Academic studies

• From scholarly studies, it is apparent the users' feelings toward using the standard "stick your finger and draw blood" test is negative overall. Researchers stated they knew that those tests are not always accurate and are often uncomfortable for patients.
• Another research report defined them as "invasive, painful, time-consuming, and a constant burden for the household budget."

Canadian Press

• The Ontario Ministry of Health announced they would provide public funding for flash glucose monitoring systems under the umbrella of the Ontario Drug Benefit (ODB) program, effective September 16, 2019.
•  Ontario and Quebec are the only two provinces to fund this type of system. This funding is good news as the ODB covers all senior citizens (65+) in the province. Senior citizens also pay a two dollar copay for every prescription.

Flash monitoring

• A new user of a continuous glucose monitoring device was very pleased with the result of her switch. "I've downloaded the FreeStyle LibreLink app on my iPhone and can check my glucose level on the fly whenever I want. The best part, though? No routine fingersticks! This is a game-changer in how I control my diabetes."
• Another user reported feeling like the weight of the world had been taken off her shoulders. "Hypoglycemic unawareness is still the main reason the information on my CGM screen makes me feel more secure because I can tell which way my blood sugar is heading in instances such as before bed, before exercise and before driving. After all, the number on my meter might be good for before bed if I know my blood sugar is stable or trending upward, but that same number might mean I need a snack if I see that I'm trending down. My CGM plays a big part in keeping me at my A1C goal for the last five years."

Bonding with other diabetics

• CGM technology is potentially visible if worn on the upper arm, which is one of the recommended areas. Its easily seen when short sleeves are worn and have prompted some bonding between people with diabetes. The conversation was published by the author of a diabetic living website.
• "The waitress came back over and brought our drinks. "I noticed your Dexcom; I wear one, too." Her face brightened. "Hey, that's awesome! I like it wearing it on my arm. But you know, sometimes I have trouble keeping the sensors stuck." We spoke in diabetes shorthand for less than a minute, comparing favorite adhesive overlay tapes and body real estate options. She pantomimed carefully putting on a shirt to show how sometimes her sensor gets stuck on the sleeve hem. I pantomimed pulling down a pair of pants by exaggeratedly stretching out the waist to show how to avoid pulling off the sensor from my thigh. She told me about the random guy at a bar who showed off his insulin pump after seeing her Dexcom sensor. We laughed at the absurdity of the whole robot-life thing. My daughter watched us, two strangers fluent in the same language."

Educating non-diabetics

• Another consumer shared how he engaged his non-diabetic friends on Facebook, giving them regular updates and encouraging them to place bets on his next meal. It appears to be an effective means of education.
• "I have come to think of the sensor device, in combination with the LibreLink scanner software on my iPhone, as a Friendly Robot Vampire who politely tests my blood glucose every minute or so and offers information and opinions. And if you don't think I'm over-the-moon happy with my Friendly Robot Vampire, just ask my Facebook friends. By the end of the first week, I had them placing "bets" about when various meals would peak my blood glucose, how high, and at what time."

Using tracking data

• The same contributor discussed how he never took his blood sugar because his A1C was low enough, and he didn't see any use. He would ask the doctor, "f I bring in the numbers, what are you going to tell me that you aren't telling me now?" His opinion has changed significantly.
• "I am now discovering the manifold joys of a food diary and medication log WHEN YOU ACTUALLY HAVE GOOD DATA TO CORRELATE WITH IT, and having a marvelous set of laboratory equipment to run tests on a population of 1, yours truly. (Oh, and the lab equipment volunteers super-useful information. Looks like I need to spread the carbs and calories around better after noon!) NOW I've got an answer to "what is testing going to do for me now?" CHANGE MY LIFE FOR THE BETTER. 

Clinical Trial New Metering system

• New technology by Control IQ is expected to be available to the public by the end of 2019. "Because correctly dosing insulin is challenging, the automated features of Control-IQ are very appealing — the changes are designed to decrease the burden for people with diabetes and to improve blood sugar management. This system has been shown to reduce hypoglycemia (low blood sugar), increase time-in-range (70-180 mg/dl), and lower A1C."
• One of the members of the trial for the system had the following review "Life with diabetes was difficult and frustrating, but I kept an upbeat attitude and assumed everyone had rough days. After two weeks with Control IQ running at night, I realized that I'd been feeling BAD all those years, both physically, mentally, and emotionally. My brain, after two weeks of using Control IQ, felt like it was on overdrive just from getting the correct amount of fuel from consistent good nighttime bG levels."

Adoption of Monitoring Apps

• There are over 300,000 health apps for download, which are designed for a variety of needs from weight loss to the management of diabetes. The challenge in the marketplace is that these apps are not subject to federal regulation, and there are no medical guidelines in place to help physicians and patients select an app. Patients usually resort to the internet, but there is no definition of the critical features an app should have for it to meet the needs of a diabetes management app. Research has indicated barriers to usage include financial (no money), temporal (no time) and technical (Don't know how to use it).
• Despite the level of interest, the level of uptake has not been as high as expected, especially for those living with type 2 diabetes (T2D). Although no one is sure, the reason most often suggested is that without clear evidence of their benefit, there will be only sporadic adoption.

Challenges with Cell Phone Monitoring

• ⁦There are also unforeseen problems when using cell phones to monitor bG. A medical doctor posted the following tweet upon the announcement that no cell phones would be allowed into the concert. "@Madonna ⁩ if my cell phone controls my insulin pump and reads my continuous blood glucose meter am I excluded from your show? Will you make exceptions for phones that function as medical devices? #T1D #diabetes-awareness #wearenotwaiting." Madonna has not answered.

People with diabetes with Vision Problems

• There is, however, help for people with vision impairment, which is a common complication of diabetes. Typical glucose monitors have relatively small screens. Now, meters with large screens and "talking" meters are available.

Research Strategy

Recent Technology and Tools in the Everyday Management of Diabetes — North America

1. Smart Insulin Pens

• Increase in the number of diabetic patients has prompted the growth of smart insulin pens.
• Smart insulin pens are capable of providing insulin externally. They are affordable and can help manage diabetes effectively.
• Usage of smart insulin pens, unlike traditional insulin pens, can reduce environment pollution because the pens are refillable. In other words, insulin cartridges can be replaced.
• "The ability to pre-load doses in smart insulin pens is significantly motivating the overall demand increasingly. Also, the collaboration between industry giants and specialty firms in the market are promoting further expansion of the smart insulin pens market".

2. Closed-Loop Frameworks

• The closed-loop system was developed to automate insulin delivery in real-time while providing "predictive diagnostics unique to the individual, with a goal of dramatically simplifying diabetes management".
• However, according to MedScape, the closed-loop system failed to be user-friendly. About 40% of patients stopped using it within a 9-month frame due to technical difficulties.
• Therefore, an advanced closed-loop system was introduced called "hybrid closed-loop system".
• This new and refined closed-loop system works via algorithm-based communications.
• Unlike the old closed-loop system, the hybrid closed-loop system can be used by anyone above the age of seven.
• With the emergence of hybrid closed-loop systems, the field of diabetes technology is a step closer to developing artificial pancreas.

3. New and Improved Test Strips

• Diabetes test strips or blood glucose test strips are used for blood glucose testing.
•  Glucose oxidase present in the test strip reacts when blood is placed on it.
• "The test strip has electric terminals which allows the meter to measure the current between the terminals".
• "The current between the terminals changes depending on the level of gluconic acid that has been produced. The blood glucose meter then uses an algorithm to work out the blood glucose level based upon the difference in current".
• There are several innovations being made in test strips. For instance, the new and improved test strips can detect underfills and allow the users to reapply blood if necessary.

4. Continuous Glucose Monitoring

• Continuous glucose monitoring (CGM) is considered to be one of the most popular and advanced diabetes management technology.
• As the name suggests, CGM is used for monitoring glucose level in real-time or over a period of time.
• Traditional blood glucose meters can only provide a brief overview of glucose level at one-go. However, CGMs are capable of recording previous readings and can provide detailed data on an individual's highs and lows of glucose level.
• CGM is meant for the management of both type 1 and type 2 diabetes. This diabetes technology is capable of preventing low-glucose incidents effectively.

5. Diabetes Management Apps

• According to a web-based survey, about 52.2% of type 1 diabetes patients and 33.3% of type 2 diabetes patients reported using apps meant for diabetes management.
• The escalation of this trend is primarily due to the increase in the prevalence of diabetes worldwide. Also, diabetes remains to be one of the most expensive diseases in the world. This contributes to the trend as well.
• In addition, self-care is becoming more and more widespread. "Good diabetes management following a standardized medical and behavioral treatment protocol improves quality of life, and may prevent complications and premature mortality". As a result, diabetic patients are turning towards cost-effective diabetes management where apps come into the picture.

Patient Behaviors

• According to NCBI, diabetes technologies do not decrease 'diabetes distress scores'.
• However, patients do claim that when the technology is user-friendly and blends with the everyday-tasks of day-to-day life, it slightly reduces the burden caused by the disease and improves the overall quality of their lives.
• Smart insulin pens are gaining prominence due to their ability to supply insulin externally. This is one of the most recent technologies/tools that was quickly welcomed by diabetic patients.
• "The critical importance of early glycemic control to prevent acute complications and halt disease progression to prevent chronic complications only intensifies as these costs, including the rising costs of insulin, increase". As a result, the usage of CGM is increasing among patients with type 2 diabetes.
• Although closed-loop frameworks initially failed to fulfill the needs of a diabetic patient, the improved hybrid closed-loop system is slowly gaining prominence.

RESEARCH STRATEGY

BAYER — ASCENCIA

PRODUCTS

• The Contour NEXT and the Contour NEXT EZ are blood glucose meters available from Ascencia in Canada.
• Described as the next generation in diabetes monitoring, the Contour NEXT ONE incorporates a blood glucose meter with a smartphone app to enable better diabetes control.
• The Contour NEXT Link 2.4 and Contour NEXT Link are blood glucose meters that are linked to insulin pumps to avoid transcription errors and to ensure optimal diabetes control.
• Ascencia also offers the Microlet NEXT, a lancelet, and Contour NEXT Test strips.
• The most recent products launched by Ascencia were the Contour NEXT ONE, launched in February 2017 and the Contour NEXT Link 2.4, launched in April 2017.

COMPETITIVE ADVANTAGE

• Ascencia uses innovative solutions to empower people living with diabetes and to simplify and improve their lives. The specialist expertise they have in diabetes management has enabled them to develop high-quality solutions and tools that impact on the daily management of diabetes.
• They have a history of forming strategic alliances with other companies in the industry to develop new technologies, that are not only innovative but have real-life implications for those with diabetes.
• This has enabled them to maintain their competitive advantage.
• An example of this is the 2017 strategic alliance formed with the Insulet Corporation, the leading provider of tubeless insulin pumps. This alliance allowed them to develop a product that provided those with diabetes a continuous insulin delivery system powered by accurate blood glucose readings.

MARKETING STRATEGIES

• Ascencia's marketing strategy uses the tagline "The #1 pharmacist recommended brand of blood glucose meters".
• They rely heavily on the development of partnerships with other healthcare providers and consumers to support their existing products and to maximize revenue streams.
• The implementation and growth plans of the product portfolio are set out by the American Brand Marketing team and incorporated into the Canadian marketing strategy by the Canadian Director of Marketing.
• In 2017, Ascencia teamed up with the NHL's Max Domi to create a new online marketing campaign to promote its diabetes management products. The campaign was known as "Light It Up".
• This campaign saw the company move away from an inspirational based campaign to one that focused more heavily on the Ascencia products.
•  Online advertising has become the company's primary focus due to cost constraints in a competitive industry.
• They have found it to be a more cost-effective medium than television. It has a comparable reach, as Ascencia can market its products at the entire diabetes community.

ROCHE — ACCU-CHEK

PRODUCTS

• Accu-Chek has three main product areas in the Canadian market.
• It's meter systems include Accu-Chek Guide, Accu-Chek Aviva, Accu-Chek Aviva Connect and Accu-Chek Aviva Nano.
• The company offers two lancing devices, the Accu-Chek Softclix, and the Accu-Chek Fastclix.
• Accu-Chek also offers a range of data management options. The mySugr and connect apps allow data to be transferred between the meter and phone to improve diabetes control.
• There is also an Accu-Chek online system that allows results to be monitored through the computer.
• Accu-Chek Smartpix and Accu-Chek 360 provide the software and hardware for computers as well as a range of resources for the diabetes patient.
• The most recent product launched by Accu-Chek was the Accu-Chek Guide System and Simple Pay savings program. This product aimed to make managing diabetes easier and more affordable.
• The Accu-Chek Guide System was launched in May 2017.

COMPETITIVE ADVANTAGE

• Accu-Chek has been recognized as the quickest and most pain-free system of monitoring diabetes.
• The app provided by Accu-Chek has some innovative features that differentiate it from the competitors. One of the most notable is the ability to calculate insulin bolus injections.
• This technology is important for those who use insulin pumps that do not have a feature that automatically calculated if an insulin bolus is required and the necessary dose.
• Their apps also can integrate into other health apps such as the Apple HealthKit. The company is working on technology to integrate the product into smartwatches.
• Accu-Chek's subscription model for test strips and savings plans are a unique way that they seek to differentiate from the competitors.

MARKETING STRATEGIES

• Accu-Chek focuses on pain-free, easy, and time-efficient diabetes management in its marketing strategy.
• It focuses on the ability to measure blood glucose levels within five seconds. The market strategy emphasizes the system as being the quickest and best looking system.
• The company markets itself around the idea that if you don't want diabetes to slow you down, this is the way to go.
• There is a focus on the ability to have a lifestyle that does not revolve around diabetes management.

ABBOTT — FREESTYLE LIBRE

PRODUCTS

• The FreeStyle Libre Flash Glucose Monitoring System is the company's primary blood glucose monitoring system.
• A link system is also available. This product is known as the FreeStyle Libre Link and allows patients to monitor their diabetes from their mobile devices.
• The company also offers four other blood glucose meters with a range of different features. These meters include FreeStyle Libre, FreeStyle Precision Neo, FreeStyle InsuLinx, and FreeStyle Lite.
• Launched in Canada and the US in 2018, the FreeStyle Libre Flash Glucose Monitoring System represents a major innovation in the way diabetes is monitored and managed.

COMPETITIVE ADVANTAGE

• The FreeStyle Libre Flash Glucose Monitoring System gives the company a huge competitive advantage.
• It operates using sensor pads to monitor blood glucose levels. The patient is no longer required to obtain finger prick blood samples as the sensors continuously measure blood glucose levels.
• The values are displayed following a user-initiated scan enabling up to date information throughout the 14-day life cycle of the sensor.
• The product offers the ability to track trends and adjust medications accordingly.
• Literature surrounding the product launch has described it as revolutionary.
• Data suggests that the average diabetes patient will save $120 per month by using the sensor system.
• Research has also suggested that the sensor system leads to better HbA1c levels. The research has shown over time a clinically significant decrease in HbA1c levels when the sensor system is being used.

MARKETING STRATEGIES

• The new FreeStyle Libre Flash Glucose Monitoring System is at the center of the company's current marketing strategy.
• The painless and continuous ability to monitor blood glucose levels and better diabetes control, as a result, is emphasized throughout the marketing strategy.
•  Convenient, easy, discrete, and user-friendly are four terms used in the marketing strategy to create associations for the consumer.
• Their second-generation system is currently undergoing regulatory review in North America, having been approved earlier in 2019 in Europe.
• Abbot plans to increase the production of lower-cost sensors between three to five times in the next few years. Their strategy is to maximize the savings to the consumer using the sensor system.
• The product is the fast-growing diabetes monitoring product globally, with over 1.5 million users. This is emphasized in the company's marketing strategy.
• The marketing strategy around their other blood glucose meters emphasizes the sleek, modern look. There is an emphasize on, no longer having to keep monitors hidden. They should become a part of daily life.

RESEARCH STRATEGY