Why they will lose
There are many reasons why the conventional blood glucose monitoring market is dying a slow and painful death. Commodization, price contraction combined with newer and better technology are just some of the reasons. Another reason not talked about much but a very real reason is the complexity of performing what is supposed to be a simple test. Years ago, when meter accuracy was all the rage we attended a symposium held by the FDA on this subject. One of the speakers outlined that if done by the book, that is following each and every step in the manual, there were 28 steps to perform a simple glucose test and as he noted that was 27 too many.
Today there are lots of companies who believe they can turn sand into gold by transforming glucose data into patient relevant, patient actionable information. They believe this will increase average testing frequency because this data will now become important to the patient. But as we note if the patient does not test or does not test often enough this house of cards falls to the ground.
When we first started writing some 20 years ago everyone said the reason patients did not test as often as they should was because performing the test was “painful”. Then came alternate site testing which was supposed to be virtually painless which of course did nothing to increase testing frequency. Next came meters on pretty colors, then faster test results, then smaller blood samples and still average testing frequency did not increase.
After being hit alongside the head with a baseball bat companies began to think there must be other reasons why patients don’t test as often as they should. Unfortunately, when they finally began to think, something that does not happen often in this wacky world, continuous glucose systems were coming to market which combined with competitive bidding marked the beginning of this long and very painful death march.
Yet in attempt to resurrect the dead along came all these way cool whiz bang cloud enabled systems. These companies believed they could make money not from selling razor and razor blades but by improving patient outcomes. Now let’s avoid the subject of whether any of these companies have actually proved they can do this. The reason we avoid it is none of them have. Sure, they make lots of unsupported claims but we have yet to see a REAL clinical trial which proves they work.
Let’s also avoid the fact that CGM is on its way to replacing BGM and that CGM provides more and better data. Let’s also avoid the fact that the newer CGM systems, those from Dexcom (NASDAQ: DXCM) anyway, will not just be more patient friendly their cost will be on par with current conventional test strips.
We’ll give another reason why all these cloud enabled systems are doomed to fail, the task of testing. See what most don’t get is that CGM does not just give patients more and better data even in their current form they are much EASIER to use then a conventional meter. Since most have no clue what patients go through each day allow us to enlighten you a little.
With a CGM, and we’ll use Dexcom as the example not because it’s the best it’s also the one we use and are very familiar with, the patient selects a site for the sensor, inserts it, waits two hours, calibrates with two finger sticks and off they go. Readings are sent to their smartphone and for the next seven or so days the only time they use a conventional meter is when they calibrate which is typically once every 24 hours.
Compare that to a conventional meter. Now even before a patient test they need to make sure they have all their stuff, the meter, the test strips and lancing device. Stuff they must carry around with them all day since they are supposed to be testing 3 or more times each day. And we haven’t even gotten around to the act of performing the test, which as we noted earlier if done by the book, which no one does by the way, takes many steps. Keep in mind these steps are supposed to be repeated each and every time the patient tests.
Someone needs to explain to us why any patient would want to go through this day in and day out even if the data is being transformed. Would it not be easier to slap on a CGM, turn it on and not worry about having all your stuff. Would it not be more patient friend if instead of sticking yourself 3 times per day 21 times per week 90 times per month – compare that to one sensor insertion per week and 1 test per day. What most people miss is that in the real world CGM is actually more patient friendly and much easier to use than a conventional monitor.
It’s not just better data, it’s a simpler system for the patient to use and it’s only going to get easier. Some say that non-intensively managed patients won’t use a CGM as it’s just too much data, which of course is nuts since they aren’t analyzing the data the system does that for them.
What no one seems to acknowledge is that none of these way cool whiz bang cloud enabled systems work if they don’t have data. This is like selling a closed loop insulin delivery system and not including the sensor that drives the system, no CGM data and this way cool whiz bang toy is just another insulin pump. The simple fact is CGM is the easiest most patient friendly way to get this data.
Listen we are not against patient coaching, interactive messaging or all these way cool things but without data these systems are worthless. And any way you cut the shortest distance between the patient and data is a CGM. So again, we need someone to explain to us why these companies continue to hold such lofty valuations.