the newness factor wears off?

Yes, all these way cool apps are now communicating with all the way cool CGM’s. And some communicate with the very cool “smart” insulin pens. Others want to talk to the patients iPhone, Apple Watch or Fitbit. Yet when it comes to things what and when a patient eats that so far is all manually entry. Even if that information could somehow be entered electronically without the patient having to do anything we doubt anything would change.

See what all these people seem to have forgotten is people with diabetes have lives outside of diabetes They do not spend every waking moment thinking about or wanting to deal with their diabetes. Sure its fun to play with the toys for a little while but once patients discover that hey they really don’t feel any different or that no matter what the app/coach tells them they are still taking the same pills at the same time so why bother.

While none of the app makers will acknowledge this that when it comes to insulin using patients, their target market, their days are numbered thanks to insulin dosing algorithms which continue to get better. Think about this just for a moment Livongo, OneDrop and others have built entire business models on the premise that they can help insulin using patients better manage their diabetes. Sure they all claim to help non-insulin users too but there is scant evidence to support this.

So what happen when Tyler gets here? (Tyler is our name for a “smart” insulin pen – app -CGM system) What happens to all these apps when these very sophisticated insulin dosing algorithms are part of these systems? We’ll tell you what happens they all become obsolete and worthless. None of these companies have a clue what it takes to reach and influence the patient who do not use insulin. Which isn’t just sad but very stupid given that non-insulin using patients outnumber insulin using patients by a 10 to 1 margin.

The reality here is companies like Livongo, OneDrop and the like will be just fine as a greater fool will come along and buy them. They will buy into the hype, the way cool, the whiz bang. They won’t bother to do much due diligence and will likely write a very big check. Management and the investors in these companies walk away with a huge smile on their faces and hefty profit too. But the patient, remember them, they got what? They certainly aren’t getting an easier life.

There is no question in our mind that thanks to these sophisticated insulin dosing algorithms life is about to become much easier and more pleasant for insulin using patients. That it won’t be long before these patients will not have to worry about carb counting, correction factors and all the calculations they make. This will be done by the algorithm with the insulin delivery by either a pump, pen and even an old fashioned syringe.

But what about patients who don’t use insulin or a GLP-1? What about the millions of people who take pills? Are they not worthy? Do they not have diabetes? Because they only take pills does this mean they don’t need or want help? Seriously this bias towards insulin patients makes us want to puke.

These patients want their lives made easier. They do not want to spend all this time interacting with all these apps especially when they get nothing in return. And anyone who says they get better outcomes think again. These patients can’t even define what that means and frankly could care less.

All these apps reminds us of the old days when BGM companies said that alternate site testing would finally bring glucose monitoring to the masses. That since testing was “virtually” painless these patients who didn’t test because it hurt to perform the test would find religion and begin testing.

Never mind that the reason these patients didn’t test wasn’t because of the pain. They didn’t test because the number was meaningless it carried no value to them PERSONALLY. Even those who did find religion quickly learned their physicians didn’t look at the logs, that nothing changed when it came to when and how many pills they swallowed. So why bother doing it in the first place.

Like so many things in diabetes all these apps are just disease management reincarnated using fancy technology. Like disease management they look cool and sound great. But in the real world, a place where the app developers do not live, they don’t work. At least not for the millions of patients using oral therapies alone to manage their diabetes.

Yes we are thrilled that life for insulin using patients is about to get much, much better. That is truly awesome. But there are what 6 million insulin using patients in the US and how many who do not? However as per usual everyone just loves the toys in the toy box and could care less if the toys are actually played with.

When its all said and done all the patient will be the last one to see a payday, if at all and that flat out just sucks.