By Guest Writer David Kliff, Publisher, Diabetic Investor
This week, the FDA’s official approval of semaglutide, which will now be called Ozempic, got a lot of attention. While this is good news for Novo Nordisk, as Ozempic joins Lilly’s Trulicity and AstraZeneca’s Bydureon in the once-weekly GLP-1 category, I think we need to look elsewhere to see the big picture of the future of diabetes treatment.
Although it has taken much longer than I anticipated, market dynamics are forcing companies to think differently and we are now on the verge of patients being prescribed diabetes management systems rather than individual pieces of the system. Here Lilly is the furthest along, as they have the most comprehensive portfolio of diabetes medication and are now adding devices to the mix. Whether it’s an interconnected insulin pen/CGM/App or new insulin pump, Lilly will soon be able to offer doctors and payors a holistic solution to diabetes management.
Ironically companies like OneDrop and Livongo fit into this mix too. The value of all these interconnected companies is not the device that collects the data; the real value comes from converting data into action. This patient coaching is the only thing missing from Lilly’s system.
I think two big winners here will be Dexcom and Abbott, as CGM is the cornerstone of every system, the straw that stirs the drink. What people will need to understand is that CGM is not just for insulin-using patients but all patients regardless of their therapy regimen. They need to look beyond what these devices do today. The fact is, once included in a system these devices will deliver data just as they do now; the difference will be how this data is displayed to the patient.
An intensively managed insulin-using patient will get all the bells and whistles, the fancy charts, cool graphs and yes, those annoying yet necessary alarms. However, a non-intensively managed patient will see zones only, and percentage of time in each zone – something Green, Yellow, and Red. Now, they can, if they wish, see all the fancy stuff, but my guess is most will opt for the simple zone percentages. Of course, the coach/doctor/CDE, whoever is helping the patient, will see all the data as well. The twist will be the better systems will also include data analytics and recommendations based on these analytics.
Diabetes management systems aren’t just to make the patient’s life easier, but also anyone who interacts with the patient. The better systems will do what physicians do not have time to do, nor are they paid for — data analytics.
I don’t see Lilly or any current diabetes drug company taking the physician out of the loop completely, but I can see a company like Amazon minimizing their role. The fact of the matter is diabetes management for 80% of the patient population isn’t overly complex. Throw a CGM into the mix and you now can tell two things. First, whether a patient is taking their meds, and next, whether these meds are working. CGM makes all this possible and is the reason why the folks at Dexcom/Google and Abbott are smiling.
My vision is that in the future the patient’s digital device, whether it’s a smartphone, tablet, etc. will become the hub of all their health information – which means this is battle over platforms.
Google, Amazon, and Apple, all of whom are now making the deep dive in diabetes, have a vested interest in getting patients onto their platform. While they may not see diabetes management as profit center per se, they can see diabetes management expanding their platforms. And if they wanted to, any of these companies could easily buy any of the diabetes drug companies.
The fact is every diabetes drug company — every diabetes company — should know that either they somehow find a way to work with these tech giants or they are history. This is why Dexcom partnered with Google and why Sanofi spent $250 million to do the same thing. It’s also why Merck is working with Amazon. The reality is diabetes management systems will become a battle over which platform these systems run on.
As we just witnessed with CVS acquiring Aetna, and Amazon acquiring Whole Foods, certain acquisitions can turn markets upside down. Is there any reason to believe that Amazon, Apple or Google won’t change diabetes management just as they did with every other market they touched?
Most people today will focus on the little news that yet another diabetes drug, another once-weekly GLP-1, has been approved by the FDA. They will miss the bigger picture that these drugs and devices are just pieces of a puzzle, that these pieces are often interchangeable and indistinguishable. It’s only when they are woven together that they make a picture.
Courtesy of the DiabeticInvestor.com and David Kliff, Editor www.diabeticinvestor.com