Who will it be?

Who will it be?

Before we arrived in NOLA we noted that this conference once dominated by drug companies would this year be about data, not data from the many studies presented here. Data generated from the patient which in turn is transformed into patient relevant patient actionable information. That the diabetes story of the future is not about the individual pieces of diabetes management rather diabetes management systems. Systems which include everything a patient needs to manage their diabetes, drugs, devices and apps. At the center of this system will be the patient’s smartphone, think of this as the hub that holds all spokes of the wheel together.

Well that day is here and the only question remaining is who will get there first and who will play in this sandbox. The answer is the folks who will win this race aren’t even presenting here in NOLA but there is no question their presence is being felt. No these folk aren’t in New Jersey, Northridge, Denmark, Indianapolis, London or Paris – no the hub of the diabetes world is now located in Silicon Valley.

Now let’s be clear here Medtronic (NYSE: MDT), Johnson and Johnson (NYSE: JNJ), Lilly (NYSE: LLY), Novo Nordisk (NYSE: NVO) and even our friends in France Sanofi (NYSE: SNY) want to play in this sandbox and some believe they can do it on their own. However, the truth is all of these players and others are just pieces of someone else’s echo system.

We don’t just say this because the folk in Silicon Valley have more vision and gobs of money, we say this because the folks in Silicon Valley live in the future and the folks on the show floor for the most part are living in the past. The folks on the show floor, with some notable exceptions, are trying to please the wrong constituency, while the folks in Silicon Valley are trying to please the only constituency that matters – the patient.

The folks on the show floor, again with some exceptions, are trying to please physicians, researchers, the ADA and JDRF. Many still have not gotten the memo about the consumerization of health care, that the role of the physician is changing from all knowing to a more consultative role. That in the future patients will not need to be in the physical presence of a physician, that its possible with interconnected diabetes management that a patient in Chicago could work with a physician in Tiburon, California.

Technology is changing the rules of the game and companies like Verily, Apple, Samsung, Qualcomm, Facebook, Amazon and Yahoo know how to play this game.

Let’s be clear here this does not mean that device or drug technology is not important but he fact is the devices and drugs used with diabetes are interchangeable. We know the device and drug companies hate to here this but the fact is both drugs and devices have become commodities.

To illustrate our point there is race going on to develop … wait for it .. a “smart” insulin pen. Yes, a way cool whiz bang insulin pen that .. wait for it … communicates with the cloud and sends information to … wait for it .. a way cool whiz bang app. Diabetic Investor has heard that Lilly who at one time invested in Companion Medical has decided to terminate that relationship and go with an internally developed “smart” pen. Others are developing devices which work with existing disposable pens. The fact is no matter how way cool or whiz bang these devices may be they all do basically the same thing just in slightly different ways.

The same can be said for all the way cool whiz bang cloud enabled glucose meters or all the way cool whiz bang “smart” insulin pumps.

The reality here is it’s not about which drugs or devices a patient uses but how effectively the patient uses these devices and that my friends is why data is the key. Data that is transformed into patient relevant patient actionable information in a format that the PATIENT is comfortable with.

Now this does not mean the physician will not have input but even here the input will likely come from the diabetes management system provider. The fact is physicians are really no different than patients as they don’t have the time nor are the compensated for data analytics. In the future the diabetes management system will not just communicate with the patient but also with the physician. Giving the physician suggested options for each patient they consult with.

Why would a physician go along with such an approach, we can think of two reasons, either they are employed by the system provider or they understand they will get paid based on patient outcomes. Either way the role of the physician changes and becomes more of a diabetes coach.

Back in the day the physician was almost a god like figure whose words were rarely questioned. Today with information available in nanoseconds the patient is playing a more active role in their health and wellness. They no longer simply accept the advice of a physician as if it was the gospel. They are true consumers of health care, consumers who do their research and take ownership of their health and wellness.

It is no longer a question of if patients will be prescribed diabetes management systems, but when that day gets here and who the players will be. Yes, the companies here in NOLA will have a place within the system but the folks in Silicon Valley will be running the system.