Introduction

Companion Medical — InPen

• The InPen was launched by Companion Medical in late 2017 as a smart insulin pen and the first Bluetooth-connected insulin pen on the market for both Type I and Type II diabetes.
• Companion Medical's InPen received FDA approval in the U.S. in July 2016, but didn't launch the product until December 2017. Details about the product launch were shared just two weeks prior in the #DData17 ExChange event at Stanford University.
• To help market the InPen, Companion Medical worked with Tenth Muse Design to define their audience, present the value of the product, and reach consumers more efficiently. Tenth Muse Design helped build a brand strategy for the InPen, as well as app design for the Bluetooth compatibility, and even digital/print marketing campaigns to advertise the pen, among other things [7]
• Key marketing points that were addressed in the product launch event and other marketing channels included:
• The InPen functions as both an insulin infusion pen and a portable, instant, and real-time tracking device.
• The InPen does not require users to wear a device on their body 24/7 constant monitoring, but rather tracks data for up to a year using Bluetooth technology. The pen would also cost users only $35 for an entire year upon being prescribed it by a healthcare provider.
• InPen is a reusable device that was also promised by its manufacturer to have future expansions and versions created with greater capabilities.
• The InPen was marketed as a "smart" pen system, during a time in which smart technology, especially geared towards home and simpler living, was also growing in popularity. To emphasize the pen's smart capabilities, its features for tracking insulin levels and giving recommendations were highly marketed.
• At its time of launch, the InPen was the only FDA-approved device of its type on the market for diabetes patients. The pen was also marketed as an option for any patient ages 7 and up, as well as being compatible with other diabetes devices, including the Novolog, Humalog, Dexcom G5/G6, and Fiasp.
• Another commonly marketed feature of the InPen was the ability for users to pair multiple pens through the device's app on mobile devices, share data collected from the pen, and even receive alerts on device stability, expiration, and refills.
• The launch of Companion Medical's InPen was considered to be a success by the company for a few key reasons. These included:
• The fact that the InPen was the first-to-market and only of its kind insulin device with an integrated diabetes management mobile app. [3]
•  Medtronic, another pharmaceutical device company, is currently seeking to acquire rights to Companion Medical's InPen to maintain and increase market share. Companion Medical was also offered the opportunity, which they took, to receive upwards of $27.5 million in funding from K2 HealthVentures via a loan and security agreement to help with commercialization and product growth.
• It is estimated that once Medtronic acquired Companion Medical and their InPen, the device will bring in anywhere from $30-$35 million from sales of over 50,000 devices in 2020, which would be triple what the product did in 2019. [4]
• To further accentuate the success of the InPen, Companion Medical recently launched a new version of the device in April 2020, which included new meal therapy modes to help users count their carbohydrates, estimate what to eat and how much, and even the approximate dosages for each injection. In addition, the new pen offers users an optional active insulin display for more confident dosing side-by-side with more detailed insight reports.

Abbott: FreeStyle Libre

• The Abbott FreeStyle Libre was initially launched in the U.S. in 2017, but has been updated on an annual basis with new features that continue to impact the diabetes market. To ensure market success, Abbott ran a test drive for the FreeStyle Libre in 2015 to see how users reacted to and enacted with the device.
• The FreeStyle Libre device itself is a 14-day wearable, 1-hour warm up continuous glucose monitor (CGM) device the eradicates the need for daily finger pricks to monitor blood glucose and insulin levels. The product is sold at approximately $120/month for three sensors, in addition to a one-time purchase of $60 for the reader device.
• To engage a wider audience, the FreeStyle Libre was marketed as a solution to individuals suffering from both Type I and Type II diabetes. Around two-thirds of current users have Type I diabetes, and one-third suffers from Type II.
• Major points of interest that were portrayed in marketing efforts for the FreeStyle Libre device included (and still do include to this day):
• The device offers painless application with no daily finger pricks.
• Outside of the U.S., the FreeStyle Libre device has only a 1-hour warm up period and does not require a prescription to obtain.
• Scans for real-time glucose information can be obtained through clothing, offering a device that is less invasive, painful, and intrusive to user privacy than other continuous glucose monitors. The device is also waterproof so that users can shower and swim with it on.
• The FreeStyle Libre device is more affordable than other CGM competitors, offering users a low upfront cost and affordable monthly payments for continued usage.
• Success metrics that have indicated the great success of Abott's FreeStyle Libre device are largely monetary or focused on number of users. Such data points show that:
• Abbott had global revenues of $380 million during the first quarter of sales from the FreeStyle Libre.
• By Q2 of 2017 in the U.S., Abbott Laboratories sales from the FreeStyle Libre increased by 40% from Q1.
• By mid-2018, the FreeStyle Libre device had over 650,000 users, and the device was expected to and did reach over 1 million users by 2019.
• In a research study conducted by Creative Medical Research, the FreeStyle Libre device was reported by users to be accessible, empowering, and autonomous. These same users have reported that they check their levels with the device anywhere from 30-50 times a day because of its ease of use and accessibility to pertinent information in an instant.

Dexcom — Dexcom G6 Continuous Glucose Monitoring (CGM) System

• The Dexcom G6 CGM device is a competitor product to the FreeStyle Libre that also did very well on the market. This device is an auto-applicator that places a sensor under the skin that can then detect and track blood glucose levels and transmit data to a mobile app.
• Primary differences between the Dexcom G6 and the FreeStyle Libre include:
• The Dexcom G6 sensor is wearable for only 10 days, while the FreeStyle Libre can be worn for 14 days.
• Both devices are completely waterproof and neither requires regular finger pricks or calibration.
• The Dexcom G6 is more expensive than the FreeStyle Libre, with an initial purchase cost of $299 for the transmitter and 3 sensors.
• The FreeStyle Libre has a 12-hour warm up period in the U.S., 1-hour warm up in other parts of the world, and the Dexcom G6 has a 2-hour warm up period globally.
• Primary focus points for the marketing initiatives of the Dexcom G6 referenced the following notes:
• The Dexcom G6 CGM device was clinically proven to help users lower their A1C levels, as well as reducing their risk for hypoglycemic incidents.
• The mobile app in which the Dexcom G6 device stores data from scans can be customized by users to create alerts and alarms for their glucose levels, in addition to offering users the ability to share their data with up to 10 followers.
• Dexcom operates in conjunction with CLARITY Reporting Software to provide users with detailed data on their blood glucose and other related values to help them successfully and easily manage their diabetes.
• The Dexcom G6 device has been approved by the FDA for use in children ages 2 and up.
• The transmitter device that is part of the Dexcom G6 has been created to be a third of its original size, has a three-month battery life, and includes built-in Bluetooth connectivity to reduce the need for manual scans. The transmitter automatically sends updates to users mobile app every 5 minutes so long as the mobile device is within 20 feet of the transmitter.
• The Dexcom G6 CGM device was considered to be a success by its manufacturer, as it produced $171.2 million in global revenue in Q1 2017, which was a 31% increase from the previous year.

Eversense CGM System

• Eversense CGM is a system developed by Senseonics Holdings and was launched in the US in 2018. The Eversense CGM system comes with a fluorescence-based sensor and a smart transmitter that one wears over the sensor for data communication. In addition, the system consists of a mobile application that displays glucose alerts, trends, and values.
• Besides Eversense having the first long-term, implantable CGM sensor, “the system is also the first to feature a smart transmitter that provides wearers with discreet on-body vibratory alerts for high and low glucose and can be removed, recharged, and re-attached to the skin without discarding the sensor.” The sensor is placed subcutaneously in the upper arm via a brief in-office procedure by a healthcare provider.
• The messaging surrounding Eversense CGM after its launch primarily focused on the product’s speed and accuracy through customer testimonials. In social media, customers posted pictures wearing the sensor and mentioned how the system changed their lives. Eversense then reposted these images on its social media pages advocating for people with diabetes to become part of the Eversense family.
• In addition, Eversense emphasizes that the procedure of placing and removing the sensor is simple and fast. In video advertisements, Eversense CGM is featured as being a system that can be used for 90 days without any replacements. Also, the advertisements stress on the system’s accuracy.
• The tone in the messaging used by the company is formal and friendly and words such as “fast” and “accuracy” are constantly used. A majority of the posts and advertisements about Eversense CGM feature customer testimonials to promote user experience.
• In 2019, Eversense CGM launched the “Be Unstoppable” campaign that targeted naïve and experienced CGM users. The company used digital marketing to develop interest among patients.
• The main marketing channels of the company are its social media pages and in particular, Facebook, Twitter, Instagram, and YouTube. In addition, the company participates in various diabetes conferences to create awareness among healthcare professionals
• The company’s clinical training team works hand-in-hand with US healthcare providers from their initial training to full certification status considering that a strong network of healthcare providers is important when it comes to building strong adoption of the device.
• Total net revenue for Senseonics increased to $21.3 million in 2019 primarily because of the increased sales of Eversense in the United States.

Dexcom G6

• The Dexcom G6 CGM system was launched in the US in 2018. The system comes with a simple auto-applicator, a sensor and transmitter, and a display device.
• The auto-applicator is a one-touch applicator that simply inserts a small sensor under the skin. The sensor measures the glucose levels and sends data wirelessly to the display device using a transmitter. The display device is a small compatible smart device or touch screen receiver that shows real-time glucose data.
• Dexcom G6’s sensor can be worn for 10 days and is water-resistant.
• Dexcom G6’s messaging mainly focuses on user benefits and features of the device. The messaging is informative and helps in creating awareness among people with diabetes.
• Dexcom directly markets to health care professionals that can “educate and influence patient adoption of continuous glucose monitoring.” The company directly markets to diabetes educators, physicians, and endocrinologists.
• In addition, the company focuses on direct to consumer marketing efforts and targets individuals with Type 1 and insulin intensive Type 2 diabetes. The company’s marketing channels include video and digital media, print, television, offer sponsorships, diabetes-related events, brand ambassador programs, and public relations.
• Dexcom also promotes its system through Facebook, Instagram, and Twitter where it shares user testimonials. The posts, which come with pictures from customers, quote the positive sentiments of users about the system with a friendly and informal tone. On its YouTube page, Dexcom focuses on publishing informative posts about ways of using the Dexcom G6 system and its advantages.
• In addition, Dexcom G6 has several ad campaigns that have run on national television, such as “Navigate Diabetes Better,” “Diabetes Didn’t Come Up,” and “Without Fingersticks.” In its television advertisements, the messaging is formal and features experts and customers, including children with Type 1 Diabetes, discussing the benefits of the device. Words, such as “control,” “private,” “easy,” and “Zero Fingersticks” are regularly used in the messaging.
• Dexcon’s total revenue in 2019 increased by 43% to $1.48 billion, which is attributed to the increase sales of disposable sensors and the introduction of the Dexcom G6 CGM system in the market.
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Values, Opinions, Pain Points, Attitudes, and Fears

• Children and adolescents with type 1 diabetes feel stressed and challenged by insulin injections, dietary restrictions, low blood glucose, and feelings of being different.

• From a study conducted by the American Diabetes Association, many adolescents with type 1 diabetes struggle with the misunderstanding that the disease places limits on them.
• They, however, change their attitudes over time.
• Patients who are diagnosed as adults believe that having a positive attitude and being careful allows them to do anything they want. They can then lead normal lives.
•  Seeking support and learning from others is deemed to be important for dealing with type 1 diabetes. Support groups such as diabetes camps are believed to help children that are diagnosed with the disease fit in.
• People diagnosed as adolescents or adults find that knowing someone else with type 1 diabetes is important for social support.
• Most people with type 1 diabetes feel that having low blood glucose, feelings of being different, and dietary restrictions can impact their quality of life and adherence to a diabetes regimen.
• Many adults are comfortable injecting insulin and checking their glucose manually but young children are leery of needles, relying on automated glucose monitoring and insulin delivery.
• For many young adults with type 1 diabetes, the unpredictable and unpleasant negative impacts of hypoglycemia lead to a constant fear of hypoglycemia. As a result, fear motivates them to overreact. The most common and serious focus of anxiety for many people with type 1 diabetes is the fear of low blood sugar.
• According to a study conducted on 18 adults with type 1 diabetes, the quality of life for young adults with type 1 diabetes is significantly associated with fear of complications, fear of hypoglycemia, and self-efficacy.
• Six in 10 are afraid of long-term complications, 70% report being scared that diabetes will affect their feet, and 42% often worry that they will have a low-blood glucose crisis when asleep.
• Fears extend beyond disease management and include fears of the burden the disease places on family, being denied insurance, and concerns about getting a job and having children.

Spending Habits

• Adults and children with diabetes spend a lot of money (averagely $2,500 a year) on out-of-pocket health care.
• For people with type 1 diabetes, insulin is a substantial expense, but is not usually the biggest expense, accounting for only 18% of the total expenses.
• According to findings in JAMA Internal Medicine, a peer-reviewed journal, people with type 1 diabetes mostly spend on diabetes-related supplies such as insulin pumps, glucose monitors, and syringes.
• The study revealed that 4 in 5 children with type 1 diabetes use continuous glucose monitors, insulin pumps, or both, in comparison with just 2 in 4 adults.

Preferences

• Among adults with type 1 diabetes, better levels within each attribute or outcome are preferred compared to worse levels. This means that they prefer experiencing "fewer hypoglycemic events (glucose <69 mg/dL) and hyperglycemic events (glucose >180 mg/dL)"
• Type 1 diabetes adult patients also prefer having lower personal monthly treatment costs.
• Preferences are also held for spending less time in a day managing the disease and more time in the optimal blood glucose range.

• People with type 1 diabetes place the most importance on reducing the severity and frequency of weekly hyperglycemic and hypoglycemic events.

Hobbies and Interests

• A story suggests that some caregivers dedicate their lives to supporting research for type 1 diabetes and participating in activities that were specifically designed for communities of type 1 diabetes patients and caregivers.
• Caitlin, a type 1 diabetes patient herself and a caregiver to her husband and two daughters who all have type 1 diabetes, says they have dedicated their lives to advocating for continued type 1 diabetes research. She shares she and her family remain committed to supporting the Juvenile Diabetes Research Foundation (JDRF), a non-profit organization that funds research on type 1 diabetes.
• She also shares that she and her family are members of their local JDRF chapter who regularly participate in their chapter's annual walk.
• Raising funds seems to be an activity type 1 diabetes caregivers are also interested in. According to Caitlin, she and her family are hosting their own annual fundraising event, a golf tournament they named The Four of a Kind Golf Tournament. Held in Massachusetts, this tournament raises funds not just for her family but for other type 1 diabetes patients as well.

Habits

• One caregiver and parent of a type 1 diabetes patient shares that she has this habit of taking a caregiving break twice a year. Her husband and children go camping each summer and each fall to bond with each other and to give her some time for herself.
• She considers this break a way for her to recharge physically and mentally and for her husband to learn the ropes. She views it as a form of self-care.

Attitudes

• Parents of children with type 1 diabetes seem to feel guilty that they have given their children the disease. They know that the development of type 1 diabetes is partly due to genetics.
• Caitlin in the previously mentioned story, for example, shares that she and her husband "felt awful" for giving type 1 diabetes to their children.
• Caregivers of type 1 diabetes patients also seem to view caregiving as a 24/7 job. Caitlin shares she is on diabetes duty all the time and she "never really have a day off." For Caitlin, caregiving is "a constant job that won't ever let [her] take a break."

Challenges

• Having enough money to pay for insulin and other diabetes-related supplies seems to be one of the key challenges caregivers of type 1 diabetes patients face. Caitlin shares that while there is insurance, it is not sufficient to cover all their diabetes-related expenses. Affording all the needed supplies is a major hardship for Caitlin and her husband.
• A research study also shows that caregivers of type 1 diabetes patients prefer lower monthly treatment costs, and that this preference is stronger among caregivers of older type 1 diabetes patients than among caregivers of younger type 1 diabetes patients. Caregivers of younger type 1 diabetes patients seem to be more concerned about "avoiding hyperglycemic and hypoglycemic events."
• Burnouts seem to be a problem as well. Maria, a parent and caregiver of a child with type 1 diabetes, shares that "burnout is real" and "can happen fairly quickly."
• According to Maria, caregivers, especially parents of young type 1 diabetes patients, are inclined to suffer from emotional and mental exhaustion because they have a lot of day-to-day activities to do and errands to run. They are always on edge, and they suffer from constant worrying and lack of sleep.
• A survey reveals that around 64% of caregivers of type 1 diabetes patients report having difficulty sleeping at night, while around 86% report that caregiving has, in one way or another, disrupted their nighttime sleep.

Aspirations and Motivations

• Caregivers of type 1 diabetes patients seem to be hopeful that one day there will be a cure for type 1 diabetes. Caitlin shares that her only wish is that her daughters Addison and Kayley will "see a cure in their lifetime."

• Caregivers of type 1 diabetes patients seem to draw inspiration from their patients and their families. For Caitlin, her family and the bravery, dedication, and love they show for one another are a source of inspiration.

Research Strategy

Social Media Usage Among Diabetes and Heart Disease Patients

• Social media is commonly used to facilitate selfcare between patients and caregivers in research studies. In a metastudy of diabetes and social media use, social media was used specifically for selfcare facilitation in 77.1 percent of the studies.
• The diabetes metastudy referenced a cardiac disease study in referring to social media usage and accessing the web for information (indicating the figures are comparable). That study found that social media use was generally low (28 percent) but most common among patients under 70.
• A study completed in 2018 found that 24 percent (40 / 167 = 0.2395209580838323 or 24 percent) of diabetes patients (type 1 and type 2) visited diabetes-specific social networking sites.
• For diabetes specifically, Integrated Diabetes Services, which touts itself as the worldwide leader in one-on-one diabetes consulting, has about 5,000 followers on Facebook.
• The American Diabetes Association, by contrast, has 772,667 followers.
•  EatingWell, a food and health magazine that includes diabetes recipes regularly, has more than 3.3 million followers on Facebook. By these figures, the largest audience of Type 1 diabetes patients may be reached by food or recipe-promoting outlets rather than businesses or organizational outreach.

Web Usage for Selfcare

•  79 percent of internet users in the United States search for health-related information in general.
• Among those who used social media in the cardiac disease study, patients accessed the web for general health information 65 percent of the time, medication use 56 percent of the time, and disease-specific information 43 percent of the time. For a similar age group, it could be extrapolated that patients with diabetes who use social media use the web to find information about their disease 43 percent of the time.
•  Almost one third of global respondents with Type 1 diabetes replied that they turn to Facebook groups, diabetes groups, or the internet first when they have a concern related to their diabetes management.

Mobile Apps for Diabetes Selfcare

•  52 percent of patients with Type 1 diabetes have used apps to help manage their condition.
• Mobile apps and other technologies are often deployed to assist patients with selfcare, intervention, and education purposes.
• In 2018, a major effort was launched to evaluate the 300,000 health apps available at the time to make specific recommendations to diabetes patients (the DANA App Review). At launch, there were 300 recommended apps. However, the partnership abruptly ended and the project hasn't continued, leaving patients without a reliable repository for diabetes app reviews.
• Articles such as this one in Everyday Health (a diabetes blog) recommend apps for diabetes patients.
• This global study catalogs popular apps from 2019:

 

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Research Strategy

What They Consume

• Caregivers of people with type 1 diabetes consume video content, digital guidelines, articles, magazines (e.g., digital and print), blogs, and reports to assist them with managing diabetic patients.
• They visit informational websites from various organizations created for the care of patients with type 1 diabetes such as the site for the Juvenile Diabetes Research Foundation (JDRF), which receives more than 171,000 visitors each month (85.54% of its traffic comes from people in the United States). Through the JDRF website, caregivers can obtain informational guidelines, articles, and blog posts from the official JDRF blog site. Caregivers access video content through the JDRF YouTube account, which has nearly 5,000 subscribers and a combined 720,000+ video views.
• They also use the website for the American Diabetes Association, or diabetes.org, which maintains 1.37 million monthly visitors. Through this organization, they can find articles, reports, etc.
•  Other resources that they consult include organizations such as Type One Nation, Cornerstones 4 Care, and Children With Diabetes.
• Additionally, caregivers observe video content through websites of diabetes organizations such as Cornerstones 4 Care, while finding books and research news through other organizations like Children With Diabetes.
• Caregivers listen to podcasts such as Diabetes Connections with Stacey Simms Type 1, All 4 One - Type 1 Diabetes, Pardon My Pancreas, Your Diabetes Breakthrough, Type 1 on 1 | Diabetes Stories, TypeNone - Type 1 Diabetes (and more!), NutritionFacts.org Video Podcast, DivaTalkRadio - Divabetic, and DiabeticTim Podcast: Type 1 Diabetic Interviews, among many others.

Where/How They Consume

• Type 1 diabetes caregivers consume media via a variety of platforms, including online portals from diabetes organizations, social media accounts such as Facebook, etc.
• A search through Facebook in September 2014 revealed over 1,000 diabetes support groups using the social media platform, a figure that is likely to have expanded since then. Through these groups, they obtain useful resources for the management of type 1 diabetes, along with advice, sympathy, etc.
• Some Facebook groups devoted to caregivers of those with type 1 diabetes include the Carb Counting Mama Network (326 members), CGMitC Off Topic (7,800 members), Diabetic Life Management (4,500 members), Type 1 Diabetes (11,900 members), and Type 1 Diabetes Support Group (41,600 members).
• In addition, they also visit their local libraries to browse through print magazines devoted to the management of diabetes.

How They Find Media

• According to Future Science, social media has transformed into a vital source of information for caregivers of individuals suffering from type 1 diabetes. A graphic from Semantic Scholar indicates that Facebook remains one of the leading sources of psychosocial support for these caregivers.
• Furthermore, these caregivers find media from diabetes support groups, who typically congregate at churches, community centers, and even hospitals. Also, they use online support communities, where caregivers can discuss their experiences with type 1 patients, including their parents, children, etc., and locate solutions from community members.
• Caregivers of patients with type 1 diabetes utilize blogs and magazines dedicated to people with the condition. They also use those sources to locate blogs and videos on type 1 diabetes.
• Diabetes organizations such as JDRF provide caregivers with access to the websites of their partner organizations where they can find information and resources on managing type 1 diabetes.

How Much They Consume

• An analysis of web traffic from two popular websites for caregivers and patients with diabetes, diabetes.org and JDRF, reveals that visitors typically spend an average of 1 minute and 40 seconds on these sites ((1.21 + 1.58)/2).
• On average, type 1 diabetes caregivers and patients go through at least two webpages on websites dedicated to treatment and management of the illness ((1.62 + 2.66)/2).

Research Strategy:

SOCIAL MEDIA USE OF ENDOCRINOLOGISTS

•  51% of their readers expected to use social media more going forward.
•  41% of readers felt that social media platforms benefit their careers.
• LinkedIn is by far the leading social platform with 27% reporting that they share both professional and clinical information on the platform and 71% stating they login at least monthly. In addition, 10-20% of readers state that they use Facebook and Instagram to share both types of information.

 

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• However, a larger majority (33%) state that no social media is used for these facets of their practice and 46% state they use social media for personal use only.
•  19% of readers state they use Doximity at least monthly.
•  87% of endocrinologists and diabetes educators state they use YouTube on at least a monthly basis, though weekly (32%) is more common.
• Twitter usage is only seen in 43% of respondents.
• Overall popularity (as of 2014) can be easily viewed in this chart:

 

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• When asked if they used social media to learn about new products and services, 64% indicate that they do either sometimes or frequently while 14% indicate they never do.

GENERALIZED HIGHLIGHTS OF SOCIAL MEDIA USE BY PHYSICIANS

• According to an October 2019 article by Medscape, the top physician influencers are: Dr. Rich Besser; Austin Chiang, MD, MPH; Ester Choo, MD, MPH; Dana Corriel, MD; Zubon Damania, MD; Jessi Gold, MD; Jen Gunter, MD; Emily Jacbos, MD; Danielle Jones, MD; and Rose Marie Leslie, MD. (Please note that these are likely the top influencers among patients and not necessarily solely among physicians).
• In addition to the above referenced Doximty (which boasts usage by 70% of US physicians), there are a number of other physician networking sites. These include: Sermo (approximately 800,000 users globally), DailyRounds (with about 30,000 users), QuantiaMD (about 200,000 users), AmongDoctors, and Figure1 (aimed at both doctors and students).
• MayoClinic has developed a social network for medical professionals.

OTHER ENDOCRINOLOGY SPECIFIC PUBLICATIONS

• Endocrine Practice is "the official journal of the American Association of Clinical Endocrinologists (AACE)."
• The Endocrine Society lists the following as their "top-ranked peer-reviewed journals": Endocrine Reviews, The Journal of Clinical Endocrinology & Metabolism, Endocrinology, and the Journal of the Endocrine Society.
• The Endocrine Society also hosts a podcast series called the 'Endocrine Feedback Loop' which "features an expert educator and a topical specialist dissecting recently published journal articles and discussing implications for clinical practice."
• "Frontiers in Endocrinology publishes rigorously peer-reviewed research from basic molecular and cellular communication to clinical care." Research from this site is indexed via Web of Science, PubMed, MEDLINE, and Scopus. The site touts over 3,600 on-board editors.
• The Society for Endocrinology publishes six journals: the Journal of Endocrinology, the Journal of Molecular Endocrinology, Endocrine-Related Cancer, Endocrine Connections, Endocrinology, Diabetes & Metabolism Case Reports, and Clinical Endocrinology. They also publish a quarterly magazine called 'The Endocrinologist' which contains "opinion pieces, research and practice updates and Society news for members".
• The New England Journal of Medicine has a dedicated endocrinology portion of their website which offers the ability to sign up for update emails.

Causes, Symptoms and Diagnosis

• Type 1 diabetes (T1D) is usually diagnosed during childhood or adolescence.
• It is an autoimmune disorder that causes the immune system to attack the body as though attacking pathogens, thereby destroying specific cells in the pancreas. Thanks to this misguided attack, particular autoantibodies are usually found in people with T1D.

• Symptoms of T1D are very sudden. Common T1D symptoms include often urinating, consuming excess water, always feeling hungry even during meals, extreme fatigue, delayed healing of injuries, blurry vision, and unexplainable weight loss regardless of increased appetite.
• Some patients may reach diabetic ketoacidosis (DKA) before T1D is diagnosed. DKA is a phenomenon where blood glucose is critically high, and the cells do not get nutrients due to the absence of insulin. Some adults newly diagnosed with T1D may have symptoms similar to type 2 diabetes. It is easy to diagnose T1D in children by checking blood sugar.

Living with the Disease

• There is no cure for T1D. Lifelong insulin therapy is mandatory to improve the quality of life and prevent deterioration. Also, T1D patients are expected to take care of their emotional health, consistently track blood glucose levels, plan healthy meals, and care for their physical needs. Insulin needs fluctuate with diet and activity levels.
• Insulin can be administered as a powder to be inhaled or injected. Several patients need two or more insulin injections a day based on self-monitoring of blood glucose levels. Therefore, T1D patients do not need to consult medical professionals continually; they can make informed decisions on their medication. Some medical professionals they need include physicians, dietitians, nurses, and selected specialists.
• After the commencement of treatment, patients may experience a "honeymoon" period, which is a brief period (from one week to two years) when the pancreas secrets some insulin.
• Unfortunately, patients (especially adolescents) report that adhering to T1D treatment is difficult. Lapses in proper medication result in suboptimal glycemic levels, increasing the risk of hospitalization for DKA, and decreasing quality of life. According to patients, insulin is so important that the experience of being without insulin is a "life or death" emergency.
• Managing the disease has proven to excessively intrude into patients' lives, as some report that they have no relief from the need for insulin shots. It gets even worse; some patients fall into depression, post-traumatic stress disorder, and suicidal thinking. All patients complain of high-stress levels on account of the disease.

• Many patients have discovered that they can not depend on the United States' healthcare system to provide for their insulin needs. Insulin access barriers (IAB) include expensive health care (including the cost of consulting professionals), inadequate financial institutional response, and challenging life transitions (such as job loss, death of a family member, and divorce).
• Insulin costs compete with other expenses, straining finances and relations in households. Insulin out-of-pocket monthly fees range from $75 to $2000 depending on patients' insurance coverage and insulin requirements.
• It was discovered that the prevalence of T1D varied from state to state due to differences in services. A few states do not mandate that insurers provide for diabetes treatment and supplies. Unfortunately, some health insurance plans do not cover medications such as insulin, and when they do, patients struggle with high premiums, co-payments, deductibles, and coverage limitations. In some cases, unfamiliar brands of insulin are forced on patients by their financial institutions. To crown it all, several insurance companies do not replace mistakenly damaged insulin supplies.
• To mitigate insulin expenses, patients resort to dropping their insulin doses drastically; prevent IABs by taking out loans and selling assets to afford insulin;and sometimes begging for insulin supplies. These approaches do not always succeed and can affect patients' health, finances, future opportunities, and relationships.
• The major threats to T1D patients are uncertain access to insulin, insulin distress, and IABs. The significant barriers to treatment among adolescents are cost, obtaining needed information, and communication issues.

Key Findings

• In the past 30 years, new treatment methods for Type 1 Diabetes (T1D) have been developed by addressing immune mechanisms related to gene, molecule and cell. Although some clinical trials could change the natural progress of T1D, none of them have delivered permanent remission. This issue of treatment is particularly challenging for new-onset T1D.
• T1D has had an increasing effect on young people in the US, especially those who are in their adolescence. They tend to have a lack of control about diet, such as candy. Although measures are in place requiring close monitoring by parents on their children's diet, the adherence to treatment plan remains a major concern.
• Despite more than 40 treatment options been approved by the FDA in the US, they bring limited change to glycated hemoglobin (A1C) and to the percentage of patients who could control their glycemic level. The main causes of inadequate control of glycemic levels are the complex treatment regimen and the insufficiency and inconvenience of obtaining medicines, resulting in deficient adherence to medication by patients.

• Self-managed education is an essential part of the diabetes treatment plan in general, where there are key factors associated with patients in devising the treatment plan. They include "age, school or work schedule and conditions, physical activity, eating patterns, social situation and personality, cultural factors, and presence of complications of diabetes or other medical conditions."
• As advised by the CDC in the US, diabetes is mainly managed by patients themselves, with support from health care practitioners. Patients are advised to consult health care providers regarding the development of the T1D disease treatment plan. Doctors could advise patients on the key aspects of treating T1D, such as the dosage of insulin, the target level of blood sugar, stress management and eating and exercise activity plan. Concerning children's patients, the treatment plan is expected to be different from adults.
• The testing or monitoring of blood sugar (glucose) level is a critical part of treating diabetes, as doctors use this information to assess the status of patients' diabetes and make daily adjustments to the treatment plan. Many types of devices are used to test the glucose level at home or health care facilities.
•  Authorized by the US FDA, there are some criteria, such as accuracy, ease of use and storage memory, for selecting a device. Health care practitioners could make recommendations on devices for their patients and suggestions on how to use them. Moreover, the American Diabetes Association (ADA) also publishes standards on various devices for delivering insulin and monitoring glucose.

• Based on the above-mentioned research, devices authorized by the FDA and/or meet the standards of ADA are expected to be two credible sources for health care providers to learn about diabetes technology in the US. For example, some glucose monitoring devices are suitable for patients who are 18 years or older.
• With the trend of patient-driven management and care, health care providers are also expected to be informed by patients who are exposed to certain new medical devices. The outbreak of COVID-19 has also accelerated the use of remote monitoring and mobile solutions in hospitals. For example, the FDA has recently expanded the approval of remote monitoring to non-invasive devices, such as continuous glucose monitors.

Research Strategy

Research Strategy:

Background

Overview of global Ventilator Market:

Case Study

Manufacturing of Medical Respirators and Ventilators - Ford and General Motors:

• During the pandemic crisis, around mid-March, Ford delayed its launch of off-road Bronco SUV, and stepped-up along with its manufacturing conglomerate, General Motors (GM) for the production of ventilators. Both U.S. auto manufacturers have recently completed their multi-million-dollar contracts with the U.S. Department of Health and Human Services, by adding 80,000 ventilators to the U.S. Strategic National Stockpile.

1. Ford

• Ford teamed up with GE Healthcare to manufacture ventilators at the Rawsonville Road plant in Michigan. Ford's $336 million contracts wrapped up on 28th August, after its final shipment of the Model A-E ventilator unit.
• Ford claimed to have produced more than 50,000 powered air-purifying respirators in collaboration with 3M, and also manufactured 75 million pieces of personal protective equipment (including 19 million face shields, 42 million face masks, 1.6 million washable isolation gowns).
• In addition, Ford claims to continue manufacturing of personal protective equipment, plans to deliver 10 million face masks to school districts across the U.S.
• Ford named this project after a symbolic event in American history, “Project Apollo.” After the Apollo 13 launch in 1970, the lunar landing was aborted due to the failure of an oxygen tank, forcing the astronauts to improvise a fix. This symbolizes the situation of the Ford automobile manufacturer, which was tasked with manufacturing ventilators to provide a fix for the pandemic.
• During the pandemic, the Ford manufacturers launched a series of PR ad-campaigns that were strategically designed (i) to motivate Americans to step-up for charity, and (ii) present the face of Ford manufacturer as a true American patriot and a humanitarian.
• In an inspirational TV advertisement under the rubric “Built for America,” Ford presented a new PR strategy, where there was no mention of specific vehicles. Instead, it presented three spot pitch in different ads (mentioned below), which were largely meant to celebrate U.S. workers as Ford prepares to reopen most U.S. manufacturing facilities Monday.
• "The Connection" - The ad mentions an unbreakable connection between the Ford Motor Company and America.
• "Why we are here" - According to the ad, 'We are here for a reason, and it's bigger than selling cars, we are here to build for the people who build and shape this country.'
• “The Reason" - highlights Ford’s factory workers in Michigan, Illinois, and Kentucky, noting that Ford employs more hourly workers than any other U.S. automaker. In the advertisement, actor Bryan Cranston narrates, “We’re here for a reason, and it’s bigger than selling cars,”
• According to Ford’s director of U.S. marketing, Matt VanDyke, "Americans are putting a renewed focus and understanding on where things are made, I think there’s an increased appreciation for that.” 
• Matt VanDyke in an interview with Fox News shared insights about Ford's ongoing commercials, which were aimed at the following pointers:
• Connecting their customer bases, and showing them a greater purpose which is beyond automobile manufacturing.
• Patting the workers on the back - recognizing the hard work of their employees.
• Illustrating Ford's mission in community-wide efforts such as supporting food banks, and food drives.
• Highlighting Ford's efforts in mitigating the spread of COVID-19, by making personal protective equipment and ventilators
• These sequence of aspirational marketing advertisement not only promoted the products, but also promoted a sense of patriotism, reflected a sense of greater purpose beyond selling cars, and in the process echoed a humanitarian image of the company; because the American public is interested in knowing about the company where consumer products are manufactured. 
• The central theme of Ford manufacturer's advertisement was that "when America faces a crisis, we build what people need."
• The humanitarian efforts of Ford were also highlighted to national and international media, during President Trump's visit to it's Michigan manufacturing base.
• In addition, Ford used social media avenues such as Facebook to connect with its consumers and promote their agenda for associating the Ford brand with good, which was in accordance with Harvard Business Review strategies for marketing during the COVID crisis.

• The response of U.S. consumers to the PR campaign:
• Ad’s EQ Score was 6/10 — a composite score based on the intensity of emotions viewers felt while watching, plus a campaign’s ability to drive brand metrics such as brand favorability and purchase intent – it performed really well, scoring 6 out of 10, compared to the US average of 5/10.
• Brand favorability of 53% - the ad performed well above average (i.e., around 39% for U.S. normal ads). Brand favorability was the fourth-highest ever recorded in the US automotive market, which was 14 points higher than Ford’s previous highest score.
• Purchase Intent of 40% - amongst the top-10% U.S. campaigns.
• Ad rating for 'Social Good reasons' was 24% - one of the top five automotive videos for social good scoring.

2. General Motors

•  General Motors (GM) partnered with Ventec Life Systems to manufacture 30,000 ventilators, at its manufacturing base in Kokomo, Indiana. GM estimated that it would cost $750 million to manufacture the required ventilators, which was cut down to a $490 million contract with the federal government.
• The GM-Ventec partnership grew out of StopTheSpread.org, a collective effort of private and philanthropic organizations to address the shortage of ventilators.
• GM has produced more than 10 million masks, with the production of masks utilized by the company's employees, or donated to community organizations.
• Unlike, the conventional ventilator, which was complex, had multi-function capability, more expensive, GM produced a different critical care ventilator called the VOCSN V+Pro, a simpler device consisting of only 400 parts.
• Weiss Memorial Hospital, a community hospital in Chicago was struggling with budgetary constraints prior to this crisis, and ventilators were much-needed at the facility when GM-manufactured ventilators came to the rescue. The hospital CEO, Mary Shehan said, "Ventilators are a much-needed infusion of critical resources to care for our patients. We are extremely grateful for the support and to all those who are rallying to ensure that our front line caregivers have the necessary supplies to care for our patients. We need all the help we can get now to rise to this unprecedented challenge." 
• By August 2020, the U.S. National stockpile for ventilators was sufficient, no longer reporting of ventilator shortages.
• Besides a website update, General Motors did not actively publicize their efforts in manufacturing ventilators. However, GM received extensive coverage and huge publicity through all media sources.

3. Medtronic

• Medtronic is one of the leading manufacturers of ventilators. During the pandemic, the company has increased its production of ventilators by five-folds, producing more than 1000 ventilators per week. Recently, the company has collaborated with SpaceX to manufacture critical components for Medtronic’s critical care ventilators.
• To further scale up production and distribution, Medtronic has partnered with other ventilator manufacturers to form the Ventilator Training Alliance. Its partners include Dräger, GE Healthcare, Getinge, Hamilton Medical, Nihon Kohden, Philips, Vyaire Medical.
• In addition, the company has committed to not raise ventilator prices during the pandemic era and is currently partnering with government authorities to allocate ventilators in high-risk and high-need areas.
• Medtronic has offered a 2:1 match for monetary donations made to eligible nonprofits worldwide. Since February, the Medtronic Foundation has committed $13 million in donations to support health systems and vulnerable communities worldwide.
• According to Fortune Magazine, Medtronic has been selected for the 2020 ‘Change the World’ list.  
• Medtronic launched a new feature for its higher-end Puritan Bennett 980 ventilator with two U.S. hospitals, allowing clinicians to adjust the setting remotely, thus reducing physician's exposure to patients with COVID-19. Nearly 8,500 ventilators were installed at 940 hospitals across the U.S.
• The Puritan Bennett 560 ventilator, is planned to be sold in the U.S. market and in 35 other countries at less than $10,000 each, which is remarkably lower cost as opposed to other ventilator manufacturers, in an attempt to capture a large market size in the U.S.A.
• Medtronic has published PB 560 Ventilator design specifications to allow other private manufacturers to scale up productions. The company's executive vice president, Bob White said, "By openly sharing the PB 560 design information, we hope to increase global production of ventilator solutions for the fight against Covid-19." 
• Medtronic was part of 'The COVID Coalition,' where the company is donating its printers and printing staff to the cause and has also paid for the cost of cutting thousands of transparent shields.
• Additional efforts towards combating COVID by Medtronic can be accessed here.

Limiting Event Capacity

• Some state governments are limiting the number of people that can enter events. For example, Nevada Gov. Steve Sisolak announced a "new meetings directive to increase attendee limits up to 250 per room or 50% capacity, with a limit of 1,000 per group."
• Las Vegas's Shot Show is implementing the new guidelines, as the event is now limited to "50% of the listed occupancy."
• Washington State Governor Jay Inslee recently modified Phase 2 and Phase 3 restrictions around business meetings and similar activities, effective September 21, 2020. According to the new guidance, meetings and business events will be limited to a capacity of 30% or 200 guests.
• In Florida, some cities, like Orlando and Miami, are also starting to allow in-person events with limited capacity. As of September 18, 2020, select facilities in Miami, including convention centers, are allowed to open at 50% capacity "with health and safety restrictions in place."
•  Orlando’s OCCC implemented a series of precautionary measures, which include limited capacity on the exhibit floor. This venue has implemented such measures since July 2020.
• Another example is the Dallas Market Center, which has held two in-person trade shows with controlled access as well as health and safety implemented guidelines.

Changing to Digital or Hybrid

• Some trade shows in the US that have been canceled throughout the country are taking place either virtually or as hybrid events (virtual + in-person).
• According to a recent survey, about 63% of trade shows organizers that have postponed events "are adding a hybrid or virtual component to their future events." Also, 81% of these organizers shifted to digital. From April to July 2020, virtual trade shows have increased from 15% to 41%.
• For example, the Exhibition and Convention Executives Forum (ECEF) will now be held as a virtual event, while the Professional Convention Management Association's Convening Leaders, will take place as a hybrid event.
• Virtualizing trade shows is a challenging task, as these are "built entirely around the in-person experience," as this facilitates learning, product demonstration, and deal closing. However, virtual trade shows have brought some benefits to the industry. For example, Ben Chodor, president of Intrado Digital Media, stated: “One of the benefits of virtual trade shows is that it allows attendees to control the conversation and ask questions, increasing their ability to get the information they want.”
• In addition, the US Small Business Administration "has made participating in virtual international trade shows eligible for federal State Trade Expansion Program (STEP) grants."

Including Educational Content

•  Offering educational content is one of the best ways to keep the visitors' attention and break the monotonous cycle of simply visiting the different virtual booths.
• The opportunity to learn new and interesting things is a great way to hook the audience and present your products in a unique way.
• Inviting industry specialists and key note speakers can ensure that the vendors leave your booth satisfied.
• Attendance is also a non-issue as travel and time-zone differences are eliminated, which means that by announcing the specific webinars and info-sessions in advance, the virtual booth can ensure maximum attendance.
• Moreover, including small fun quizzes and other events that offer the audience special giveaways and presents throughout the session can be another way of keeping maximum engagement and collect quality leads.
• However, it is important for virtual vendors to also include a final Q&A session at the end of the webinar to maximize the engagement and collect valuable leads to increase the conversion rates.

Enabling and facilitating live chat

• One of the main things that decides whether an event has been a success or not is audience engagement. 
• To make sure that the audience has an easy time interacting with the virtual booth, it is important to use live chat tools that facilitate the communication between the customers and the representatives.
• Engagement is especially important as over 90% of the visitors usually attend virtual trade shows to search for and buy new products.
• The maximum interaction between visitors and exhibitors is one of the best ways to ensure that the customer either leaves satisfied or buys something, especially if the 1:1 interaction was successful. 
• Live chat and video tools can also save exhibitors a lot of time by eliminating the need for long queues around booths.
•  FAQs and live group chats can also be extremely beneficial in addressing the customer needs, especially when vendors focus on asking open-ended questions, as those are extremely helpful in understanding the customers' needs.
• The most important thing, however, is that live chat tools help vendors gain and qualify leads, which increases their chances for more sales.