Close Concerns Weblog

A Big Effort For Diabetes In The Big Apple

Amidst the unceasing hope for a cure to diabetes, it is easy to forget the real reality of those living with diabetes in the present.  There are too many people with diabetes who are not receiving proper care or who are unaware that they are living with diabetes. With that said, we were heartened to learn about the new Gerald J. Friedman Diabetes Institute at Beth Israel Medical Center in New York City is dedicated to providing diabetes education, care and research of the highest quality in a brand-new facility on the Beth Israel campus.

Byetta on TV ...

I just blogged at Revolution Health about the new Byetta TV ad.
http://www.revolutionhealth.com/blogs/kellyclose/new-byetta-tv-ad---ch-7783
Curious what strikes people most about the ad .. for me it is how normal they all seem with diabetes. I like watching them. If you just want to see the Byetta ad, go to

http://www.youtube.com/watch?v=UccrcOlv55I

Cheers ...!

Good news for a select few type 1s...

Between 400 and 2,000 American type 1 patients , according to medical experts at the University of Chicago, can stabilize their insulin levels with sulfonylurea pills, and forever rid themselves of daily glucose monitoring and insulin pumps.

EASD wrap up: It’s all about insulin

Our little team just got back from Amsterdam where we went to find out about diabetes research in Europe. For us, it was a great week for science and learning at EASD and we feel lucky this is part of our job. The most important newsworthy event at EASD was the interim report by the Treating to Target in Type 2 Diabetes (4-T) Study Group, comparing mix, prandial (mealtime), and basal (long-acting) insulin analog regimens for the treatment of type 2 diabetes. Overall, all three insulins worked less well than had been imagined by many of the doctors and educators with whom we spoke, with only 8-24% of patients in any of the groups reaching the A1c target of 6.5%. Admittedly, 6.5% is a very big goal for which to aim, and they all began at a starting place of ~8.5%. The results of the 4-T study, as well as the conclusions for several other talks at EASD, do suggest that more combination therapy for type 2 patients is needed to reach ever-tighter targets - probably not JUST Lantus alone, not Novolog alone, not metformin alone, etc - it might work for a bit but it won't work forever (that said - Novolog alone worked the best, suggesting that the more one takes insulin, the better one does - so wouldn't a pump be best!?). We think this study bodes well for the GLP-1 drugs (Exenatide, Liranglitide) and to some extent for the the DPP-4 inhibitors (Januvia and in Europe, Galvus), which are in some quarters replacing sulfonylureas as an add-on of choice (at least, where insurers are willing to pay for them - more places than might have been expected!). The other theme this year that really seemed to resonate was, in addition to combination therapy, earlier, more aggressive, and more personalized therapy - figuring out what fits each patient best. Here, simple is best, because we all have to get our therapy in such a hurry, at least here in the US.

Lilly's winning tagline, "we take diabetes personally"

Was nice to catch some glimpses in Amsterdam of some new ads companies have - though the real ads I'm hoping to see this week are the Byetta direct-to-consumer ads I heard about Monday but have yet to see. There are 60-second ads to be played on shows like Sixty Minutes and ads in places like Time Magazine and the Economist (Johnny reads this cover to cover every week but I rarely get past Asia, unfortunately, except when they are writing about healthcare or art, both of which they should do more of...) Anyway! I like these little "We take diabetes ... personally" spots. I find them warming and loved that they were all over Amsterdam - not just in the exhibition halls but right out there in real life. Right where diabetes should be ... and, increasingly, is. Last night at Kinko's, the man looking up our account number said, when he found it, "Close Concerns, what is Close Concerns!" I told him we we a little company that focused on the business of diabetes, and before I could say anything else he said in a resigned way "Right, I have that." "You too?" I said. Surprised, but not really. I asked him when he was diagnosed (everyone has that moment etched on their brain, don't they, whether we like it or not) and he said recently, and after we talked about that for awhile, suddenly members of the same club, he said he was taking metformin, which he didn't like, due to his upset stomach. I was sad to find out he not only didn't have a diabetes educator, but he didn't even know what one was ("what is that?"), and he also didn't know what A1c meant. I played the hip "Faces" Ad Council piece for him on youtube (www.midiabetesa1c) and that was great - he wrote down the website with zero prompting and said he was going to tell his doctor about the test. Yes, some days it seems like we've come a far way, other days less far. Anyway, it's not hard to figure out why I like that tagline, 'we take diabetes personally' ... as long as I'm thinking about it pretty much 24/7, it's nice to think others are too who are helping take care of us. I'm a marketer's dream, I know ... so of course we'll watch this campaign and let actions speak louder than words! In the meantime, I do like those images... and Eli Lilly had perhaps the best news of any company at the EASD this year when it said a couple of days ago that Dr. Robert Heine had joined the company. Dr. Heine has been involved in impressive research trial after impressive research trial over the years and it says a lot for Lilly that this luminary would join them starting next month in Indianapolis, Lilly's headquarters. Excellent win - when it's all said and done, I may or may not be drawn to an ad campaign, but it starts and ends with the science so bully for Lilly that it has drawn such an exceptional researcher to its folds. Presumably Dr. Heine feels he can make a bigger difference for patients in helping develop new medicines - we certainly hope so!

EASD Day #1 - Very busy time as diabetes hits Amsterdam...

EASD is nuts - there are 1500 people trying to get into 1000-person rooms!

Some early news:

- Lilly and Amylin had a packed room for their symposia on insulin and GLP-1 -- Lilly is in charge of the global launch and it's being introduced currently throughout Europe. The booth was packed throughout the day, as was Merck's - Byetta and Januvia are the newest drugs on the block and it will be fascinating to see how they are taken up and what reimbursement looks like throughout the EU.
- Novo Nordisk also had a day-long symposia (this seems to be a European phenomena) on Monday and this was extremely well-attended. Insulin and liraglutide, of course, were the topics of the day. Dr. Michael Nauck noted that Liraglutide dosing would be available in 0.65, 1.25, and 1.9 mg/day. This might be a little confusing to PCPs although of course choice would be viewed by those that understand the therapy well as a benefit. Weight loss seems dose dependent, starting at 1.25 and above. Novo Nordisk's booth was among the most well-traffic'd on day one, with doctors checking out the full complement of insulins as well as research on lira.
- At the end of day #1, Pfizer released 8-year safety data for Exubera. This was reassuring to see. We are excited for the next generation device. Our take is there were a number of barriers to the first generation but that if safety data continues to look good, inhaled insulin has the potential to lower the population A1c. It's fashionable, of course, to deride the class - from our view, anything that could help patients improve their A1c is a win, and if the therapy can be accessed more simply and easily, it will have a better chance. Clearly, insulin is insulin is insulin and it's hard to teach - no way around that.
- Novartis had an excellent session and note that it would likely see approval for Galvus in the EU shortly - they got some promising feedback in the last couple of months. It is expected to be able to be used with metformin, SFUs, and TZDs - this is a broader label than Januvia has overseas (it does not have SFU label in the EU). We are very impressed at all the work Novartis has done, in particular that it started a five year outcomes study two years ago - so we'll see long term data just three years from now. Very smart and terrific commitment to see from the company.
- The Abbott booth was packed with people vying for a first look at the approved continuous monitoring device Freestyle Navigator. Excitement abounds. The early generations aren't always perfect and we don't expect this to escape early hassles, but it's terrific to see it out and it will be great to watch movement toward the next generation.

Back to the canals of Amsterdam!

Diabetes to receive unprecedented public attention through Ad Council campaign ~

There is an incredible new public service campaign focused on diabetes that went live at 12:01 am EST today - Check it out, an amazing nonprofit organization called the Diabetes Care Coalition worked with the Ad Council, the ADA, and the JDRF to put together an outstanding new public service campaign focused on diabetes - this is putting diabetes big in the news today. Highly regarded doctors Ann Albright and Dr. John Buse for ADA and Paul Strumph for JDRF are key spokespeople and the message is on the importance of patients taking care of themselves and what actionable care (including knowing one's A1c) means. Fabulous since according to the press release ~80% of patients in NYT aren't aware of what their A1c is. Wow. That is moving backwards .. and hopefully this campaign will move us forwards.

Many great companies that you would imagine would be involved are - Abbott, Bayer, LifeScan, Roche, Novartis, Novo Nordisk, and Sanofi - notably absent from this list in terms of big companies in diabetes are Eli Lilly, Medtronic, and Merck, and Pfizer - the latter three are, of course, faily new to diabetes.

From this campaign, diabetes will receive unprecedented public attention, starting today (Sept. 13), with the announcement of the first national public service campaign for the disease. We believe that this campaign signals a watershed for recognizing diabetes as a public health crisis.

For more on the ads, go to www/doabetesa1c.org, www.midiabetesa1c.org, or www.adcouncil.org – you can also see the three spots on our website at www.diatribe.us (hit Know Your A1c under video) or check it out on YouTube http://www.youtube.com/watch?v=I3qgCzZq0ag (diaTribe diabetes are the search terms).

Weighing in on Bariatric Surgery and the NEJM recent reports

Nearly 180,000 people underwent gastric-bypass operations in the US last year (the most common type of bariatric surgery in which the volume of the stomach is reduced). Patients and health care professionals are taking a new look at bariatric surgery (surgery used to treat morbid obesity) in light of two landmark studies published in the August 23rd New England Journal of Medicine (NEJM).