The Battle to Control Continuous Glucose Monitoring (CGM) Market

Diabetes, a chronic condition, was once considered a disease of affluent countries, but within a short span of time, it has rapidly emerged as one of the leading cause of death in low and middle-income countries. Cause for the diabetes pandemic has been attributed to rapid urbanization, unhealthy diets, increasingly sedentary lifestyles and higher rates of obesity. According to International Diabetes Federation (IDF), globally there are about 425 million diabetes patients in 2017, Asia-Pacific region is the epicenter of this diabetes pandemic with more than half of the sufferers residing in this region. WHO studies indicate that diabetes is among the top 10 leading causes of death globally.

Diabetes leads to many serious problems to vital organs including eyes, kidneys, nerves and is a precursor to heart disease, stroke and ulcers leading to amputation of limbs. The adverse health consequences of diabetes can be avoided or delayed through regular screening and diligently complying with treatment regimes. Glucose monitoring kits are an essential part of standard diabetes care, monitoring of glucose level in blood has to be done regularly as the glucose monitoring tests provides quick response to hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar), so, that monitoring helps in planning of medications or treatment including diet adjustments, amount of insulin intake, exercise planning, etc.

Various glucose monitoring modalities such as invasive, non-invasive and lab-based methods are available, the non-invasive methods are still in infancy and in coming years may have a major impact in increasing affordability and treatment compliance, the lab-based methods are the most accurate measure to determine the patient glucose levels but are time-consuming, need trained technicians and a large volume of sample. This makes the (invasive methods) self blood glucose monitoring (SBGM) and continuous glucose monitoring (CGM) the best methods for glucose monitoring.

In SBGM, because there is the time interval between blood glucose level measurements, a sudden change in glucose levels cannot be determined and may prove fatal, also the requirement of frequent pricks of fingertips is the leading cause for less patient compliance. This is where the advent of continuous glucose monitor (CGM) plays an important role, the CGM system can determine the glucose level in real time throughout the day and night. The CGMs monitor whether the glucose level is reaching a high or low limit and notifies connected insulin pumps to release a predetermined dose of insulin from an integrated device. Currently, continuous blood glucose monitors are recommended only for people with type 1 diabetes who use intensive insulin therapy and type 2 diabetes patients who are insulin dependent. A combined insulin pump and continuous glucose monitor are also available.

Because the CGMs increase patient compliance with therapy regimes, the number of companies that are working on the development of CGM products is increasing rapidly. The current market players are adopting various approaches such as the development of implantable sensors (Senseonics), and pricing strategies (Dexcom Vs Abbott) to enhance market position. The fight for the top position in the CGM market has emerged between Dexcom, Abbott Laboratories and Medtronic. Abbott with the approval of its FreeStyle Libre2 in high-value U.S. and Europe market has emerged as a top contender, over last four quarters it has gained substantial market share and has generated revenue close to a billion dollar. With a combination of product differentiation in terms of technology and substantially increasing the duration of sensor implantation, and eliminating the need for transmitters to transfer data, Abbott’s FreeStyle Libre 2 substantially reduced the economic burden on diabetes patients FreeStyle Libre 2 (~$1,000) Vs Dexcom G6 (~$5,000) per year. Sensing the opportunity for growth, Medtronic has re-entered the standalone CGM market with the launch of its Guardian connect system. This system does not require a receiver and it directly integrates with a smartphone, the transmitter is integrated with the sensor and connects to a smartphone via Bluetooth and is rechargeable. Dexcom has integrated its latest zero fingersticks G6 CGM system with Tandem Diabetes Care’s t:slim X2 insulin pump with Basal-IQ technology that predicts low glucose levels 30 minutes ahead and suspends insulin if the glucose levels are expected to drop below 80mg/dL.

Some of the recent developments of the CGM market are, Abbott receiving U.S FDA approval in July 2018 for FreeStyle Libre 14 day’s flash Continuous glucose monitoring systems. In July 2018, Senseonics launched Eversense CGM is indicated for continuously measuring glucose levels in adults (18 years older) with diabetes up to 90 days at a time for people with diabetes. In March 2018, Medtronic Minimed received FDA approval for Guardian Connect that measures glucose levels for every 5 minutes and displays the values through Guardian connect app.

Companies operating in the CGM market are Dexcom, Inc. (U.S.), Medtronic, PLC (Ireland), Abbott Laboratories (U.S.) and Senseonics (U.S.).

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