IQVIA Holdings, Inc. · NYSE:IQV
IQVIA — Technical Presentation (November 2019)
44 slides from IQVIA's technical presentation, Nov 12, 2019
Slide 1: A Movement in Diabetes: Using Time-in-Range
A Movement in Diabetes: Using Time-in-Range We b i n a r November 12, 2019 Copyright © 2019 IQVIA. All rights reserved. IQVIA® is a registered trademark of IQVIA Inc. in the United States and various other countries.
Slide 2: Speakers
Speakers Executive Director, IQVIA Institute Founder and Chair of the Board, Vice President, Head, CV, The diaTribe Foundation Metabolism, Renal, and Senior Vice President, IQVIA Reproductive Health Centers of President, Close Concerns Excellence, IQVIA 1
Slide 3: Advancing Glycemic Management in People with Diabetes
Advancing Glycemic Management in People with Diabetes 2
Slide 4: A look at the components of the IQVIA Institute report
A look at the components of the IQVIA Institute report Type 1 and Type 2 Diabetes in the United States Evolution of blood glucose management in Diabetes Reduction in complications and costs by improving TIR Approaches to further use of TIR in the U.S. PwD population 3 This study is based on research
Slide 5: Eras of Diabetes control
Eras of Diabetes control Fatality Containment Management Optimization Future Pre-1922 1923–1980’s 1980’s–2016 2016–Now Future Pre-insulin Basic insulin Modern insulins Advanced insulins Advanced insulins Capability treatment Limited SMBG Non-insulin oral Limited F/CGM use Broad F/CGM use HbA1c for t
Slide 6: The ecosystem of blood glucose management incorporating continuous glucose monitoring
The ecosystem of blood glucose management incorporating continuous glucose monitoring HCP and PWD set PwD experiences improved time in treatment plan and range, HbA1c, fewer short and intent to monitor glucose using CGM long term complications, higher Complementary laboratory tests/measures and care
Slide 7: Methodology for assessing reduction in complications and associated costs achieved by improving TIR
Methodology for assessing reduction in complications and associated costs achieved by improving TIR 1 2 3 • A relationship between HbA1c and • Based on selected peer- • The HbA1c values associated with TIR was needed as there is limited reviewed articles, a TIR of 58%, 70% and 80% were longitudinal
Slide 8: The current and proposed alternate state of treatment for People with Diabetes
The current and proposed alternate state of treatment for People with Diabetes CURRENT STATE ALTERNATE STATE Key Statistics Key Statistics Age 41 years TIR70-180 23,24 58%^ Age 41 years TIR70-180 >70% Indication Type 1 TAR>180 23,24 37% Indication Type 1 TAR>180 <25% Duration of Diabetes 20 years TB
Slide 9: 10-year incidence of developing Diabetes-related complications after improving TIR
10-year incidence of developing Diabetes-related complications after improving TIR in PwD with Type 1 and Type 2 Diabetes TYPE 1 Diabetes TYPE 2 Diabetes COMPLICATION 58% TIR 70% TIR 80% TIR COMPLICATION 58% TIR 70% TIR 80% TIR Myocardial Myocardial 3.29 2.65 – 2.97 2.25 – 2.70 12.76 11.99 – 12.39 1
Slide 10: 10-year cost reduction by improving TIR in people with Type 1 and Type 2
10-year cost reduction by improving TIR in people with Type 1 and Type 2 Diabetes to 70% and 80%, US$Bn $2.1–4.2 billion $4–7 billion Uses Beck et al to HbA1c equation Uses Beck et al Uses Vigersky and 2019 TIR to McMahon 2019 TIR 7.0 HbA1c equation to HbA1c equation Uses Vigersky and McMahon 2019 T
Slide 11: Summary of 10-year cost reduction after improving TIR to 80%
Summary of 10-year cost reduction after improving TIR to 80% and reducing the rate of hypoglycemic events, US$Bn $6.7–9.7 billion Uses Beck et al 2019 TIR to HbA1c equation Uses Vigersky and McMahon 2019 TIR to HbA1c equation 9.7 6.7 Cost reduction after improving TIR to 80% from 58% and reducing hy
Slide 12: 10-year per person cost reduction associated with incrementally improving TIR in Type 1
10-year per person cost reduction associated with incrementally improving TIR in Type 1 Diabetes, US$ 2,289 Percentage point increase in TIR70-180 30 2,160 25 721 1,979 20 572 1,853 15 428 1,636 10 20 261 1,470 5 <7.0% 7.0-7.9% >8.0% Starting HbA1c Value Source: IQVIA Core Diabetes Model, 2019 Notes
Slide 13: Why People with Diabetes Love Time-in-Range
Why People with Diabetes Love Time-in-Range 12
Slide 14: The many faces of a 7% A1C
THE MANY FACES OF A 7% A1C (and an average blood glucose of 154 mg/dl) 180 180 180 mele Jorerkecccccosocoobe wiy/egocoedcceoccefposcele auayeces UD ee ee Pd 70 70 mg/dl mg/dl mgt] oo OCC eee eoreroceeoee O > am” 12am 12am 12am 120m 12am 12am 40% 40% High _In-Range 70% 100% In-Range 5% Low In-Range 2
Slide 15: One-click access to my CGM patterns = Gamechanger!
One-click access to my CGM patterns = Gamechanger! Data: Kelly Close, Dexcom CLARITY app
Slide 16: Ambulatory Glucose Profile (AGP) shows my 90-day blood glucose trends
Ambulatory Glucose Profile (AGP) shows my 90-day blood glucose trends Data Source: Kelly Close, Dexcom CLARITY app
Slide 17: Automated weekly emails and notifications: frictionless data insights
Automated weekly emails and notifications: frictionless data insights dQ&A (2019): 78% of Dexcom users currently use Weekly Summary the CLARITY app dQ&A (2018): 57% of Dexcom G5 and t:slim X2 users use the CLARITY app Data Source: Kelly Close, Dexcom CLARITY app
Slide 18: Questions we wonder about quarterly A1Cs
Questions we wonder about quarterly A1Cs: • What times of day are in-range BGs, highs, and lows occurring? Why? • Should medication dose be adjusted? Timing? • What’s going on with food, sleep, exercise, stress, decisions? What is working? What is not working? • I just made a change – but did it mak
Slide 19: TIR can help to contextualize A1C
TIR can help to contextualize A1C A1C: A1C: 17% 31% 6.3% 6.2% 82% 56% 13% 1% A1C: 29% A1C: 8% 6.3% 61% 6.1% 92% 10% 0% Source: Adam Brown
Slide 20: Time-in-Range has "A Big Impact" on daily life
Time-in-Range has “A Big Impact” on daily life Type 1 Type 2 on insulin Type 2 no insulin (n=1,016) (n=1,141) (n=1,266) #1 Time in Range Time In Range Time In Range Unexpected BG #2 Numbers A1c A1c Non-Diabetes Non-Diabetes #3 Dosing Insulin Health Issues Health Issues Unexpected BG #4 Hypoglycemia
Slide 21: +5% TIR = +1 hour per day
+5% TIR = +1 hour per day +8% TIR per day = 1 extra month per year in-range
Slide 22: People with Diabetes can use TIR
People with Diabetes can use TIR: What happens when I eat different foods? Photos + CGM = Magic!
Slide 23: TIR exists whether or not it's being measured with CGM
TIR exists whether or not it’s being measured with CGM using professional CGMs Blood Glucose Meter
Slide 24: Diabetes is not destiny: striving for FNIR!
Diabetes is not destiny: striving for FNIR! Flat, Narrow, In-Range
Slide 25: What can we learn from ~500,000 CGM users?
What can we learn from ~500,000 CGM users? Median CGM User Lowest-Scan Users Highest-Scan Users N=470,643 readers 10 Scans/Day 4 Scans/Day 40 Scans/Day Estimated A1c 7.5% 8.2% 6.7% Time-in-Range 56% 48% 70% (70-180 mg/dl) 13.5 hours/day 11.7 hours/day 16.9 hours/day 2% 2% 1.6% Time ≤54 mg/dl 34 minu
Slide 26: Normoglycemia—the goal
Normoglycemia—the goal. Mean glucose: 99 mg/dl Time 70–140 mg/dl: 97% Coefficient of Variation: 17% 10 days blinded CGM (n=153 without Diabetes) Beck, EASD 2019
Slide 27: CITY study. 6 months of RT-CGM in Type 1s Ages 14-25
CITY study. 6 months of RT-CGM in Type 1s Ages 14-25 Mean A1c Mean Time-in-Range 8.9% 8.5% 37% 43% Mean Time >180 mg/dl Mean Time>300 mg/dl Mean Coefficient of Variation (CV) 58% 54% 18% 14% 42% 39% Laffel, ADA 2019
Slide 28: WISDM study. 6 months of RT-CGM in Type 1s Ages 60+
WISDM study. 6 months of RT-CGM in Type 1s Ages 60+ Mean A1c Mean Time-in Range 7.6% 7.2% 56% 63% Mean Time >180 mg/dl Mean Time <70 mg/dl Mean Coefficient of Variation (CV) 37% 34% 5% 3% 41% 37% Carlson, ENDO 2019
Slide 29: Dr. Rich Bergenstal quote on equitable CGM access
“It’s not just giving CGM to those with A1cs of 7.2% and getting them down to 6.9%. We won’t see a flattening of the curve if we only do that…We need to be more equitable, regardless of A1c, ability to pay, race, or ethnicity. It’ll take more work on our part but we’ve got to make it happen if we’re
Slide 30: Progress! ADA posters show promise of CGM
Progress! ADA posters show promise of CGM in: Youth with Type 2 Diabetes (973-P; LaRoche et al.) Newly Diagnosed Type 1s (1358-P; Prahalad et al.) Primary Care (1280-P; Martens et al.)
Slide 31: Emerging standard of care includes TIR, based on CGM developments
Emerging standard of care includes TIR, based on CGM developments
Slide 32: Learn more at diaTribe.org/time-in-range
Learn more at diaTribe.org/time-in-range
Slide 33: Learn more at diaTribe.org/time-in-range
Learn more at diaTribe.org/time-in-range
Slide 34: Time-in-Range: Thoughts from an Endocrinologist
Time-in-Range: Thoughts from an Endocrinologist 33
Slide 35: Three pillars to manage dysglycemia
Three pillars to manage dysglycemia The whole is greater than the sum of its parts Chronic Hypoglycemia Glycemic Variability Hyperglycemia DCCT (T1D) and The limiting factor in Emerging glycemic UKPDS (T2D) have treating People with target clearly demonstrated a Diabetes link between A1c and develop
Slide 36: Glycemic Variability
Glycemic Variability Measurements of fluctuations of glucose over an interval of time Short-term GV: within-day and between day Long-term GV: based on serial determinations over a longer period of time, usually involving HbA1c There is no consensus on how short-term or longer- term GV should be meas
Slide 37: Glycemic Variability: TIR and GV are mathematically and conceptually linked
Glycemic Variability* TIR and GV are mathematically and conceptually linked, they are not interchangeable Measurements of fluctuations of glucose over an interval of time Short-term GV: within-day and between day Long-term GV: based on serial determinations over a longer period of time, usually invo
Slide 38: GV and CV clinical outcomes
GV and CV clinical outcomes Before 2015: Several studies had shown a positive association between GV and macro (and micro)vascular complications Since 2015: Studies have supported this is an independent risk factor for total mortality and CV death in both T1 and T2 Adversely affect plaque Extends cQ
Slide 39: Diabetic Kidney Disease
Diabetic Kidney Disease Diabetes is the leading cause of CKD in the world • The most important RF for developing DKD is hyperglycemic burden (hyperglycemic exposure over time) ? • The structural abnormalities seen in DKD are unique to Diabetes and develop only in the context of elevated glucose leve
Slide 40: Diabetic Kidney Disease: GV and DKD
Diabetic Kidney Disease GV and DKD T2D T1D A1c variability was found to associate with worsening The longitudinal Finnish Diabetic nephropathy study of albuminuria in cohort of individuals with T2D. individuals with T1D, long-term A1c variability predicted the development and progression of renal di
Slide 41: ATTD Consensus Statement Values for TIR
ATTD Consensus Statement Values for TIR Advanced Technologies & Treatments for Diabetes (ATTD) This international consensus report has been endorsed by the American Diabetes Association, American Association of Clinical Endocrinologists, American Association of Diabetes Educators, European Associati
Slide 42: Approaches to Further the Use of Time-in-Range Across Three Stages of Maturity
Approaches to Further the Use of Time-in-Range Across Three Stages of Maturity ESTABLISH Objective: ADVANCE Establish importance of TIR for blood glucose management across Objective: PERPETUATE key stakeholders Advance importance of TIR and • Finalize consensus and overall promote ease of use of Obj
Slide 43: Mission (can be) Accomplished!
Mission (can be) Accomplished! 42
Slide 44: Thank You!
Thank You! The IQVIA Institute The diaTribe Foundation www.iqviainstitute.org www.diaTribe.org [email protected] [email protected] @IQVIA_Institute [email protected] @diaTribeNews