zegalogue rescue glucagon

[podcast src=”https://html5-player.libsyn.com/embed/episode/id/19038512/height/90/theme/custom/thumbnail/yes/direction/forward/render-playlist/no/custom-color/3e9ccc/” width=”100%” scrolling=”no” class=”podcast-class” frameborder=”0″ placement=”top” primary_content_url=”http://traffic.libsyn.com/diabetesconnections/Ep_377_Final_Zegalogue.mp3″ libsyn_item_id=”19038512″ height=”90″ theme=”custom” custom_color=”3e9ccc” player_use_thumbnail=”use_thumbnail” use_download_link=”use_download_link” download_link_text=”Download” /] After decades with just one not-so-user-friendly option, another shelf stable rescue glucagon enters the market. It’s called Zegalogue, FDA-approved and coming soon in both an auto injector and a prefilled syringe. One additional future use will be in the Beta Bionics iLet pump with two chambers – one for the insulin and one for this glucagon.

Stacey talks with Frank Sanders, President of Zealand Pharma U.S. and Dr. David Kendall, Senior Global Medical Advisor. This interview covers everything from the use of Zegalogue now to cost and a look at how far treatments have come.

This podcast is not intended as medical advice. If you have those kinds of questions, please contact your health care provider.

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Episode transcription below

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Stacey Simms  0:00

Diabetes Connections is brought to you by Dario health manage your blood glucose levels increase your possibilities by Gvoke Hypopen, the first premixed autoinjector for very low blood sugar and by Dexcom keeping you in control with an integrated system for diabetes management.


Announcer  0:21

This is Diabetes Connections with Stacey Simms.


Stacey Simms  0:27

This week after decades with just one not so user friendly option, another rescue glucagon enters the market. It’s called Zegalogue, one future use will be a pump with two chambers, one for the insulin and one for glucagon.


Frank Sanders  0:43

So, with insulin being one side of that equation, when glucose does go lower, instead of simply shutting off the insulin and waiting for it to clear from the system, you have counterbalance, or the ability to counter regulate with the glucagon infusion in small little delivery boluses.


Stacey Simms  1:02

That’s Frank Sanders president of Zealand pharmacy in the US, he and Dr. David Kendall, their senior global medical advisor, join me to talk about everything from the use of Zegalogue now to cost and to look at how far treatments have come. And spotting a diabetes pump in the wild never gets old. I’ll tell you a quick story about what happened with us. This podcast is not intended as medical advice. If you have those kinds of questions, please contact your health care provider.

Welcome to another week of the show. I’m so glad to have you all here we aim to educate and inspire about diabetes with a focus on people who use insulin. My son Ben in the state is 14 years ago with type one, my husband lives with type two, I don’t have diabetes, I have a background in broadcasting. And that is how you get this podcast.

Thank you for the great feedback out last week’s not really a bonus episode. But second episode that I’ve been doing, I changed it up again. And I released Diabetes Connections in the news, many of you have already listened to it. But I’m thrilled that I’m getting reaction. I don’t even mind if it’s constructive criticism or just I hate it. I really would like to know what you think I’m experimenting throughout the month of May. We’re going to do four episodes of in the news live on Facebook first on Wednesdays at 430. And then a podcast episode that will turn around probably Thursday night or Friday morning and get you caught up on the week’s news. So please let me know we have a post going in the Facebook group as well.

You know, six years ago, I launched this podcast and I liked that I’m still experimenting with it. And I hope that you do too because the idea is just to get you good information that you can use whether it’s long format like we’re going to do today, or short headlines, like I’m trying with that in the news stuff. And of course we throw in some personal stories here and there. And after this interview, I’ll tell you about Benny’s first wrestling match and how you know we spotted diabetes in the wild.

Alright, my guests this week are from Zealand Pharmaceutical, they just got FDA approval a few weeks ago for Zegalogue. The newest shelf stable emergency glucagon, you know, it really is incredible when you think about it the last 40 or 50 years more than that all we’ve had for emergency glucagon has been the stuff in the red or orange emergency box, the kind that you have to reconstitute yourself you know, and studies show that most people even those trained you don’t use it very well especially under stress. And now we have three options vaccine me and G vo hypo pen and Vega log. You’re going to hear from Frank Sanders. He’s the president of Zealand pharmacy and Dr. David Kendall. He is their senior global medical advisor Frank Sanders has been in the pharmaceutical industry for more than 25 years. He has been with a company called therapeutics he’s been with Johnson and Johnson’s pharmaceutical arm many of you are familiar with Janssen pharmaceutical. He’s been with GlaxoSmithKline and Dr. David Kendall has held many leadership positions in the diabetes community including at mankind at Lilly at the American Diabetes Association and at the International Diabetes Center in Minneapolis. Dr. Kendall and I also go way off topic toward the end because he served as a clinical investigator with the dcct and edic trials here homeless tourists will remember those evidence based on hope episode, which is one of my all time favorites, I will talk about the DCC T and edic trials at the drop of a hat. And I was so excited that Dr. Kendall can too

Okay, quick disclosure gotta tell you, your competitor to this product is a sponsor of this show. In fact, I’m about to read an ad from them. But as you know, Diabetes Connections is here to help you get information about the diabetes community and I don’t limit who we talk to because of who spends money on advertising. Now on the flip side, the advertisers are also on board with all of that so I give them a lot of credit to longtime listeners are familiar with all of this, but just in case, I like to talk about it every time and let’s keep things on the up and up.

Okay, let me tell you then Diabetes Connections is Brought to you by Gvoke Hypopen and our endo always told us that if you use insulin, you need to have emergency glucagon on hand as well. Low blood sugars are one thing, we’re usually able to treat those with fast acting glucose tabs or juice. But a very low blood sugar can be frightening which is why I am so glad there’s a different option for emergency glucagon. It’s Gvoke Hypopen . Gvoke Hypopen is pre mixed and ready to go with no visible needle, you pull off the red cap and push the yellow end onto bare skin and hold it for five seconds. That’s it, find out more go to Diabetes connections.com and click on the Gvoke logo. Gvoke shouldn’t be used in patients with pheochromocytoma or insulinoma. Visit gvokeglucagon dot com slash risk.

Frank Sanders, Dr. Kendall, thank you so much for joining me today. I’m really interested to learn more about this. I appreciate you being here.


Unknown Speaker  5:50

Thank you. We’re glad to be here as well. Yeah. Thanks so much,


Unknown Speaker  5:52



Stacey Simms  5:53

You got it. So Frank, let me start with you. If I could just, you know, to give us an overview a little bit. We’ve never talked before, if you could kind of catch me up on what Zealand is all about. And then we’ll talk about Zegalogue.


Frank Sanders  6:05

Yeah, sure. Thank you for the question. I appreciate it, Stacy. So I’ll start by saying that Zealand is a global biotechnology company and a world leader in peptide therapeutic development. Well, it may seem like a new company, the company was actually founded in 1998. It is headquartered in Copenhagen, Denmark. And we have our US presence and our company in our corporate office in Boston in the seaport area. So the company has approximately 330 employees worldwide. And our we believe our distinguished advantage is our unique peptide platform that allows us to design and engineer highly innovative peptide and peptide like medicines for, you know, for multiple conditions. So we have a 20 year legacy in r&d and peptide therapeutics, and we’re very proud of what we’ve delivered.


Stacey Simms  6:50

Can you take just a second and I when we hear peptide on this podcast, we just think about that C peptide test, right? That helps figure out if it’s type one or type two diabetes, what does a peptide therapeutic be?


Dr. David Kendall  7:02

I’m happy to take that one. And Frank, please feel free to chime in. But Stacy, a peptide in the common ones that I’m sure this audience knows about are things like insulin, glucagon, or modifications there. But they are very simply the proteins. In the body peptides generally referred to proteins which are made up of these building blocks we call amino acids, usually up to 25 to 50 of these amino acid segments plugged together glucagon, which we’ll be talking about today, and LC glucagon is made up of 37 of these building blocks. So peptides that are commonly known are just those proteins that circulate in the body or makeup, the structure of the body.


Stacey Simms  7:46

Alright, let’s talk about Zegalogue. I think most of my listeners are familiar with the concept of needing emergency glucagon sometimes, but tell me the specifics about Zegalogue

Frank Sanders  7:56

So the clinical profile Zegalogue  is compelling. And we are actually out in active dialogue with payers right now. And we have been in dialogue with healthcare professionals and patients around the profile through market research before we execute a full product launch following approval. And the approval of Zegalogue is based on the results from three randomized, double blind placebo controlled controlled phase three trials, that’s a mouthful in both children and adults with type one diabetes. And what’s marketed and notable about Zegalogue is the median time to blood blood glucose recovery of 10 minutes that we’ve seen across all three phase three trials. More specifically, in the phase three trials. 99% of adults recovered in 15 minutes in the main adult trial, and 95% of pediatric patients recovered and 15 minutes in the pediatric trials. So So we believe the dialogue offers patients and caregivers in an important new choice for the for the management of severe hypoglycemia, which is a condition where minutes obviously matter, so we’re eager. So the launch the product, in just over a month and late June,


Stacey Simms  9:02

didn’t take me into that study a little bit more in terms of how low people were, if you can share that.


Dr. David Kendall  9:09

Happy to do that, Stacy and as Frank mentioned, glucagon, the native peptide or protein that many people have known about, and I’m sure many of your listeners are familiar with has been around and available for treatments since the 1960s. But what Zegalogue and dasiglucagon the active molecule was able to do is make modifications in that peptide chain to ultimately lead to chemical that we felt was suitable for development that went through those clinical testing programs that Frank talked about, and specific to those trials to bring this forward as a medication that could be reviewed and approved for the treatment of severe little bunch of blood sugar, or what we call severe hypoglycemia required that in controlled fashion, taking volunteers, courageous and really volunteers to whom we are incredibly grateful to use an insulin infusion, so give insulin in their vein in a controlled way, bring their blood sugar below a specific level, usually that level is 70 milligrams per deciliter or lower, slightly higher in the studies with children, and do that in as controlled away as possible, then stop that infusion of insulin. And this is really meant Stacy to mimic what might happen in an unexpected, unanticipated severe low blood trigger event. And those individuals then are given a dose either of placebo medicine, or in the case of these studies, Sega log and its pre Approval Form dasiglucagon, and then in those same trials, not for direct comparison, but just to understand what the world was familiar with, we also gave selected individuals, the traditional glucagon from the emergency kit that many people may know, which is the one that requires that it be reconstituted, mixed up, drawn back up in a syringe and then given so the studies took experimental, low blood sugar, let’s say on average, the value is just below 70. Got the dose of medication. And then we measured the so called time to recovery that Frank talked about which in all of these trials was how long it took to see that number no matter where it started to come up by 20 points. So a very consistent measure of recovery time. And as Frank said, the median time to recovery was 10 minutes across each of the three larger phase three trials. And you looked at the 15 minute time point, which is a very important one for watching loved ones recover and making sure that they either are responsive or another dose of medicine can be given 99% of adults, 95% of children had recovery


Unknown Speaker  11:55

in that time period.


Dr. David Kendall  11:56

So very important to understand how the trials were done. But ultimately, it led to our review and approval as a treatment for severe low blood sugar.


Stacey Simms  12:06

Wow, I appreciate you going through so thoroughly, I have a couple of questions, because I have a couple of friends who have gone through clinical trials for products like this. I don’t know if they were specifically in this one. But as you said, You don’t just sit there and say, Okay, give me all that insulin, no, I’m gonna go low. You know, we really have to thank those people. But you mentioned some of them got a placebo. So I know it was a safe environment. But what does that mean? Like they just sat there and went low for a while?


Frank Sanders  12:32

Yeah, I’m always amazed the Food and Drug Administration, their regulators are thoughtful and cautious about how these studies are designed, we are as well, in placebo, obviously, is done only in a controlled setting where we understand what the potential risks of giving, essentially, no therapy might be. But knowing that in these studies, as I said, Even though zega log is approved for the treatment of truly severe low blood sugar, these were not patients that lost consciousness couldn’t manage for themselves, but in a controlled setting where we could give them an intravenous injection of glucose if we needed to, or ultimately rescue them with safety glucagon administration, these were individuals who had to understand that they were going to go low, probably feel something they felt before not necessarily feel comfortable, and then know that there was a chance they were getting just saltwater sailing, or potentially getting one of the other two therapies. And obviously, they were monitored very carefully. And we didn’t allow this to go on, you know, indefinitely. They were ultimately treated either with glucose by vain or given something to eat.


Stacey Simms  13:42

I’m curious to, again, I appreciate you letting me go down this rabbit hole. There is an interesting conversation all the time in the diabetes community about letting those go. And I know some of you, as you listen gasped. But I mean, there are some times where you’ll sleep through a low or you’ll just won’t notice although you know, you’re 7075 and then you’ll, you’ll float back up because your liver has kicked in it. You know, I’m curious, I know, this wasn’t what the study was designed to do. But was there any information from the placebo folks of them kind of recovering without treatment?


Right back to Dr. Kendall answering that question. But first Diabetes Connections is brought to you by Dario. And the bottom line is you need a plan of action with diabetes. We’ve been lucky that Benny’s endo has helped us with that and that he understands the plan has to change as Benny gets older, you want that kind of support. So take your diabetes management to the next level with Dario health. There are published Studies demonstrate high impact results for active users like improved in range percentage within three months reduction of a one c within three months and a 58% decrease in occurrences of severe hypoglycemic events. Try Dario’s diabetes success plan and make a difference in your diabetes management. Go to my dario.com forward slash diabetes dash connections. For more proven results and for information about the plan now back to Dr. Kendall, answering my questions about those that kind of resolve on their own.


Frank Sanders  15:13

So the the proportion of people who recovered with placebo therapy was extinguishing Lilo, I will say, at least in the 15 minutes time period, by 45 minutes, either they had recovered or we allowed them to recover. I know a bit more about this, because I spent my early years of research doing these experimental low blood sugar studies. And your comment about letting the logo is not something I certainly would advise as a health care professional, but it does happen. And the risks if it’s not a severe low, are often you know, an inconvenience or disrupted sleep or in some cases, complete lack of awareness. The risk there, Stacy is any low blood sugar makes a subsequent low blood sugar more likely. And the typical symptoms and responses that the body has, will diminish when the body has seen multiple episodes of low blood sugar. It’s as if the body’s saying I’ve seen this before, I’m going to quit warning you and treating it. And that, as we’ve learned over time is one of the risk factors for an unexpected and more serious and severe hypoglycemic event. So I would not recommend letting the logo


Stacey Simms  16:24

be either, I want to be very clear. But it is something that is discussed. It’s not as though that’s something that to be very clear as you listen and to you all to, it wasn’t something I said in that I endorse it. It’s just that it does happen. And we see that sometimes you don’t treat a low and sometimes it bounces back. So I didn’t mean to imply that we should be twiddling our thumbs while our kids are low.


Dr. David Kendall  16:48

Right? And you’re absolutely right, the body does maintain some of those defenses as ecolog. What we’re talking about here is there for those circumstances where the defenses are no longer adequate, someone loses consciousness, the ability to care for themselves. Alright,


Stacey Simms  17:05

let’s let’s get back on track here. Again, thanks for following me down that rabbit hole. And I’m always fascinated by studies and the process. Frank, let me ask you what so what is this is tell me a little bit about the product itself because we have other products on the market. Now you mentioned already the rescue kit that needs to be reconstituted, there’s a nasal spray, there’s a shot.


Frank Sanders  17:22

Now this was this is so second log is indicated for the treatment of severe hypoglycemia, and pediatric and adult hit and adult patients with diabetes. Ages, six years and above, we’re going to be launching it with two forms available. We’re one of those is going to be an auto injector a single dose auto injector and the other will be a single dose prefilled syringe, but both of which can be used immediately without requiring reconstitution that may allow for easier use at that moment when it’s needed. And so you know, that really at a basic level, that’s that’s core to what what Zegalogue is. And we again, believe that based on the clinical study that David David has talked about the study data all three is that what distinguishes like a log is really the the median time to recovery of 10 minutes across all clinical trials and the consistency of response rates and adults in pediatric patients again, referring back to the data that David presented. So we’re eager to introduce this product again and a couple short weeks here and offer this begin to offer this to patients and caregivers alike.


Stacey Simms  18:25

shelf life, you know, do I need to put in the fridge? Can you speak to that?


Frank Sanders  18:28

Very good question. So I’ll talk a little bit about the storage and stability and David if I if there are details to add, please add but Zegalogue has a three year total shelf life when stored in refrigerated conditions in once removed from refrigerated conditions that can be kept at room temperature for up to 12 months. So stability and storage conditions of Zegalogue provide for options for people with diabetes, you’re at risk of severe hypoglycemia to have this available at home, you know, in the refrigerated conditions for up to three years or out of you know, refrigerated conditions, either at home or away from home for up to a year and event that it’s needed. So we believe that these dual storage conditions will be attractive to the lifestyle of patients with diabetes


Stacey Simms  19:12

couple of years ago, gosh, was it ready for the pandemic It must have been in the fall of 2019. So not too long ago, I ran into Ed Damiano of beta bionics and asked him you know what’s going on? How are things and you know, they’ve got their own, we’re actually talking to them in a couple of weeks. So let’s talk about this as well. But my understanding correct me if I’m wrong, is that this is the brand of glucagon that they want to put in the dual hormone pump down the line. I don’t know how much anyone can speak to any of this. So feel free to say no, because I know it’s it’s not coming. Now, this is not what we’re talking about here To be clear, but this is one of the most anticipated developments in pump therapy. And I’m curious, can you speak to this is that correct?


Frank Sanders  19:57

Well, let me tell you this and then David, you could you can add to this as well. as you see fit, but yes, I mean that’s a glucagon we consider this a platform therapy, you know. So obviously we’re launching dasiglucagon in the form of Zegalogue as a rescue therapy for severe hypoglycemia. But it’s the first of a long string of other potential launches with dasiglucagon. In the future you had mentioned, the partnership that we have in place with beta bionics that what I will say is that it’s a great partnership, we’re very pleased with the progress that we’re making with this program, as we near the initiation of phase three trials. And so you know, everything is really moving forward at a steady rate there with that partnership. And we also have the David can touch on as well with dasiglucagon a program and place for use in congenital hyper and hyper insulin emia as well. So so the product itself is being studied for multiple applications to benefit multiple patients, not just with severe hypoglycemia, but with other with other specialty and rare disease areas. So it’s just the beginning, if you will, it’s like a log is this really the beginning for the use of the molecule much, much more to come over the next three to five years. Like Frank said, we’re


Dr. David Kendall  21:05

really excited to be in the partnership with beta bionics I had in his team dasiglucagon is the platform and that Frank described, we see it as helping us leverage opportunities across what we call the hypoglycemic spectrum. So testing it, we hope in weeks and months ahead in phase three in the bio hormonal we call it artificial pancreas, the bionic pancreas, with beta bionics, but also for other hypoglycemic disorders, some in the setting of diabetes, like small doses that may be used for exercise or during illness, where it’s not an emergency situation, all of these are planned investigations, but not yet part of the approved use of Zegalogue. Similarly, the condition, Frank alluded to congenital hyperinsulinism, where children are born with the dysregulated continuous secretion of insulin, so it’s not diabetes, but they suffer recurrent and significant hypoglycemia, then there are very limited therapies. Thankfully, it’s an ultra rare disease, but one that is really want for better therapies. And similarly, there are other health conditions where unexpected low blood sugars occur outside of the setting of diabetes. And we think because of some of the unique characteristics that deci glucagon has the stability at room temperature that it can and we hope will be applied, certainly in clinical studies, we hope in the future for patients with some of those conditions.


Stacey Simms  22:38

So it’s interesting a couple of weeks ago, maybe a couple months ago, now we spoke to Leo Brown, who was on The Amazing Race, we will he lives with diabetes, I guess, but he has congenital hyperinsulinism. And his they basically removed most of his pancreas. And is that the kind of thing you’re talking about where this would be an alternative treatment for somebody like that, perhaps?


Frank Sanders  22:57

Precisely. And so that’s one of the approaches, historically to this condition, congenital hyperinsulinism was to remove the offending organ, the pancreas, which, as you witnessed, will leave somebody living with insulin deficient diabetes, so a form of type 1 diabetes that’s surgically induced, but it was one of the only available therapies, we feel like that see, glucagon. And other approaches can counteract that hyperinsulinism, particularly in the youngest children, where there are the greatest dangers for these low blood sugars. And we hope either limit the need obviate the need for surgical interventions, and add to the tools that pediatricians in particular can use to manage this incredibly challenging disease.


Stacey Simms  23:45

And just back if I could to beta bionics, can you share anything about Gosh, I feel like we’ve just been waiting for this for a very long time. In terms of how it works. I know that, again, that’s in clinical trials coming up. So you can’t talk about a lot, but I’m just trying to picture what I you know, we fill the insulin pump with insulin, then we just fill the other chamber with the gun. I mean, it just to me seems so revolutionary. I’m trying to kind of parse any information that you can share with us.


Dr. David Kendall  24:10

Yeah, it’s you’re spot on Stacy. It’s basically a two chamber pump. So think of how current insulin pumps are programmed. And in fact, with the hybrid closed loop systems, they were tied to continuous glucose monitoring to adjust the insulin delivery and those systems that have that capability. Add to that the same sort of functionality, but with glucagon, or in this case, dasiglucagon infusion that is regulated by the pump and by the glucose measurements. So with insulin being one side of that equation, when glucose does go lower, instead of simply shutting off the insulin and waiting for it to clear from the system, you have counterbalance, or the ability to counter regulate with the glucagon infusion and small little delivery boluses just Like insulin does for higher glucose is so similar to and in fact managed in much the same way as the insulin infusion for high glucose. The glucagon chamber and infusion wouldn’t give those doses as glucose values declined, or were at certain levels,


Stacey Simms  25:15

if they’re a second inset on the body for that I can’t imagine goes to the same inset as the insulin.


Dr. David Kendall  25:21

Yeah, so So all of that is part of the development process. Obviously, these are two separate hormones. And one of the components of dasiglucagon, as Frank talked about is it’s, it’s stable in this so called aqueous solution, which for you will need that saltwater, the things that circulate in the body. So you know, while in theory, they could come through the same system, the plans in place, and the previous studies have been done with two separate fusion sites. But again, connected to the same pump system. So yeah, there’s some sophistication involved. And I think back to pre CGM, when people said I have to wear this device now people often do quite well wearing two devices, their CGM and their pump. So depending on the ultimate design and approach to this, we certainly see the clinical promise as being something that’s very encouraging. And then overcoming those engineering and technical challenges will be part of what faces our team with the beta bionics team. Really interesting. I


Stacey Simms  26:22

can’t wait to talk to them to to get more information. Thanks for sharing what you could I appreciate? Absolutely. Let’s talk about cost and access. What is this going to cost? I mean, I know that a lot of it depends on insurance. You started out by saying you were talking to payers, it’s so sad that that’s the first thing we have to talk about.


Frank Sanders  26:38

That’s a good, it’s a good question. These are obviously obviously amongst the first questions we always get when we’re launching any product. So so we our strategy, from a pricing perspective, is the price Zegalogue at parity meaning add or are the same as existing products on the market? And we’ve based this strategy really on the value that psychologic provides? I think you’re the bigger question is, is it going to be accessible for patients at launch. And you know, and really, that’s, that’s the reason why we are out actively engaging managed care customers today, both at payers and pbms, and Medicaid providers. And so I’ll share that the the conversations have been have been very good that the profile Tagalog is being received very favorably, and we do expect to have favorable accesses, that is ecolog. At launch, that will continue to build as with any new product launch that will continue to build and improve over the first six months of launch. And I think as as you know, Stacey, from our conversations a little bit earlier, as I’m a caregiver myself, in my in my life, my my wife is been, you know, suffering for from stage four cancer for a number of years, and she’s doing doing very well. But we we every day, interact with the healthcare system, and really have to think through barriers to access, whether that those are financial barriers or barriers to delivery of the product through specialty pharmacies, and we are really designing our patient support capability at Zealand. With that in mind, meaning, how do we make sure that when we’re launching a product, we’re able to provide the resources and forms of financial assistance and other resources to help address any sort of access barriers that may exist. So so there’s really don’t become transparent, so do we, so to speak, or, or, or a barrier for patients. And it’s not just things like financial assistance, we are also putting programs in place to be able to make access easy in terms of product acquisition and distribution, for example, by looking at at home delivery solutions and other things so so we really are going to roll out a patient support system that is really fit for launching a product like this, in this error today where we also have to worry about COVID. So we’re ready to go on all fronts in that area.


Stacey Simms  28:50

And we’ll link up information as it comes out on patients assistance and access and things like that. But I’m always curious. And I I know the US health system is very complex. But why budget parity, why not launch and say we’re gonna be $30? Less? How come nobody ever launches and says we’re gonna come out and we’re gonna make it affordable out of the box?


Frank Sanders  29:09

Yeah, I mean, we we look very carefully at multiple different pricing options and research it very carefully before we make a decision around it. And the price that we choose, really any company chooses. But in this case, I’ll just talk about what Zealand does is the one that we that we think is going to ensure that we are going to get the best access possible for the product at a price point that that is representative of the value, the clinical value that the product brings to the market and that and that really led us to a parody pricing strategy, not a premium pricing strategy, not a discounting strategy, but one that is at parity with the rest of the market. And you know, again, based on the feedback that we’ve had in advance of setting the price and after setting the price and discussing with managed care organizations, we feel that we got it right.


Stacey Simms  29:56

Yeah, but you didn’t get that from patients with all due respect. I can’t imagine a patient said that’s the right price.


Frank Sanders  30:01

Well, I think if we ask anyone, any consumer about about the price of the medicine, you know, the will will always get the response of, can we why that can cannot be lower? Can it be lower? That’s absolutely fair.


Stacey Simms  30:14

Before I let you go, as I was looking through everybody’s bio here, David, I can’t let you go without asking you about the diabetes control and complications trial and the edic trial, I love to talk about these studies. I have I talked to a lot of parents whose children have been diagnosed, you know, recently, I run a very large Facebook group for Charlotte, North Carolina area. And I always say like, you’ve got to look at these these amazing trials that were done years ago, that show how much better things are getting. And I would love to just, I don’t even know what I want to ask you. But I would love to give you the floor to just say that we didn’t even know that a one c mattered, we didn’t know the control made a difference. And to me, the edic trial is the one that shows me how much things are getting better. I do my right on any of that.


Dr. David Kendall  30:59

And well, you’re talking to a very biased audience of one in me. So I grew up in the dcct edic era, I started in diabetes research in 1981, just as dcct was kicking off. So I’ve been either close to or seeing patients in dcct edic, through its entire history. And we’re now 40 years out from the start of that trial. And yes, absolutely. These are 14 141 of the most courageous, incredible people who committed literally decades of their life to helping us understand what benefits may come from improving glucose control, particularly early on in the course of type 1 diabetes. And what I love is that many of these are patients I know to this day who are celebrating their 17th and 18th birthdays, I’m in the setting of type 1 diabetes. And unequivocally dcct, in my mind is one of the 10 great research studies in medicine, it demonstrated the benefit of having blood sugars as well controlled as possible, as early in the course of diabetes as possible. and maintaining that for as long a period as possible that I always catch that by saying, you know doing it as rationally and safely as possible. And what we’re talking about here today, meaning severe hyperglycemia was first really made evident to us in the dcct. where, you know, on average, every patient had a severe event per year during the study, because we were working so hard to control glucose. So it ties back to our topic. And yeah, for the next three and a half hours of this podcast. I’d be happy to add more if you’d like. Frank will never invite me back. So


Stacey Simms  32:48

Oh, no, no. Okay, wait, one more question about the dcct edic. Is there a follow up? Will we get another one of all these people soon? Or is it kind of


Dr. David Kendall  32:58

it continues to this day, and there are various components to it, it is much less thorough and intensive in terms of the follow up, but the 30 and soon 40 year follow up of those patients has been and will be published and presented as the years go ahead. So this is the study that probably will only end when we run out of investigators and individual volunteers for the study.


Stacey Simms  33:26

I gotta say I look at those studies. And I’m so glad you mentioned the brave and wonderful people in them. Because that has my son was diagnosed right where he turned to 14 years ago. And what they have done, has changed his outcome. It’s just fabulous. So thank them next time you see I’m telling Stacy and Charlotte. Before we finish it, was there anything about that video segment that we didn’t cover?


Dr. David Kendall  33:48

Yeah, I’ll close and then toss it back to Frank. But I think one of the things that first attracted me to Zealand but also the work around Zegalogue is that hyperglycemia really remains one of those conundrums, one of the rate limiting features of managing diabetes most effectively, and bringing forth the two legs Zegalogue to help patients have the peace of mind make a plan for when the unthinkable might happen, a severe event. And doing so with the data that we’ve talked about where you have this very rapid and reliable response to Desi glucagon and the clinical trials for this, like many other emergency therapies, you don’t want to have it, but you certainly want it on hand if you need it. So all of that, to me is central to what we’re doing, not just with the clinical studies, but with the clinical launch of Zegalogue.


Frank Sanders  34:43

Now very good. I would just just close by saying what excites us about this launch in particular, is that there are 4 million people in the United States with diabetes on multiple daily injections of insulin and these patients are at higher risk of having severe hypoglycemic event. And despite the fact that there are 4 million people in the US with diabetes on on multiple daily doses, only approximately 14% of that population is prescribed a glucagon rescue therapy. So So what’s been interesting is and positive is this is with the introduction of newer innovative therapies over the last year and a half, two years, more people are becoming aware of these treatment options, and the market is growing by by 10%. And we believe that that’s really just the beginning is the you know, having Zegalogue in the market, that’s yet another innovative option has the ability to further grow this by increasing awareness. And we’re excited about the positive impacts effect that will have on patients and their caregivers.


Stacey Simms  35:44

Well, Frank Sanders, Dr. David Kendall, thank you so much for joining me and explaining all this. I really appreciate you spending so much time with me. Thank you.


Announcer  35:56

You’re listening to Diabetes Connections with Stacey Simms.


Stacey Simms  36:02

I will link up more information about Zegalogue. And about the DCCT EDIC trials as well. And if you haven’t heard our episode, evidence-based hope, I highly, highly, highly recommend it, especially for newer diagnosed people and families. It’s not just a look how far we’ve come kind of thing. But it also puts in perspective, a one see numbers, things right now that you can do to live a long and healthy life with diabetes. And it doesn’t mean that you need to always have you know, a super low A1C I think especially as parents, we often lose track of the happy, good life thriving with diabetes, because we’re so focused on getting that that time and range and those super low a one season those trials really put it in perspective for me, and what you need to really live well. And it’s not what a lot of people on Facebook, what have you believe in just a second, I want to give you an update on how Benny’s doing and wrestling has started. And oh my goodness,

but first Diabetes Connections is brought to you by Dexcom. And it really is hard to remember what things were like before we started using Dexcom. I had a woman asked me what was our plan for kindergarten. And we were still a good four or five years away from Dexcom at that point, so it’s really interesting to look back because it is so different. Now we were doing something like 10 finger sticks a day when Benny was going to kindergarten. I mean, even when he got older, we still did at least six to eight every day more when he wasn’t feeling well or something was off. But with each iteration of Dexcom we’ve done fewer and fewer sticks. The latest generation the Dexcom g six eliminates finger sticks for calibration and diabetes treatment decisions. Just thinking about Benny’s little worn out fingertips makes me so glad that Dexcom has helped us come so far. It’s an incredible tool and Benny’s fingertips are healthy and smooth, which I never thought would happen when he was in kindergarten. He for glucose alerts and readings from the G6 do not make symptoms or expectations. Use a blood glucose meter to make diabetes treatment decisions. learn more, go to Diabetes connections.com and click on the Dexcom logo.


Aren’t if you’ve been listening for a long time or you follow me on social media, then you know that Benny is finishing up his sophomore year in high school and he started wrestling when he was a freshman he got injured right at the beginning of the season. He tore his meniscus. And he was out for the 2020 season, which was right before COVID. They were able to get a full season in and he was part of the team. He was like manager and he went on crutches to every match. And he was pretty incredible season they won the state championships for the first time. It was just a really fun year, but he had to sit on the sidelines. So that was kind of a bummer. But he is back. He’s worked really, really hard. And of course with COVID they kept putting off the season. And we always thought there is absolutely no way there’s going to be wrestling. So he actually went out and got a job. I’ve mentioned before he got his vaccine, he’s at a grocery store. And he’s been working really hard. And so when wrestling came back, it was kind of a tough decision to make. But he was able to work it out with his work schedule. And this kid is so busy, and they had their very first match.

As you’re listening it would be last week. So Benny had his very first you know, match. But that’s not the story. I want to tell you what was amazing. And by the way, I can’t watch wrestling. Do you watch wrestling if your kids wrestle? I can’t watch any sport my kids play because I’m the loud mouth mom. So I’m always the one like trying to look at her phone. So I’m not screaming I’m not being rude. I’m not not paying attention. But I’m shockingly I have comments. So I try to keep them to myself. But wrestling is just so gross. It’s so rough. I can’t stand it. But they come out on the mat and the ref comes out and he’s like you know our loved ones with clean Theodora and I’m looking at the ref and I immediately Look at his belt line because there’s a T slim pump. He’s wearing a T slim next to you know, it’s right on his back. And I was sitting very close. So part of me wanted to yell like, excuse me. Hello, sir. But I didn’t do anything. I didn’t say anything. I did take a couple of pictures which was probably very inappropriate, this poor man, but I couldn’t help myself. It was so exciting. They faced two different schools. So it was the match that He was in and then there was another match. They didn’t wrestle in, and my daughter had just come home from college. So after that first match, I said goodbye. I said, Okay, if I go and I left, I went home because my daughter, Lea, I haven’t seen her in a while. So I wanted to run home to her. And I couldn’t talk to the ref, because he went from one match. Immediately, he crossed the gym and went to the other match. Then he came over to kind of talk to me as I was leaving, and I told him and I, you know, it wasn’t sure if he’d be like, Mom, it’s so lame. You know, who cares. But he lit up, he was excited, and he wants to go say hi, but it was just such a busy night. And these reps are just working, working, working that, you know, as I said, I didn’t get a chance to talk to him, but he didn’t get a chance to talk to him. So I’m hoping that we see him again, as these wrestling matches go on. But hey, if you’re listening ref in Mecklenburg County, North Carolina, drop me a line. And thank you very much for not noticing the bananas lady behind you taking pictures of your back.


Before I let you go quick note I will be speaking at the camp Nejeda event survive and thrive. That is on June 5. It’s a virtual event. We are looking forward to friends for life in July, I will be there I’m not sure in what capacity as a speaker yet waiting to hear from them. Because it’s very different this year, far fewer speakers, but I will be there as a vendor. So I hope I can meet at least some of you. And please join me tomorrow. If you’re listening as this first drops on Wednesday, May 12, as I’m doing every Wednesday in May 4:30pm. Eastern on my Facebook page Diabetes Connections i will be doing in the news, my newscast that I’m trying out and then we’ll turn that around and drop it as podcast episode. They’re very short. My goal is to make them not only less than 10 minutes, hopefully less than eight or seven minutes. I’m really trying to keep it very tight and just have some headlines. But the top stories of the past week, all types of diabetes really be useful for you to make it bite size make it relevant. So let me know what you think. Thank you, as always to my editor John Bukenas from audio editing solutions. Thank you so much for listening. I’m Stacey Simms. I’ll see you back here in just a couple of days. Until then, be kind to yourself.


Benny  42:19

Diabetes Connections is a production of Stacey Simms Media. All rights reserved. All rounds avenged

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