Seismic waves running through the #diabetes community today as rumors and speculation fly after Bloomberg reports that $DXCM and $PODD are in potential merger talks. Let's take a step back and look at this logically. (a 🧵) finance.yahoo.com/news/dexcom-ta…
On the surface, this makes at least *some* logical sense. While the clinical data on the G7 shown at ATTD this year looks to be basically best-in-class, Abbott's FSL3 is a serious competitor as a full iCGM, and I'd expect @dexcom to make moves to hinder their entry...
...into the "integrated" market driving AID systems- especially given the Libre's price point.
Keep in mind that (according to FinTel), $DXCM still has a (small) piece- 1.74% of $TNDM. Tandem and Insulet aren't really competitors right now, but that could change if/when..
...Tandem's Mobi Tubeless pump launches.
Both $TNDM and $PODD have announced plans for FSL integration with their AID systems, which will threaten $DXCM's position as the "premier" CGM. abbott.mediaroom.com/2020-02-19-Abb…
Sentiment among people with #diabetes is led by people with #T1D and the products they use. Eating into DXCM's market share in that space would be a coup for Abbott. abbott.mediaroom.com/2020-06-29-Abb…
It's also worth noting that at least some of the "smart money" doesn't see this as a good/likely acquisition/merger. seekingalpha.com/news/3842140-d…
This *could* be someone (or multiple someones) at one (or both) company(ies) floating the idea to gauge sentiment, both in the financial markets, and within the #diabetes community.
There's also the recently announced departure of PODD's CEO to consider. Is it related? Was this a protest move? The board removing a potential roadblock? There's still probably more shoes still to drop. medtechdive.com/news/insulet-c…
I don't see any obvious antitrust issues coming into play if this does happen. $MDT is still the 800-lb gorilla in the space, but they're still playing catch-up in the US AID market. OP5 and CIQ both kick the snot out of the 770, and the 780 isn't (yet) approved.
So, to sum up- I don't see this as meriting a freak-out. It's interesting, and there's a lot of moving pieces that are up in the air, and there are signs that it could be more than just a rumor. From some angles, a PODD/DXCM merger makes sense. From others, less so.
All that aside, as insulin pumps become software-controlled "digital syringes" and CGMs improve in accuracy and responsiveness, commoditization of those products is somewhat inevitable, and the industry is probably due for some consolidation.
Patient preferences/experiences and the software that runs the systems will be the differentiating factors. In the end, a CGM is just a data source, and a pump is just a delivery mechanism. 🤷♂️
Update from upthread. I was relying on @fintel_io's data re: DXCM still owning a piece of Tandem. That info is apparently outdated.
14-day comparisons! Photo 1 (2/27-3/12) is the baseline. #2 (3/13-3/26) is full #closedloop with Humalog and #DynamicISF. #3 (4/20-5/03) is full closed loop w/a 50/50 Humalog/Lyumjev mix. Best results with faster insulin. TIR gains are minimal (starting from a high baseline). 1/?
What jumps out at me are the reductions in variability. Also, the Lyumjev/Humalog results probably would have been even higher TIR and less variable had the restaurant not messed up last night, delivering basically a whole chicken rather than the 2 chicken burritos I ordered. 2/?
Common conditions in full #closedloop- basically no manual boluses. Even if a meal sent me close to 300 (16.7). Manual boluses were only applied when the loop was not running (comms failures, #CGM warmup, etc) maybe 2/week. No carb counting at all. Ate when hungry. 3/?
Since people are going gaga over the Vertex Pharma T1D stem-cell announcement yesterday, here's a quick review of where we are, and how we got here: 🧵👇
We've been able to make islets and beta cells from stem cells for quite a while, too. Here's a review article from 2012 (yes, almost a decade ago) summarizing progress on stem-cell derived beta cells up to that point: ncbi.nlm.nih.gov/pmc/articles/P…