The Diabetes Landscape

Part
01
of seven
Part
01

Diabetes Overview

There were approximately 464 million people worldwide in 2019 who had diabetes. Diabetes is slightly more prevalent in men, individuals who have an immediate family member with the disease are at greater risk for developing diabetes, and a key challenge in low and middle-income countries is insulin access and storage. Current treatments for diabetes are insulin and a medication called Metformin, while potential treatments for the disease in the future are cell therapy and "a bioengineered mini-organ where insulin-producing cells are encapsulated within a protective barrier."

Recent Progression

Prevalence in Men vs. Women

  • In 2019, the estimated diabetes prevalence rate among women worldwide was 9%.
  • In 2014, the prevalence rate of diabetes among women worldwide was 7.9%.
  • We also found that "women with type 1 diabetes have a 40% higher excess risk of premature death than men with the disease."
  • In 2019, the estimated diabetes prevalence rate among men worldwide was 9.6%.
  • In 2014, the prevalence rate of diabetes among men worldwide was 9%.

Group Most Affected By Diabetes

  • With regard to type 1 diabetes, those most affected by it (have the greatest chance of developing it) are individuals who have an immediate family member with the disease and children, young adults, and teenagers because that's the most-common age range for developing the disease (though a person of any age can develop it).
  • With regard to type 2 diabetes, those most affected by it (have the greatest chance of developing it) are those who are ages 45+, inactive, overweight, have prediabetes, previously had gestational diabetes, and/or those with an immediate family member who has type 2 diabetes. Most of those risk factors (the group most affected) are the same for prediabetes.

Challenges in Low & Middle-Income Countries

  • From a prevention standpoint, such efforts with regard to diabetes "remain rudimentary in most developing countries." The importance of that challenge is magnified by the fact that in 2019, "79% of adults with diabetes were living in low- and middle-income countries."
  • Substantial challenges pertaining to diabetes In low and middle-income countries include "[t]he cost of diagnostic tests and scarcity of health manpower", including for monitoring those with diabetes.
  • The medical infrastructure in low and middle-income countries also presents another challenge with regard to diabetes, as "[r]eliable laboratories, patient education programs, glucose monitoring equipment and access to medical clinics can be difficult to access in some countries."
  • Insulin access and storage are other key challenge in low and middle-income countries, as it "can be expensive and difficult to find in some countries", plus individuals in those countries "might not have the resources to keep" insulin stored in a location with cool temperatures, which it has to be.

Current Treatments

  • Insulin is "[t]he main medication for managing type 1 diabetes. " Insulin is needed for individuals who have type 1 diabetes because "the pancreas of a person with type 1 does not produce the hormone [insulin]."
  • Type 1 diabetics have "to receive insulin at several points throughout the day," including prior to or after eating.
  • The insulin can be injected into the body via insulin pump, needle/syringe, insulin pen, inhaler, jet injector ("a fine, high-pressure spray into the skin"), or through an injection port.
  • Since people with type 2 diabetes don't always need insulin, some take medications to manage their levels of blood sugar. One of those popular medications is Metformin, which "helps reduce blood sugar and make insulin more effective, as well as assisting weight loss, which can also reduce the effects of diabetes."
  • Other types of medications for people with type 2 diabetes are alpha-glucosidase inhibitors, biguanides (which Metformin is one of), bile acid sequestrants, DPP-4 inhibitors, meglitinides, SGLT2 inhibitors, sulfonylureas, thiazolidinediones, and GLP-1 agonists.

Future Treatments

  • A potential, future treatment for diabetes is "a bioengineered mini-organ where insulin-producing cells are encapsulated within a protective barrier." This potential treatment is being developed by the Diabetes Research Institute. As a showing of the positive potential of this prospective, future treatment, "the first patient in Europe treated with this approach in an ongoing phase I/II trial no longer requires insulin therapy."
  • Viacyte is a company in the U.S. developing that type of bioengineered organ for the treatment of diabetes and the phase 1 trial of its device was deemed safe, so currently Viacyte is "working on improving the engraftment of insulin-producing cells."
  • Another potential, future treatment for diabetes is cell therapy, which has been described as "one of the biggest hopes towards developing a cure for diabetes, especially for type 1 diabetes."
  • If a successful way to use cell therapy is developed for the treatment of diabetes, missing cells that produce insulin "could potentially recover normal insulin production and cure patients."
  • Sanofi and Evotec have teamed-up and are currently working on developing "a beta cell replacement therapy for diabetics."
Part
02
of seven
Part
02

Doctr's Perspective When Treating Diabetes Patients

Motivation of healthcare professionals in the management of diabetes is a collective concept covering several natters, including interests and intentions of the professional when providing care. While doctors of diabetes patients are motivated by empathy positive patient-physician relationship, they experience challenges such as inability to manage patients and limited skills and time that hinder their performance and healthcare outcome. The motivations, challenges, and frustrations for doctors when treating diabetes patients have been outlined below.

MOTIVATIONS

Physician Empathy

  • Research has linked doctor’s empathy with motivation to improved treatment to diabetes patients. Empathy signifies a practitioner’s ability to understand the world from the patient’s perspective and requires both emotive and cognitive abilities.
  • In her article, Empathy and Efficiency in Healthcare at Times of Austerity, Kerasidou (2019) noted that the cognitive aspect of empathy denotes the ability of a physician to comprehend the experience of the patient while the emotional component refers to the ability to join in the patient’s feelings. Since empathy helps one to understand the situation and predicament of the other, it causes the motivation to act.
  • In their study, Freeman-Hidreth et al. (2019) found that empathy and compassion has a significant effect on the adherence to self-management behaviors among patients with type 2 diabetes mellitus (T2DM). According to the authors, empathy occurs when healthcare providers are able to experience the positive and negative feelings of the patient, which is a component of compassion. With empathy, physicians are able to recognize the suffering of the patients and feel motivated to act to relieve their suffering.
  • In assessing the association between primary care practitioner empathy and risk of cardiovascular events (CVD) among type 2 diabetes patients, Dambha-Miller et al. (2019) found an existing correlation between practitioner empathy and reduced incidences of CVD with a statistical significance (P) of 0.01. This was observed because practitioners with empathy are motivated to provide therapeutic consultations that encourage patient empowerment, activation, and motivation towards self-management.

Positive patient-physician relationship

  • An effective physician-patient relationship motivates doctors because of the associated enhanced communication and self-care. According to MD Edge, a successful diabetes management care requires a working relationship between physicians and patients. Two key components of this relationship are shared decision-making and physical-patient communication, both that have shown improved patient satisfaction and adherence to treatment.
  • A positive physician-patient relationship encourages both parties to share medical information. Specifically, the physician is able to present treatment options to the patient and describe the benefits and risks. The patient, on the other hand, expresses his/her preference for the treatment to ensure alignment with the patient’s needs and values.
  • In a study published by the National Center for Biotechnology Information (NCBI), Layla et al. found that the nature of the interaction of physicians with their patients is a key facilitator of healthcare professional motivation. According to the authors, healthcare professional participants revealed that the nature of their interactions greatly influenced their level of motivation regarding the management of their diabetic patients.
  • Better physician-patient interaction is associated with good communication skills such as encouraging patients to engage in consultation, be attentive listeners, and keep good eye contact during therapeutic processes. This collaboration is a motivational factor among physicians who have reported feeling pleased and highly motivated when they are able to communicate with their patients effectively.

CHALLENGES

Inability to Manage Patients

  • One of the systemic barriers to diabetes management is the inability of physicians to manage patients adequately. A qualitative study published by NCBI found that 62% of physicians are unable to provide adequate self-management education to diabetic patients. Although physicians recognized the need for self-management education, they do not have reliable access to education providers.
  • Most physicians always lack a clear communication path to arrange training with patients in a timely manner. Amidst efforts to overcome this challenge, most physicians are never successful because of limited time and knowledge, especially in regard to nutrition counseling.
  • A qualitative study conducted in Muscat, Oman, to measure care providers’ perception towards challenges for service improvement at diabetes management clinics assessed the challenges that physicians face while providing care to diabetic patients. The study revealed that the major challenges preventing proper patient management are infrastructure-related. Most of the care providers interviewed reported that they shared rooms in clinics was a common practice, which included diabetes management clinics, antenatal clinics, and asthma clinics.

Limited Skills and Time

  • Most physicians are unable to offer quality diabetic management due to limited skills and time. NCBI reviewed a survey involving 600 physicians across six countries and found that almost 40% of primary care physicians and 30% of specialists considered administering insulin therapy a challenging task. About 49% of doctors also acknowledged the lack of experience in the available types of insulin.
  • NCBI also reported that doctors reported that educating patients about diabetes takes too much time. Lack of time to offer education to patients is a primary barrier to intensifying insulin therapy.
  • As of 2017, almost 73 million people had diabetes in India. However, the available healthcare professionals are not able to offer adequate counseling or education as a result of time constraints.

FRUSTRATIONS

Poor Self-management and Compliance of Patients

  • A 2019 study published by BMJ reported that poor compliance of patients with diabetes is a major source of frustration to physicians. According to the study, poor self-management among patients is a challenging factor for healthcare practitioners.
  • Most diabetic patients are unable to manage themselves appropriately, leaving their health at a vulnerable stage that is also difficult for doctors. In some instances, patients have difficulty using insulin on their own, which forces the doctors to train them.
  • Research Gate published a study, which also reported that non-adherence among diabetic patients causes great frustration among medical professionals. The mean adherence with oral glucose-lowering drugs is between 61% and 85%, a phenomenon that worsens with an increase in co-medications.
Part
03
of seven
Part
03

Living with Diabetes

The patient's perspective on living with diabetes has been discussed below. These include their frustrations, motivations, and the support they receive among others.

Frustrations

  • Patients with type 1 diabetes need insulin injections to prevent diabetic ketoacidosis. The rise in the price of insulin causes frustration for many patients and their families. A survey done by the American Diabetes Association in 2018 shows that about one-fourth of respondents admitted to skipping or rationing their insulin doses because of high, unaffordable costs.
  • Diabetes may contribute to changes in moods. It may lead to anxiety, nervousness, and confusion. Sometimes family and friends may find it hard to understand these mood swings.
  • Patients with chronic diabetes may suffer complications, like neuropathy and nerve damage. These conditions have no specific treatment except for analgesic medications.

Support

  • The support from family in all types of diabetes care has been shown to have a significant effect in improving health outcomes for patients with diabetes.
  • In Sweden, diabetes patients' are taken care of at primary healthcare centers. The cornerstone for diabetes care is self-management.
  • Evidence shows that diabetes specialist nurses educate patients and other care providers, as well as delivering direct care. The results of these actions are reduced inpatient harms and complications, reduced patient length of stay in the hospital, and improved patient satisfaction.

Motivations

  • Motivational text messages help patients with diabetes. Texts like 'Diabetes is not terrible and there are many things you can do to prevent problems from diabetes, such as monitoring blood glucose, watching your diet, keeping fit, and taking pills regularly.'
  • Providing diabetes patients with social comparison information regarding measures of their diabetes health status (like, A1C) may affect mood, motivation, and self-concept in ways that could improve or sustain diabetes self-care behaviors for some patients.

Interest in new medications

  • When patients feel that their experiences, decisions and perspectives related to the disease are taken into account, they actively cooperate with the treatment plan. In the long run, clinical outcomes are improved. When they negotiate and develop alternative medicines together, compliance is improved.

Proud moments in treatment

  • One of the proud moments in treatment in England was the announcement that flash glucose monitoring system would be free on the NHS for all Type 1 diabetes patients who qualify for it under IHS clinical guidelines. That could mark the end of the painful finger-prick testing done many times in a day.
Part
04
of seven
Part
04

"Time in Range Concept Overview

Time in Range is a newly developed metrics that enable patients to monitor and achieve the ideal level of blood sugar levels throughout the day. The time-in-range guidelines states that diabetic individuals should stay in the range of 70 to 180 mg/dl for 70% (about 17 hours) of the day. Some notable companies in the market include Abbott, Medtronic, Senseonics, and Dexcom.

Concept Overview of "Time in Range"

  • Time-in-Range” (TIR) is the measure of time percent that a person spends with glucose levels in a target range of 70 to 180 mg/dl. Time in Range can be determined after monitoring CGM data of the user for at least 14 days.
  • Time in Range captures the variation of blood glucose values, i.e., highs, lows, and in-range. Alternatively, HbA1C measures average glucose value over a two-to-three-month period. Hence, A1C cannot capture time spent across various glucose ranges in the blood.
  • A CGM device provides constant information about blood sugar every five minutes. Hence, physicians can understand the full picture of blood glucose levels spent in the target range throughout the day.
  • TIR can help physicians and patients to realize how different foods and activities can affect time-in-range. Also, the new metrics enable users to understand that they should aim to spend maximum time in-range, and take care to avoid blood sugar fluctuations.
  • According to a recent study, people without diabetes spend about 97% of the time, in-range of 70-140 mg/dl. Also, they feature an average blood glucose level of 99 mg/dl. The study also reports, that for people with type-1 or type-2 diabetes, about 70% of their day should feature 70-180mg/dl blood glucose levels.

Expert Panel Endorsements for "Time in Range"

Drawbacks of Time in Range Measurement

  • Up till mid-2019, the time-in-range blood glucose levels were not standardized around the world, i.e., though multiple studies and trials confirmed the effectiveness of TIR. Still, no standard guidelines of blood glucose range were observed globally.
  • It is observed that twice-daily finger sticks may still be required for device calibration of CGM machines. Also, CGM machines may often show lower readings compared to venous glucose readings.
  • CGM machines may become inaccurate at low glucose ranges and are available by prescription only. Further, CGM machines are expensive and cost around $1,000-$2,000.
  • It is noted that time-in-range should be actively monitored to remain effective. Alternatively, it may induce anxiety in patients over accuracy and time limitations, especially in dynamic situations.
  • Device companies have been criticized for making exclusive agreements with insurance carriers, resulting in pushing their products and restricting patients' choices.

Leading Players in CGM Device Market

How Companies are Promoting Time in Range Concept

  • Medtronic introduced a new "gamified" incentive program for BCBS-MN members who use CGM devices. The company awards points to participating users (Inner Circle) for spending more time in their target blood glucose range.
  • Abbott's FreeStyle Libre is currently being used by more than 1.5 million people in 46 countries. The company offers partial or full reimbursement for its device in 33 countries, including France, Ireland, the UK, Japan, and the US.
  • In 2019, Senseonics launched the Eversense Bridge Program Cost Assistance program for 90-Day Implantable CGM devices.

Links to Promotional Activities

  • The link to Medtronic's "Time in Range" infographic can be found here.
  • The link to Dexcom's print advertising in the Media planet campaign, distributed with the Guardian newspaper in November 2019, and can be found here.
  • The link to Abbott’s FreeStyle Libre promotional video can be found here.
  • The link to product promotions and consumer information brochures can be found here.
Part
05
of seven
Part
05

Patients' Percetion of "Time in Range"

In order to gain an understanding of the patient perspective on time in range and the relationship it has with glucose monitoring devices, we have explored popular forums, comments on diabetes blogs, and articles written by patients themselves about their experiences. Our research reveals that in general, time in range is a relatively new concept to patients and those who seek to understand it and utilize it for diabetes management find it to be helpful and empowering. Additionally, many patients view glucose monitoring devices as central to managing their time in range.

Time in Range Patient Perspectives Study

  • In 2018, an important study was published in the American Diabetes Association's journal Clinical Diabetes. The study explored diabetes patient perspectives on which factors affect their daily life the most and feel the most predictive of their diabetes management success.
  • Results from the study demonstrated that patients feel time in range is a "crucial outcome" and that along with diet and exercise, in-range blood glucose is one of the deciding factors in the improvement of both their diabetes management as well as their mindset.
  • According to the study, patients believe that the highest ranking factor, after food choices, that influences their daily lives is time in range.
  • Patients experience significant stress and worry concerning their current therapy option for managing time in range measures.
  • The authors of the study report that the data reveals time in range to be "an important mental and emotional consideration" for patients living with and managing diabetes.

Patient Understanding and Perspectives

  • The time in range concept is one that is seen by patients to be a relatively new concept for the management of their glucose levels and therefore their diabetes.
  • Patients that write publicly about using time in range for their diabetes management have very positive things to say about it. They speak of the "all-important" time in range as the "perfect diabetes statistic," helping them be "on the right path," and as a "key measure of type 1 diabetes control."
  • However, patients still seem to require a lot of education concerning time in range. Responses to a blog post written by a medical professional about the importance of time in range, yielded comments of confusion or disagreement, as well as gratitude that the author had taken the time to inform them about this metric.
  • On the other hand, many responses to the aforementioned post indicated that patients found what the healthcare professional said to be true. Comments about how people "totally agree" and that the information "makes absolute sense" are prevalent.

Use of Glucose Monitoring Devices

  • The use of glucose monitoring devices helps patients gain a sense of control over their time in range and diabetes as a whole.
  • One patient who shared his experience with his initial few weeks of using a CGM and pump. He reports feeling free and optimistic, sentiments echoed by other patients as well.
  • Another patient mentioned that the use of CGM has led to the biggest improvement in his time in range.
  • Another study about patient experiences found that using CGMs helped patients feel "empowered" because they were able to have access effortlessly to glucose data (such as time in range).
  • Not all patients, however, monitor their time in range obsessively, instead using their CGM to do most of the work for them. One patient says: "I just use cgm to make a reasonable effort at staying in range for a reasonable period of time, because I want each day to be a nice one without me zoning out below 4 or above 8 or 9."
  • Another patient in the same forum thread, mentions that without their CGM, information about their time in range is not available, indicating that they also rely on their CGM.
Part
06
of seven
Part
06

Constant Glucose Monitoring Devices: Competitive Landscape

Three of the top manufacturers of constant glucose monitoring devices globally are Roche Diagnostics, Medtronic, and Dexcom, Inc. Details for these companies are below.

Roche Diagnostics

  • The website for Roche Diagnostics can be found here.
  • Roche Diagnostics is a top manufacturer of constant glucose monitoring devices because it is listed in multiple market research studies as a leading company in the space and because of its revenue, which is $33.6 billion.
  • Roche Diagnostics is the medical device arm of Roche Holdings. It manufactures continuous glucose monitoring devices under the Accu-Check brand and has been offering diabetes management solutions for more than 40 years.

Medtronic

  • The website for Medtronic can be found here.
  • Medtronic is a top manufacturer of constant glucose monitoring devices because it is listed in multiple market research studies as a leading company in the space and because of its revenue, which is about $30.6 billion.
  • Medtronic manufactures a variety of medical devices including cardiac pacemakers, implantable mechanical devices, drug and biologic delivery devices, and innovative surgical instruments. The company entered diabetes care in 2001 and currently offers three different continuous glucose monitoring devices.

Dexcom Inc.

  • The website for Dexcom Inc. can be found here.
  • Dexcom Inc. is a top manufacturer of constant glucose monitoring devices because it is listed in multiple market research studies as a leading company in the space and because of its revenue, which is about $1.3 billion.
  • Dexcom Inc. develops innovative continuous glucose monitoring devices to simplify and improve diabetes management on a global basis. It developed its first continuous glucose monitoring device in 2006, seven years after the company was founded and since then, it has continued to improve its products. Its most recent device is the Dexcom G6 integrated continuous glucose monitoring system.
Part
07
of seven
Part
07

Constant Glucose Monitoring Devices: Competitive Analysis

While the pricing for products of Roche Diagnostics, Medtronic, and Dexcom, Inc., were unavailable on each of the company's websites, the rest of the requested information on the constant glucose monitoring manufacturers are detailed below.

Roche Diagnostics

Target Market

  • Roche Diagnostics' target market are "customers spanning the entire healthcare spectrum — from research institutions, hospitals and commercial laboratories to physicians and patients."

Pricing

  • Pricing for Roche Diagnostics' products and services are unavailable on the company website.
  • Roche said it is "working with payers and governments to develop flexible pricing solutions, such as Personalised Reimbursement Models and International Differential Pricing that can facilitate public reimbursement, as well as patient assistance programmes to help patients receive the treatments they need."
  • Some of Roche's products are available for purchase on Fisher Scientific. CoaguChek XS System costs $2,660.00, while the Roche Diagnostics Urisys 1100 Urinalysis Analyzer is $1,577.00.

Products

  • Roche Diagnostics has 50 products under its pharmaceuticals line and 12 product categories under its diagnostics portfolio, which are anatomic pathology, companion diagnostics, diabetes care, donor screening, microbiology, point of care, clinical chemistry and immunochemistry, decision support, digital diagnostics, lab automation and IT solutions, molecular diagnostics, and urinalysis.
  • Under Anatomic Pathology, products offered are Roche uPath enterprise software, Ventana DP 200 slide scanner, Benchmark ULTRA system, VENTANA BenchMark Special Stains system, VENTANA HE 600 system, VENTANA PD-L1 (SP263) Assays, VENTANA PD-L1 (SP142) Assays, and a Vantage Workflow.
  • Under Companion Diagnostics, products offered are cobas 4800 BRAF V600 Mutation Test, cobas KRAS Mutation Test | Roche Molecular Diagnostics, VENTANA PD-L1 (SP263) Assays, VENTANA PD-L1 (SP142) Assays, cobas EGFR Mutation Test v2 | Roche Molecular Diagnostics, and VENTANA ALK (D5F3) CDx Assay.
  • Under Microbiology, products offered are cobas 4800 CT/NG Test | Roche Molecular Diagnostics, cobas HSV 1 and 2 Test | Roche Molecular Diagnostics, cobas MRSA/SA Test | Roche Molecular Diagnostics, cobas Strep A Assay, and cobas TV/MG.
  • Under Point of Care, products offered are cobas b 221 system, CoaguChek XS Plus system, CoaguChek XS Pro system, CoaguChek XS system, cobas Influenza A/B and RSV Assay, cobas Strep A Assay, cobas Influenza A/B Assay| Roche Medical Diagnostics, and cobas Liat System | Roche Molecular Diagnostics.
  • Under Clinical Chemistry and Immunochemistry, products offered are cobas c 502 module, cobas c 513 analyzer, cobas c 702 module, cobas e 411 analyzer, cobas c 311 analyzer, cobas c 501 module, cobas e 602 module, cobas e 601 module, cobas e 801 analytical unit, Elecsys HIV combi PT 4th Generation (Ag+Ab test), Elecsys NT-proBNP, Elecsys Syphilis, Elecsys Troponin T Gen 5 STAT, cobas pro integrated solutions, cobas 4000 analyzer series, cobas 6000 analyzer series, and cobas 8000 modular analyzer series.
  • Under Digital Diagnostics, products offered are Roche uPath enterprise software, Roche Inventory Solution, cobas infinity IT solutions, Vantage Workflow, VENTANA CareGiver remote support, VENTANA Connect, cobas infinity POC solution, NAVIFY Tumor Board solution, NAVIFY clinical decision support apps, NAVIFY decision support, Viewics Analytics, VIEWICS Dx Optimization, and VIEWICS LabOPS.
  • Under Lab Automation and IT Solutions, products offered are cobas infinity IT solutions, cobas connection modules, cobas p 501 and cobas p 701 post-analytical units, cobas p 512 and cobas p 612 pre-analytical systems, cobas 8100 automated workflow series, LightCycler 2.0 System | Roche Molecular Diagnostics, MagNA Pure 24 System, MagNa Pure 96 System, Roche Inventory Solution, and Vantage Workflow.
  • Under Diabetes Care, the product offered is Accu-Chek, while Molecular Diagnostics has 38 product offerings.
  • Under Urinalysis, products offered are cobas u 411 urine analyzer, cobas u 601 urine analyzer, and Urisys 1100® analyzer.

Services

  • Services include technical documents, training and education, tracking orders, consulting services on the needs of the healthcare system, and an online quality assurance program for blood gas and electrolytes customers.

Value Proposition

  • Roche Diagnostics’ value proposition is that it focuses on conducting research on effective treatment, and producing medicines and innovative diagnostic equipment that improves patients’ quality of life.

Competitive Advantages

  • Roche’s competitive advantages are across three stages, which are discovery and development, clinical testing, and go-to-market.
  • Roche spent $11.8 billion in 2017 and $10.8 billion in 2018 on research and development and in November 2018, it "launched the first IVD pan-TRK immunohistochemistry assay, which is an in vitro diagnostic that will be used for analytical studies. It is capable of detecting tropomyosin receptor kinase (TRK) proteins in cancer." Roche is collaborating with GNS Healthcare to continue using machine learning techniques to help discover new drug candidates.
  • Clinical trials are essential for Roche and aside from doing its own testings, the company made acquisitions to have a further competitive advantage. Roche acquired healthcare technology company Flatiron Health in April 2018. "The acquisition allows both companies to accelerate progress towards data-driven personalized healthcare in cancer." In July 2018, Roche acquired genomic testing and profiling company, Foundation Medicine, to create more effective drugs that would help improve drug development and pricing.
  • "Roche entered a long-term partnership with GE Healthcare to build clinical decision support tools for physicians that use machine learning and combine genomics, biomarker, and monitoring data—getting Roche directly in front of the physician when it comes time for them to recommend treatments for patients."

Medtronic

Target Market

  • Medtronic's "devices, products and therapies are purchased principally by hospitals or physicians that typically bill various third-party payers, such as governmental programs (e.g., Medicare, Medicaid and comparable non-U.S. programs), private insurance plans and managed care plans, for the healthcare services provided to their patients."
  • Medtronic designs and manufactures devices related to "cardiac care, neurological and spinal conditions, and diabetes."
  • Medtronic partners with hospital clients to offer products and services that help medical institutions operate more efficiently.

Pricing

Products

  • For patients and caregivers, Medtronic has three categories of products, which are sensors, reservoirs, and infusion sets.
  • The sensors and reservoirs have two products each, while the infusion sets have seven products.
  • For health care professionals, Medtronic offers 15 product categories. These categories are Advanced Surgical Technology, Cardiac Rhythm, Cardiovascular, Diabetes, Digestive and Gastrointestinal, General Surgery, Neurological, Oral Maxillofacial and Dental, Patient Monitoring, Renal Care, Respiratory, Spinal and Orthopedic, Urological and Women’s Health, Urological and Urogynecology, and Ear, Nose and Throat.

Services

Value Proposition

  • Medtronic's value proposition is that their technologies, data, insights, and "expertise can be combined in partnership with hospitals, payers, and governments to help create aligned, value-based healthcare models that can deliver better patient outcomes — while maintaining or reducing costs."

Competitive Advantages

  • One of Medtronic's competitive advantages are its diverse products. It has "both high-margin products (like pacemakers or replacement hips) and lower-margin offers in its portfolio (e.g., its stent business). The former can act as a financial buffer if the less profitable business declines."
  • Another of Medtronic's competitive advantages are that it has products that were researched, "approved by the FDA, and accepted by both the market and physicians." As a result, it's successful in the medical technologies industry.
  • "Medtronic’s distinctive competencies are its growth strategies, large number of patents, and innovative products."

Dexcom Inc.

Target Market

Pricing

  • Pricing for Dexcom's products and services are unavailable on the company website. However, interested buyers can reach out to the company via its website for further information.
  • According to Healthline.com, Dexcom's G6 transmitter is available at pharmacies for a little less than $300, or for $146.04 at Costco.

Products

Services

  • Dexcom provides software apps for customers to see their glucose number on their smart device.

Value Proposition

  • Dexcom participates in "multiple diabetes trials by various academic and research institutions. Through the development of an automated system to dispense insulin based on continuous real time changes in blood sugar levels, these efforts aim to improve the lives of those with diabetes."

Competitive Advantages

  • One of Dexcom's competitive advantages is its partnership with diabetes drug maker Eli Lilly. In December 2019, Dexcom's CGM platform was integrated into Lilly's personalized diabetes management system. "As Lilly is one of the biggest diabetes players in the world, this deal should provide a major competitive advantage for DexCom in the years ahead."
  • When it comes to continuous glucose monitoring technology and innovation, Dexcom is said to be the leader. "Dexcom has the only CGM system on the market with a Class II designation from the FDA, which streamlines the approval process for its future devices."
Sources
Sources

From Part 03
From Part 04
From Part 05
Quotes
  • "We also show that patients feel significant stress and worry, and they believe they are falling short in diet, exercise, and weight maintenance. In addition, they believe diet and exercise and in-range blood glucose are the biggest drivers of improved diabetes management and mindset. "
Quotes
  • "Time in range has been one of the biggest improvements I have seen since starting on the MiniMed 670G system. Time in range is a fairly new term being used in the diabetes community for the amount of time blood glucose sits within a pre-determined range and provides a more accurate representation of blood glucose over a period of time. "
  • "What does sensor accuracy, time in range and decreased hypos have in common? Well for starters it’s a major weight off your shoulders knowing that you have a sensor you can trust with a system that is actively (with minimal user input) bringing your blood glucose into target and reducing the number of hypos you experience. It brings a great smile to my face when I wake up in the morning and look at my almost flat overnight CGM graph. "
Quotes
  • "I transitioned into a control over my sugar I have never had. I spent 85 per cent of my time in my target range after just two weeks on the 670 pump. Moving ahead I’m as optimistic as I’ve ever been about my new-found freedom and the opportunity and longevity it may provide."
Quotes
  • "Participants found CGM an empowering tool because they could access blood glucose data effortlessly, and trend arrows enabled them to see whether blood glucose was rising or dropping and at what speed. This predicative information aided short-term lifestyle planning and enabled individuals to take action to prevent hypoglycaemia and hyperglycaemia. Having easy access to blood glucose data on a continuous basis also allowed participants to develop a better understanding of how insulin, activity and food impacted on blood glucose."
Quotes
  • "While I’ve been using a continuous glucose monitor or CGM for eight years now, it’s only been in the latter portion of that period that I’ve come to appreciate the beauty of this metric. The medical and research community seem slow to fully embrace this measurement and fixate instead on the A1c number. There are definite exceptions to this A1c-centric focus and I think things are starting to change."
  • "To me, time-in-range, is the perfect diabetes statistic. A high percentage of TIR (80%-90%+) inherently means less time both high and low. When I can consistently measure 80%+ time in range, I feel better and enjoy more energy and clarity of mind. Focusing on staying in my ideal range (I aim for 65-140 mg/dL or 3.6-7.8 mmol/L) means I have to tame blood glucose variability. Variability is the main impediment to lowering average BG and spending more time in range. Lowering variability also means fewer hypos and increased safety."
From Part 07