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ChangeWave Research: Trends in Diabetes
September 2, 2004
ChangeWave Research Report:
Trends in Diabetes - 2004
Strong Preference for Inhalable Insulin; Exanatide Seen as Promising
Along With “Increased Self Monitoring” & “Earlier Detection” Products
Overview
This past February we surveyed Alliance healthcare members knowledgeable about
Diabetes and found diabetes cases to be on the rise – mainly because of obesity.
Inhalable Insulin was identified as the biggest winner for new therapies, and an increase
in self-monitoring was seen as the most significant new trend.
To follow-up, during the week of August 10 – 16, 2004, we surveyed Alliance Healthcare
members who are knowledgeable about Diabetes. A total of 110 healthcare members
participated, including 48 doctors. Here’s what we found:
(A) Overall Trends in Diabetes
 Most Promising New Product/Service Areas. “Increase in Self Monitoring” (45%) is
still seen as the most promising new product/service area in Phase II or III clinical
trials, followed by “Earlier Detection” (38%) and “Type II Insulin Based Therapies”
(27%).
 Biggest Gainers. In terms of momentum, “Earlier Detection” experienced the largest
increase (24 percentage pts) since the last time we conducted an Alliance Healthcare
survey on Diabetes trends (February 2004). “Increase in Self-Monitoring” also
improved from the previous survey by 17 percentage pts. On the down side, “NonInsulin Based Therapies” declined the most, dropping 9 percentage pts since Feb.
2004.
 Drugstore/Medical Supply Stores Preferred for Purchasing. Eighty-five percent of
respondents say their patients prefer to purchase self-testing and treatment products
from “Drugstore/Medical Supply Stores,” up 10 percentage pts from the February 2004
survey. “Doctor’s Office” (20%) and “Via the Internet” (19%) came in second and third,
respectively.
 Innovative Approaches to “Cure” Diabetes Need More Time. When given a list of
current innovative approaches to cure diabetes, a majority of respondents (54%) says
none will achieve success within the next 12-24 months. Significantly, 18% see Islet
Cell Transplantation to Produce Insulin” as having the best chance of succeeding in
the marketplace within 12-24 months, the only approach to reach double-digits.
 The Small Companies Most Likely to Succeed. Alteon (8%), CuraGen (8%), and
Insmed (8%) were the small companies identified as most likely to succeed over the
next 12-24 months. A percentage point behind them were Cholestech (7%) and
Emisphere Technologies (7%), followed by Stemcells Inc (6%).
Copyright ©2004 ChangeWave Research
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ChangeWave Research: Trends in Diabetes
(B) Inhalable Insulin
 Existing Patients Would Prefer Inhalable Insulin Over the Injectable Form. A
majority of Alliance healthcare respondents (61%) believe “Greater than 50%” of
existing diabetes patients would prefer to use an inhalable form of insulin rather than a
traditional injectable form. An even higher proportion of Doctors (67%) believe this to
be the case.
 Newly Diagnosed Patients Would Prefer Inhalable Insulin Even More. Better than
three-quarters (80%) of respondents believe that “Greater than 50%” of newly
diagnosed patients would prefer to use an inhalable form of insulin rather than a
traditional injectable form. Again, an even higher percentage of doctors (88%) believe
this to be the case.
 Most Patients Won’t Avoid Inhalable Insulin – Even if Pulmonary Testing and/or
Supplemental Injections are Required. The majority of respondents (61%) believe
patients won’t avoid Inhalable Insulin treatments even if it requires follow-up
pulmonary testing or supplemental injections. However, 27% of respondents say
patients would avoid Inhalable Insulin if it requires follow-up pulmonary testing or
supplemental injections.
(C) Exenatide
 Among Those Familiar With Exenatide, the Consensus is it’s Promising. Among
the one-out-of-five respondents familiar with Exenatide, 43% believe that more than
half of Type II diabetes patients not responding to oral medications will want to use
Exenatide to prevent progression of their diabetic condition.
Bottom Line: As Diabetes cases continue to rise, these survey results show promise for
several new types of therapies and technologies. First, “Increase in Self Monitoring” is
seen as the most promising new product/service area in Phase II or III clinical trials,
along with “Earlier Detection.” Secondly, Alliance healthcare respondents also see a
strong preference for Inhalable Insulin among both existing and newly diagnosed
patients. Moreover, Exenatide also appears to have real market potential as an
alternative to oral medications for treating Type II Diabetes, although the drug treatment
is still unfamiliar to many respondents.
These results notwithstanding, when given a list of current innovative approaches to
“cure” Diabetes, a majority of respondents (54%) still says none will achieve success
within the next 12-24 months (although 18% did see “Islet Cell Transplantation to
Produce Insulin” as having the best chance). Rather, innovative approaches to “cure”
diabetes that are currently being pursued, are seen by a majority of respondents as being
more than two years away from success.
The ChangeWave Alliance is a group of 4,600 highly qualified business, technology, and medical professionals in
leading companies of select industries—credentialed professionals who spend their everyday lives working on the
frontline of technological change. ChangeWave surveys its Alliance members on a range of business and investment
research and intelligence topics, collects feedback from them electronically, and converts the information into
proprietary quantitative and qualitative reports.
Helping You Profit From A Rapidly Changing World ™
www.ChangeWave.com
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ChangeWave Research: Trends in Diabetes
Table of Contents
Summary of Key Findings ............................................................................................ 4
The Findings .................................................................................................................. 5
(A) Overall Trends in Diabetes ............................................................................ 5
(B) Inhalable Insulin ............................................................................................ 15
(C) Exenatide...................................................................................................... 17
(D) Medicare and Obesity ................................................................................... 19
ChangeWave Research Methodology ....................................................................... 22
About ChangeWave Research ................................................................................... 23
Copyright ©2004 ChangeWave Research
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ChangeWave Research: Trends in Diabetes
I. Summary of Key Findings
Inhalable Insulin
Overall Diabetes
Trends
Most Promising New
Product/Service Areas
 Increase in SelfMonitoring (45%)
 Earlier Detection (38%)
 Type II Insulin Based
Therapies (27%)
Where Do Patients Prefer
to Purchase Self-testing
and Treatment Products?
 Drugstore/Medical
Supply Stores (85%)
 Doctor’s Office (20%)
 Via the Internet (19%)
Small Companies Most
Likely to Succeed – Next
12-24 Months:
 Alteon (8%)
 CuraGen (8%)
 Insmed (8%)
 61% of respondents
believe the majority
of “existing” diabetes
patients would prefer
inhalable insulin over the
traditional injectable form
 And 80% believe the
majority of “newly”
diagnosed patients
would prefer inhalable
insulin over the injectable
form
 Another 61% believe
most patients won’t avoid
Inhalable Insulin even if it
required follow-up
pulmonary testing and/or
supplemental injections
 But 27% say patients
would avoid the treatment
if it required follow-up
testing/ treatment
Innovative Approaches
to “Cure” Diabetes
Need More Time
 A majority of respondents
(54%) says none of the
current innovative ‘cure’
approaches for diabetes
will achieve success
within the next 12-24
months
 But 18% do see “Islet
Cell Transplantation to
Produce Insulin” as having
the best chance of
succeeding within the
next 12-24 months
Exenatide
 Consensus is it’s
Promising – 43% of
respondents familiar with
the treatment believe that
more than half of Type II
diabetes patients not
responding to oral
medications will want to
use Exenatide
Introduction
This past February we surveyed Alliance healthcare members knowledgeable about
Diabetes and found diabetes cases to be on the rise – mainly because of obesity.
Inhalable Insulin was identified as the biggest winner for new therapies, and an increase
in self-monitoring was seen as the most significant new trend.
To follow-up, during the week of August 10 – 16, 2004, we surveyed Alliance Healthcare
members who are knowledgeable about Diabetes. A total of 110 healthcare members
participated, including 48 doctors.
The findings focus on four key areas:
(A) Overall Trends in Diabetes
(B) Inhalable Insulin
(C) Exenatide
(D) Medicare and Obesity
Copyright ©2004 ChangeWave Research
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ChangeWave Research: Trends in Diabetes
II. The Findings
Trends in Diabetes – 2004
Total Respondents: (n = 110)
Doctors: (n = 48)
Healthcare Workers: (n = 26)
Other Respondents: (n = 36)
(A) Overall Trends in Diabetes
(1) Question Asked: There are a host of new diabetes products/ services in Phase II
or Phase III clinical trials. Which of the following product/service areas would you
say look the most promising? (Choose No More Than Two)
Total
Healthcare
Other
Doctors
Respondents
Workers Respondents
Increase in Self-Monitoring
45%
44%
54%
39%
Earlier Detection
38%
27%
35%
56%
Type II Insulin Based Therapies
27%
29%
27%
25%
Increase in Self-Treatment
24%
27%
19%
22%
Non-Insulin Based Therapies
24%
40%
12%
11%
Type I Insulin Based Therapies
11%
13%
12%
8%
Don't Know
7%
2%
12%
11%
Other
2%
0%
0%
3%
Most Promising New Product/Service Areas. “Increase in Self Monitoring” (45%) is
seen as the most promising new product/service area in Phase II or III clinical trials,
followed by “Earlier Detection” (38%) and “Type II Insulin Based Therapies” (27%).
Earlier Detection
Increase in Self-Monitoring
Increase in Self-Treatment
Type I Insulin Based Therapies
Type II Insulin Based Therapies
Non-Insulin Based Therapies
Current
Survey
Aug ‘04
38%
45%
24%
11%
27%
24%
Previous
Survey
Feb ’04
14%
28%
21%
12%
30%
33%
Net Gain
+24
+17
+3
-1
-3
-9
Biggest Gainers. In terms of momentum, “Earlier Detection” experienced the largest
increase (24 percentage pts) since the last time we conducted an Alliance Healthcare
survey on Diabetes trends (February 2004). “Increase in Self-Monitoring” also improved
from our previous survey by 17 percentage pts.
On the down side, “Non-Insulin Based Therapies” declined the most, dropping 9
percentage pts since Feb. 2004.
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ChangeWave Research: Trends in Diabetes
(2) Question Asked: From the patient perspective, what is the preferred way of
purchasing self-testing and treatment products? (Choose No More Than Two)
Total
Healthcare
Other
Doctors
Respondents
Workers Respondents
Drugstore/Medical Supply Store
85%
85%
88%
83%
Doctor's Office
20%
21%
15%
22%
Via the Internet
19%
17%
19%
22%
Catalog/Phone Service
10%
10%
15%
6%
Don't Know
5%
4%
4%
8%
Other
2%
0%
4%
3%
Net Gain – August 2004
Drugstore/Medical Supply Store
Doctor's Office
Via the Internet
Catalog/Phone Service
Don't Know
Other
Current
Survey
Aug ‘04
85%
20%
19%
10%
5%
2%
Previous
Survey
Feb ‘04
75%
13%
24%
15%
10%
3%
Net Gain
+10
+7
-5
-5
-5
-1
Drugstore/Medical Supply Stores Preferred for Purchasing. An overwhelming 85%
of respondents say their patients prefer to purchase self-testing and treatment products
from “Drugstore/Medical Supply Stores,” up 10 percentage pts from the February 2004
survey. “Doctor’s Office” (20%) and “Via the Internet” (19%) came in second and third,
respectively.
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ChangeWave Research: Trends in Diabetes
(3) Question Asked: Several innovative approaches to "cure" diabetes are
currently being pursued by medical researchers. Of the following approaches,
which one do you believe has the best chance of succeeding in the marketplace
within the next 12 to 24 months?
Islet Cell Transplantation (to
produce insulin)
Genetic Manipulation (creation
of "pseudo" islet cells for
transplant)
Pancreas Transplantation
Artificial Pancreas Development
None of These will Achieve
Success Within the Next 12-24
Months
Don't Know
Total
Healthcare
Other
Doctors
Respondents
Workers Respondents
18%
17%
19%
19%
5%
4%
0%
11%
3%
2%
54%
4%
2%
56%
0%
4%
46%
3%
0%
58%
17%
17%
31%
8%
Innovative Approaches to “Cure” Diabetes – Need More Time. When given a list of
current innovative approaches to cure diabetes, a majority of respondents (54%) says
none will achieve success within the next 12-24 months. Significantly, 18% see “Islet
Cell Transplantation to Produce Insulin” as having the best chance of succeeding in the
marketplace within the next 12-24 months, the only category to reach double-digits.
(3A) Question Asked: Why?
Sample of Alliance Member Responses:
a. None of These will Achieve Success Within the Next 12-24 Months (54%)
Editors Note: Many of the respondents who chose this category said the 12-24 month
timeframe is too short to achieve success, but were generally optimistic of the longerterm potential of these approaches.
 MIN9289 writes, "Some success will be obtained in the mentioned time period, but a
longer time period will be required before results offer a good handle on which of these
therapies appears most promising."
 MJW5673 writes, "Time frame too short. Further out, several of the approaches are
likely to be successful."
 VDS1474 writes, "All these "cures" are still in the experimental phase."
 AGR0426 writes, "Path to Phase III approval would likely take at least twice the time
stated."
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ChangeWave Research: Trends in Diabetes
 KCO6695 writes, "I don't think that the technology is far enough along for wide spread
usage."
 WRT9962 writes, "The sequella of whole-organ transplantation are still more
formidable than injections and the other technologies are simply MORE than 24
months away. I like to think that pseudo islets and/or islet transplants are close, but
realistically, I'm not sure they are! For me, if I were in need, I'd want a transplant that
was specific to me...that would keep me from having to take immune-suppressing
drugs...that's the big holdup. It's coming, but not in the next two years."
 SER5830 writes, "These are approaches for type 1 which is less than 10% of the
diabetic market. These procedures are very costly and are invasive and of limited
value. The timeline, if they go, is more like 4-5 years."
 KES5963 writes, "Needs prolonged testing and FDA approval."
 BCA3438 writes, "Long lead times and FDA approval."
 ELW4764 writes, "Transplants are for 'end stage' patients and, to me, just buy time at
best. Islet cell could be the 'cure' but doesn't appear to be 'ready for the market' within
12-24 months ... maybe never."
 DRK5861 writes, "Lots of problems to still work out."
 WLU8236 writes, "Pancreas transplantation: major surgery, immunosuppression
required, scarcity of donor organs, only applicable for selected type I diabetes patients
(possibly in combination with kidney transplantation). Islet cell transplantation: results
still variable though improving, shortage of donor organs, procedure still deemed
experimental. Artificial pancreas: technology continues to improve but remains
experimental; market success will take longer than 1-2 years. Genetic manipulation:
promising in the long term, a whole range of different approaches falls under this
heading, major research and clinical issues remain to be resolved. Success in
marketplace is many years away."
 TRU7599 writes, "Time scale too short."
 MAD2680 writes, "R & D development timelines along with extended trials will
elongate approvals."
 LEO7024 writes, "Too far from efficacy/approval."
 ZSA8198 writes, "Too soon to complete necessary research."
 TAC8398 writes, "Delay from clinical trials to FDA approval would most likely take
longer than 2 years."
 BOL2762 writes, "Needs lots of time to develop."
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ChangeWave Research: Trends in Diabetes
 ELS7356 writes, "It will take 4-5 years of testing and clinical trials before any of these
would be ready for marketing."
 DRJ5952 writes, "Not there yet technologically."
 8486810 writes, "More research needed."
 ALF1482 writes, "Too soon, maybe in 5-10 yrs."
 CAR8242 writes, "There is a shortage of organs for transplantation, islet cell
transplantation still requires procurement and possibly culture issues which are not
near completion."

CEN9132 writes, "The procedures sound too complicated. They will likely gain
popularity very slowly and gradually."
 COB6520 writes, "Patients must take responsibility for their health and change their
diet, exercise and lose weight. Trying to "cure" diabetes without responsibility goes
against the laws of the universe and will never work long-term."
 PEG8651 writes, "Inability for reimbursement from insurance."
 LON6196 writes, "Too complex."
 FOR3567 writes, "Complex biology more complex regulation."
 KVR1320 writes, "Pancreas and islet cell transplant are used in conjunction with renal
transplants. Isolated pancreas or islet cell transplants are years away."
 BIN8250 writes, "There is the problem of rejection with any transplant. The injections
are trivial in any event. The artificial pancreas may be expensive and cumbersome..."
 JAN4089 writes, "Some are already used, but achieved only small application."
 ALA8640 writes, "Although Pseudo Islet cells are probably less immunogenic, rejection
might still be a problem and takes sometimes many months to ascertain."

KUR3102 writes, "The research for these will not translate into products before 10
more years."

GHM8270 writes, "There may be limited use, but not large scale commercial use
within the next 2 years."

WPW6938 writes, "Not sure that progress is far enough along to say that success will
be achieved in that time frame."

GRA1199 writes, "We are not far enough advanced."
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ChangeWave Research: Trends in Diabetes

MIK6029 writes, "Too many rejection problems with transplantations; not enough cells
to be harvested for patients."

GOO3505 writes, "Large scale studies need to be completed before something could
be thought to be used for large amounts of people. Benefits need to outweigh risks."

STE3218 writes, "To much leg work to be done. Not well enough studied to be
adopted and would still rely on increase in stem cell lines."

PWG2815 writes, "Regulatory pathway issues will slow down the release to the
market place."

GDA7384 writes, "Because in the vast majority of people the problem is insulin
resistance at target cell level as well as pancreatic failure in varying degrees."

WIL1338 writes, "Creating viable cells equivalent to body cells and able to produce
insulin, regulate glucose level, is complicated and will require long term testing which
goes over the 2 years indicated above."

KEN1900 writes, "Type one diabetes is about more than insulin. Transplantation is
very expensive and creates its own problems with immunosupression."

SCI3493 writes, "Alogenate transplantation would not be suitable for diabetics due to
lower immune responses and increased susceptibility to infection. Genetic
manipulation would be promising but it still has long way to go."

SNU3210 writes, "They are not far enough along for mass use or acceptance by
insurers as proven therapies."
b. Islet Cell Transplantation (18%)
 SBE5857 writes, "Most developed as of today. Cannot predict time required as
progress is always slow."
 MAM7387 writes, "There are already methods of shielding transplanted cells from the
immune system. Of course the great breakthrough will come with gene therapy but
unlikely within 12-24 months. ..."
 DAV6135 writes, "If any of these therapies does actually achieve success and
approval for use in the next 2 years, I believe that the Islet Cell Transplantation would
be the one to be approved. Whether it can do that within the next 2 years is debatable
however."
 GOP2712 writes, "Has been tried for several years."
 SSR9050 writes, "The technology to do this is most advanced."
 COA5836 writes, "Most research interest."
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ChangeWave Research: Trends in Diabetes
 CLE2459 writes, "Genetic manipulation holds a better promise long term, however,
Islet Cell Transplantation has a better chance within the next 12-24 months due to the
positive track record and "user familiarity" with other "organ" transplants, i.e. kidney,
liver, etc."
 ALA7205 writes, "Development is proceeding well."
 MAK7890 writes, "Procedure has been developing for many years."
c. Genetic Manipulation (5%)
 AME1382 writes, "Availability in near future."
d. Pancreas Transplantation (3%)
 WSU8151 writes, "Transplant of the pancreas is a stop gap measure for now. Islet
cell, artificial, and genetic manipulation will be successful but not in 24
months...probably in 5 to 10 years."
 SR10005 writes, "There are better immunosuppressive drugs now so that the success
of pancreatic transplantation is improving. The other therapies are still at least 4 to 5
years away from reality."
e. Artificial Pancreas Development (2%)
 WOO7602 writes, "Patients are currently wearing the Minimed Pump with a sensor
which gives them real-time blood sugar information. This is BY Far the closest
technology to curing diabetes, and will likely happen Many years before islet cell
transplantation becomes commonplace."
 JGR0393 writes, "No rejection issues."
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ChangeWave Research: Trends in Diabetes
(4) Question Asked: The small companies listed below are all involved in various
aspects of the prevention, treatment and monitoring of diabetes. Of the companies
that you are familiar with which - if any - do you think is most likely to succeed
over the next 12 - 24 months? (Choose No More Than Two)
Alteon (compounds targeting
A.G.E. Pathway)
CuraGen (partnering with Bayer
on small molecule therapeutic)
Insmed (IGF-I regulates glucose
uptake)
Cholestech (Diagnostics for
Glucose)
Emisphere Technologies (oral
insulin)
Stemcells Inc. (pancreatic stem
cell)
SpectRx (glucose monitor,
insulin device)
Biotech Holdings (Sucanon
diabetes drug)
Amylin Pharmaceuticals*
Nutrition 21 (chromium
picolinate/compounds)
Hi-Tech Pharmacal (branded
OTC products)
Keryx Biopharmaceuticals
(KRX-101 for diabetic
nephropathy)
Lexicon Genetic (small molecule
drug candidates)
Not familiar with any of these
companies or their
products/technologies
Don't Know
Other
Total
Healthcare
Other
Doctors
Respondents
Workers Respondents
8%
6%
4%
14%
8%
10%
0%
11%
8%
6%
12%
8%
7%
10%
4%
6%
7%
6%
12%
6%
6%
2%
4%
14%
5%
2%
4%
6%
4%
2%
4%
8%
3%
2%
2%
4%
0%
0%
6%
0%
1%
2%
0%
0%
1%
2%
0%
0%
1%
2%
0%
0%
25%
29%
31%
14%
40%
2%
42%
0%
46%
4%
33%
3%
* Note that Amylin Pharmaceuticals was not provided in the pick list. In the “Other” category, 3% of
respondents named Amylin in their response.
The Small Companies Most Likely to Succeed. Alteon (8%), CuraGen (8%), and
Insmed (8%) were the small companies identified as most likely to succeed over the next
12-24 months. A percentage point behind them were Cholestech (7%) and Emisphere
Technologies (7%), followed by Stemcells Inc (6%).
Copyright ©2004 ChangeWave Research
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ChangeWave Research: Trends in Diabetes
(4A) Question Asked: Why?
Sample of Alliance Member Responses:
a. Alteon (8%)
 WRT9962 writes, "Alteon because they're the big player in that niche as far as I can
tell...and it's going to be a ‘big’ niche, I think...though ‘maybe’ more then 24 months
out…”
 HER4689 writes, "Cost and ease of use."
 FLO8176 writes, "Complex disease, targeting pathways may be more sensible …”
b. CuraGen (8%)
 GHM8270 writes, "Curagen/Bayer partnering on therapy will more rapidly introduce to
larger population group..."
 8486810 writes, "I believe they are working on inhaled insulin."
 FLO8176 writes, " ... Partnering with a large pharma gives access to a progression
path for following up in relevant disease models etc."
c. Insmed (8%)

GDA7384 writes, "… Target cell insulin resistance critical so glucose uptake
modulators will become more and more important."

WIL1338 writes, "Insmed is reaching phase 3 testing. The others I am not aware of
reaching that phase."
d. Cholestech (7%)
 MES5884 writes, "Easy to use in a clinic or office setting."
 TAC8398 writes, "Pipeline"
 GHM8270 writes, "… Cholestech for the diagnostic and management."
e. Emisphere Technologies (7%)
 LEO7024 writes, "Better acceptance under current conditions, FDA or patient
willingness to adapt."
f. Stemcells Inc. (6%)
 JES5551 writes, "Best approach but will only have demonstrated it - at best."
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ChangeWave Research: Trends in Diabetes
 WRT9962 writes, "Stem cells are gonna be big...but again...’maybe’ more than 24
months."
h. SpectRx (5%)

ELS7356 writes, "Improved diagnostics will be the most successful approach over the
next year or two."
g. Biotech Holdings (4%)
 WLU8236 writes, "Because Biotech Holdings will shortly launch Sucanon (in Mexico).”
 WPW6938 writes, "Sucanon will begin to be marketed in Mexico in September and
apparently has been OK’d for marketing in several other countries. It augments insulin
utilization in Type 2 DM.”
i. Keryx Biopharmaceuticals (1%)

WPW6938 writes, "Keryx KRX-101 has shown significant efficacy in phase II trials in
treating diabetic nephropathy and it has been sold in Europe for over 20 years with a
well-known safety profile."
j. Other – Amylin Pharmaceuticals (3%)

GOO3505 writes, "They are partnering with Eli Lilly to bring to market the use of
Exenatide which should we widely used."

WLU8236 writes, "Amylin expects FDA approval for Exenatide."
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ChangeWave Research: Trends in Diabetes
(B) Inhalable Insulin
(5A) Question Asked: Focusing on inhalable insulin, what percentage of existing
Diabetes patients do you think would prefer to use an inhalable form of Insulin
rather than a traditional injectable form?
Total
Healthcare
Other
Doctors
Respondents
Workers Respondents
0-10%
4%
4%
4%
3%
11%-20%
4%
6%
0%
3%
21%-30%
11%
4%
15%
17%
31%-50%
14%
15%
12%
14%
Greater than 50%
61%
67%
58%
53%
Don't Know
7%
4%
8%
11%
0-10%
11%-20%
21%-30%
31%-50%
Greater than 50%
Current
Survey
Aug ‘04
4%
4%
11%
14%
61%
Previous
Survey
Feb ‘04
7%
4%
4%
18%
63%
Existing Patients Would Prefer Inhalable Insulin Over the Injectable Form. A
majority of Alliance healthcare respondents (61%) believe “Greater than 50%” of existing
diabetes patients would prefer to use an inhalable form of insulin rather than a traditional
injectable form. An even higher proportion of Doctors (67%) believe this to be the case.
(5B) Question Asked: And what percentage of newly diagnosed Diabetes patients
do you think would prefer to use an inhalable form of Insulin rather than a
traditional injectable form?
Total
Healthcare
Other
Doctors
Respondents
Workers Respondents
0-10%
2%
2%
0%
3%
11%-20%
1%
0%
4%
0%
21%-30%
5%
4%
4%
8%
31%-50%
5%
2%
4%
8%
Greater than 50%
80%
88%
77%
72%
Don't Know
6%
4%
8%
8%
Other/No Answer
1%
0%
4%
8%
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ChangeWave Research: Trends in Diabetes
0-10%
11%-20%
21%-30%
31%-50%
Greater than 50%
Current
Survey
Aug ‘04
2%
1%
5%
5%
80%
Previous
Survey
Feb ‘04
6%
2%
2%
9%
78%
Newly Diagnosed Patients Would Prefer Inhalable Insulin Even More. More than
three-quarters (80%) of respondents believe that “Greater than 50%” of newly diagnosed
patients would prefer to use an inhalable form of insulin rather than a traditional injectable
form. Again, an even higher percentage of doctors (88%) believe this to be the case.
(6) Question Asked: Some forms of inhalable insulin may require Diabetic patients
to undergo follow-up pulmonary testing. Other forms may require patients to take
supplemental (but less frequent) insulin injections. Do you think either of these
inhalable forms would result in large numbers of patients avoiding the treatment
and staying with the traditional injectable form?
Yes, Having to Undergo Followup Pulmonary Testing would
cause large numbers of patients
to avoid the treatment
Yes, Having to Undergo
Supplemental Insulin Injections
would cause large numbers of
patients to avoid the treatment
Both Forms would cause large
numbers of patients to avoid the
treatment
Neither Form would cause large
numbers of patients to avoid the
treatment
Don't Know
Total
Healthcare
Other
Doctors
Respondents
Workers Respondents
8%
8%
12%
6%
14%
13%
12%
17%
5%
4%
12%
3%
61%
67%
54%
58%
12%
8%
12%
17%
Most Patients Won’t Avoid Inhalable Insulin – Even if More Testing and/or
Supplemental Injections are Required. The majority of respondents (61%) believe
patients won’t avoid Inhalable Insulin treatments even if it requires follow-up pulmonary
testing or supplemental injections.
A total of 27% of respondents say patients would avoid Inhalable Insulin if it requires
follow-up pulmonary testing or supplemental injections.
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ChangeWave Research: Trends in Diabetes
(C) Exenatide
(7) Question Asked: In your opinion, if Exenatide is approved, what percentage of
Type II diabetes patients not responding to oral medications will want to use it to
prevent progression of their diabetic condition?*
Total
Healthcare
Other
Doctors
Respondents
Workers Respondents
0-10%
13%
0%
0%
33%
11%-25%
22%
42%
0%
0%
25%-50%
22%
8%
50%
33%
50%-75%
39%
50%
50%
22%
Greater than 75%
4%
0%
0%
11%
Don't Know
0%
0%
0%
0%
Other
0%
0%
0%
0%
*Note that only 21% of the total respondents were familiar with Exenatide, and the above results present
the responses of that group.
Among Those Familiar With Exenatide, the Consensus is it Looks Promising. Of
the 21% of respondents familiar with Exenatide, 43% believe that more than half of Type
II diabetes patients not responding to oral medications will want to use Exenatide to
prevent progression of their diabetic condition.
(7A) Question Asked: If Exenatide is approved, do you think it will succeed or fail
in the marketplace? Why?
All respondents who provided an opinion as to whether Exenatide, if approved, will
succeed or fail, say they think it will succeed. Some see modest or limited success for
the drug therapy.
Sample of Alliance Member Responses:
a. Definite Success

WSU8151 writes, "Preliminary data looks quite good and it should succeed in the
market place...I’m also intrigued by its potential to protect beta cells. Also the various
forms will have to be compared (albumin based)..."

WLU8236 writes, "I expect it to succeed in large part because it has the marketing
power of Eli Lilly behind it."
 WOO7602 writes, "It will succeed because it targets one of the earliest defects in the
Type 2 Diabetes natural history (post-prandial hyperglycemia). I predict its HUGE
market will be in its eventual use in prevention of Type 2 diabetes in those at risk."
 SSR9050 writes, "Succeed. It will prevent vast numbers from going on insulin."
 GOO3505 writes, "It will definitely succeed."
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ChangeWave Research: Trends in Diabetes
 WPW6938 writes, "Succeed - many Type II drugs have adverse effects (e.g., GI side
effects) and the drop-out rates in the Exenatide trials were fairly low due to nausea,
indicating that most patients tolerated the side effects. Many Type II diabetics are also
using supplemental doses of insulin anyway. Exenatide studies have shown lower
A1C levels as well as a beneficial weight loss during the treatments. Researchers
studying the drug think that it may also prevent further loss of pancreatic beta cells, in
which case it would likely be recommended to be used as an initial treatment if beta
cells are preserved."
 DB76584 writes, "Succeed. Evidence that Exenatide regenerates beta cells in
pancreas. Also, Exenatide causes weight loss, and since obesity is a big problem with
diabetics, this will be helpful."
 DB76584 writes, "Succeed. Evidence that Exenatide regenerates beta cells in
pancreas. Also, Exenatide causes weight loss, and since obesity is a big problem with
diabetics, this will be helpful."
 HER4689 writes, "Succeed. Benefit of weight loss will help in marketing."
 SNU3210 writes, "I think it will succeed because people are reluctant to go on insulin
therapy for fear of becoming completely dependent on it as well as the weight gain and
difficulty in adjusting dosages based on food intake."
b. Modest/Limited Success

SER5830 writes, "Modest success because the side effect issue will not go away"

MAD2680 writes, "Succeed within limits of their total available market to penetrate.
There appears to be ‘side effects’ that may be beneficial to patients regarding weight
loss, etc."

LON6196 writes, "Succeed for a while until something new comes along in 6-12
months."

ALA7205 writes, "Limited success."

SBE5857 writes, "Low uptake."
 STE3218 writes, "Will probably see limited success as it is tried in patients that are
failing traditional therapy."
 ECR4086 writes, "The endocrinologists I have spoken with do not think this will be a
blockbuster drug, but will just be another option."
 FRE9804 writes, "The type II market is so large and growing, there is a place for many
of these drugs to make money in this market until a bio-artificial pancreas is
developed."
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ChangeWave Research: Trends in Diabetes
(D) Medicare and Obesity
(8) Question Asked: In mid-July, Health and Human Services opened the door for
Medicare to begin considering obesity an illness, which would allow treatments to
be covered solely for treating obesity. Based upon this change, can you think of a
product(s) (e.g., dietary, surgical, pharmacological) that would likely qualify as a
Medicare treatment for obesity that would also have good market acceptance?
Sample of Alliance Member Responses:
a. Surgery
 GAN3623 writes, "I think gastric stapling would qualify for treatment and be accepted
in the market place."
 CLE2459 writes, "Gastric bypass or clip, but only in severe cases (morbid obesity)."
 KVR1320 writes, "Major push is towards surgery which remains the only documented
successful treatment."
 GOP2712 writes, "Gastric bypass/banding surgery."
 DAV2704 writes, "Stapled stomach."
 WSU8151 writes, "Knowing how government works, I think that the process will be
long and slow to take effect. First, doctors will be paid for office visits involving
obesity counseling, and more surgical procedures will be covered. I don’t think that
weight loss programs will initially be covered as their success rates vary."
 JAM8235 writes, "Surgery for lap-band or gastric-bypass."
 BCA3438 writes, "Stomach Banding, X-FAT (Vital Living-VTLV)."
 MIN9289 writes, "Intestinal/stomach "stapling" procedures."
 JRJ9829 writes, "…lap banding."
 ELW4764 writes, "We all want quick fixes, thus surgery will be 'in'."
 ZEB4159 writes, "Bariatric surgery - however, good market acceptance is debatable."
 ZSA8198 writes, "Gastric Banding and gastric bypass."
 LON6196 writes, "Liposuction."
 SR10005 writes, "Gastric by-pass is an obvious effective surgical modality. Other
than that I don't know of anything on the horizon which is more effective without the
associated side effect problems."
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ChangeWave Research: Trends in Diabetes
 DRJ5952 writes, "Stomach staple surgery."
 POR7751 writes, "Gastric banding (minimally invasive) but not bariatric surgery."
 JAN4089 writes, "Surgical gastric bypass and surgical gastric bending are increasing
strong."
 SBE5857 writes, "Only clinically proven and generally medically accepted therapies
will be covered. Thus, think of banding approaches and liposuction."
 8486810 writes, "...The Roux-En-Y Bypass (Surgical) Procedure."
 JGE3402 writes, "Surgical treatment (endoscopic), the only thing that does work."
 KUR3102 writes, "Staple stomach."
 GHM8270 writes, "Gastric banding. Widespread ‘obesity treatment centers’ on the
order of dialysis centers may be in the offing."
 WJH7828 writes, "Gastric by-pass. Drugs when new generation is available. I can't
see Medicare going for nutritional supplements/substitute because it's a minefield of
unproven claims."
 SSR9050 writes, "Gastric banding surgery."
 GOO3505 writes, "Perhaps better coverage for bariatric surgery."
 ECR4086 writes, "Surgery appears to be increasingly the option of choice for those
who are morbidly obese. Mortality rate approaching 2% has not kept people away."
 PWG2815 writes, "Gastric bypass."
 AMO7582 writes, "Bariatric surgery (gastric stapling)."
 GDA7384 writes, "Surgical procedures such as apronectomy/jaw wiring in highly
selected patients."
 SNU3210 writes, "Bariatric surgery."
 FER6743 writes, "Gastric stapling."
 JGR0393 writes, "Bariatric surgery."
b. Dietary / Weight Loss Programs
 KCO6695 writes, "The only one that I am familiar with is Medifast."
 WRT9962 writes, "Weight watchers? Jenni Craig? Gold's Gym?"
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ChangeWave Research: Trends in Diabetes
 JRJ9829 writes, "Weight watchers..."
 GRA1199 writes, "Medifast."
 CHA0353 writes, "Low carb diets and carb substitutes such as splenda and atkinslike products have the most likelihood of being effective in weight loss."
 DDY0175 writes, "South Beach Diet..."
 FLO8176 writes, "Diet and exercise regime supervised by a physician (trained in this
specifically)."
 STE3218 writes, "Weight loss and dietary consultant programs that focus on the
entire patient and not necessarily fad diets. Efforts that focus on increasing
activity/exercise will also be successful."
c. Pharmaceuticals/Appetite Suppressants

LEO7024 writes, "Appetite suppressants."

CEN9132 writes, "Perhaps, dietary supplements to lose weight."

WOO7602 writes, "Meridia."

COA5836 writes, "Meridia"

8486810 writes, "Meridia (Appetite Suppressant)...”

SER5830 writes, "DiaMedica, is producing a product line for new and very early
diagnosis and therapeutics that treats type 2 and obesity but is not yet publicly
traded."

VDS1474 writes, "Rimonabant"

MAD2680 writes, "Amyln's Exenitide product."

WPW6938 writes, "Sanofi-Aventis’ phase III drug Acomplia, if approved. It would
also be marketed as an aid to help smokers quit smoking without the associated
weight gain. "

GDA7384 writes, "Older products such as metformin. Newer ones such as
glitazones."

SCI3493 writes, "Carb and lipid blockers and proper balancing the meals to avoid
hunger and craving for foods."
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ChangeWave Research: Trends in Diabetes
III. ChangeWave Research Methodology
This report presents the findings of the latest ChangeWave Alliance survey on Diabetes
conducted August 10 - August 16, 2004. The survey was for Alliance healthcare industry
members knowledgeable about Diabetes. A total of 110 Alliance Members participated,
including 48 doctors.
The Alliance’s proprietary research and business intelligence gathering system is based
upon the systematic gathering of valuable business and investment information directly
over the Internet from accredited members.
ChangeWave surveys its Alliance members on a range of business and investment
research and intelligence topics, collects feedback from them electronically, interprets
and reconciles the information in a cohesive manner and converts the information into
valuable quantitative and qualitative reports.
The Alliance has assembled its membership team from senior technology and business
executives in leading companies of select industries. Nearly 3 out of every 5 members
(58%) have advanced degrees (e.g., Master’s or Ph.D.) and 94% have at least a fouryear bachelor’s degree.
The business and investment intelligence provided by the Alliance provides a real-time
view of companies, technologies and business trends in key market sectors, along with
an in-depth perspective of the macro economy – well in advance of other available
sources.
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ChangeWave Research: Trends in Diabetes
IV. About ChangeWave Research
ChangeWave Research, a subsidiary of Phillips Investment Resources, LLC, identifies
and quantifies "change" in industries and companies through surveying a network of
thousands of business executives and professionals working in more than 20 industries.
ChangeWave has a very unique asset in its 4,600-member Alliance. We have assembled
our membership team from a broad cross section of more than 20 vertical markets such
as telecom, semiconductors, data storage, and biotechnology, along with a wide range of
professional disciplines including CIOs, IT managers and programmers, executive
management, scientists, engineers and sales personnel.
The ChangeWave Alliance is composed of senior technology and business executives in
leading companies - credentialed professionals who spend their everyday lives working
on the frontline of technological change.
This proprietary research and business intelligence gathering system provides a real-time
view of companies, technologies and business trends in key market sectors along with an
in-depth perspective of the macro economy - well in advance of other available sources.
ChangeWave surveys its 4,600 Alliance members on a wide range of investment
research topics and converts the findings into valuable investment and business
intelligence reports. ChangeWave delivers its products and services on the Web at
www.ChangeWave.com.
ChangeWave Research does not make any warranties, express or implied, as to
results to be obtained from using the information in this report. Investors should
obtain individual financial advice based on their own particular circumstances
before making any investment decisions based upon information in this report.
For More Information:
ChangeWave Research
9420 Key West Avenue
Rockville, MD 20850
USA
Telephone: 301-279-4200
Fax: 301-610-5206
www.ChangeWave.com
[email protected]
Helping You Profit From A Rapidly Changing World ™
www.ChangeWave.com
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