Changewave Research: Trends in Diabetes Treatments and Obesity

ChangeWave Research: Trends in Diabetes Treatments and Obesity

ChangeWave Research Report:

Trends in Diabetes Treatments and Obesity

Overview

During the week of January 17-23, 2007, we surveyed Alliance healthcare members on trends in diabetes treatments and obesity, including the drugs Exubera, Byetta (Exenatide) and Januvia. A total of 137 doctors participated.

(A) Inhaled Insulin (Exubera)

Bottom Line. The outlook for Inhaled Insulin remains positive. Doctor respondents believe two-thirds of their existing diabetes patients would prefer inhalable insulin rather than the injectable form. They also estimate four-in-five newly diagnosed patients would prefer inhalable insulin.

The findings onExubera –the only form of inhalable insulin currently available –were positive, with 48% of doctors saying they’re Very or Somewhat Likely to recommend it to their diabetes patients over the next year. We note that 19% say they’re Veryor Somewhat Unlikely to recommend it.

(B) Byetta (Exenatide) and Januvia

Bottom Line: In a consensus estimate, doctors say 9% of their type 2 diabetes patients currently use Byetta, but they believe 15% will begin using it over the next 12 months. Turning to recently approved Januvia, the consensus is that 8% of type 2 diabetes patients have already inquired about Januvia, and 14% will begin using it over the next 12 months.

We note that doctors rank Glucophage (12%), Glyberide (11%) and Glucotrol (10%) as the treatments most likely to be displaced by Januvia within their practice.

Bottom Line: The findings point to a risingnumber of obese patients, with three-quarters (75%) of doctors reporting an increase within their practice over the past year. Moreover, 64% say there has been an increase in the number of dangerously or morbidly obese patients over the past year.

Top Weight Control Drugs Recommended. Xenical (28%) and Meridia (22%) are the top weight controldrugs doctor respondents recommend to their obese patients, followed by Adipex (15%) and Ionamin (15%).

Most Effective Drugs. Doctors consider Xenical (11%) to be the most effective weight control drug they recommend, followed by Adipex (9%) and Meridia (8%).

Weight Control Products. Weight Watchers (44%) is the top weight control product/ diet that doctors have recommended to obese patients over the past 12 months. A Low-Carb Diet (35%) ranks second, followed by a Low Fat Diet (32%). Similarly, these remain the top products/diets doctors say they’ll recommend over the next 12 months.

Summary of Key Findings

The ChangeWave Alliance is a group of 10,000 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 ™

Table of Contents

Summary of Key Findings...... 2

The Findings...... 4

(A) Inhaled Insulin...... 4

(B) Byetta (Exenatide)...... 6

(D) Obesity...... 12

ChangeWave Research Methodology...... 16

About ChangeWave Research...... 17

I. The Findings

Introduction

During the week of January 17-23, 2007, we surveyed Alliance healthcare members on trends in diabetes treatments and obesity, including the drugs Exubera, Byetta (Exenatide) and Januvia.

Doctors (n=137)

(A) Inhaled Insulin

(1) Question Asked: What percentage of existing Diabetes patients do you think would prefer to use an inhalable form of Insulin rather than a traditional injectable form?

Doctors
0% / 0%
1%-10% / 2%
11%-20% / 4%
21%-30% / 4%
31%-40% / 3%
41%-50% / 10%
51%-60% / 9%
61%-70% / 10%
71%-80% / 19%
81%-90% / 12%
91%-100% / 18%
Don't Know / 9%
Other / 0%
No Answer / 1%

Current Survey Consensus Estimate = 67.1%

(1A) 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?

Doctors
0% / 1%
1%-10% / 0%
11%-20% / 1%
21%-30% / 2%
31%-40% / 1%
41%-50% / 4%
51%-60% / 9%
61%-70% / 4%
71%-80% / 13%
81%-90% / 20%
91%-100% / 41%
Don't Know / 4%
Other / 1%

Current Survey Consensus Estimate = 80.9%

Inhalable vs. Injectible Insulin. The outlook for Inhaled Insulin remains positive. Doctor respondents believe two-thirds of their existing diabetes patients would prefer inhalable insulin rather than the injectable form. They also estimate four-in-five newly diagnosed patients would prefer inhalable insulin.

(2) Question Asked: Last year, the FDA approved a form of Inhaled Insulin called Exubera (made by Pfizer in collaboration with Sanofi-Aventis and Nektar Therapeutics). Are you familiar with Exubera (Inhaled Insulin)?

Doctors
Yes / 72%
No / 28%

Increased Doctor Awareness of Exubera. Nearly three-in-four doctors (72%) report they’re familiar with Exubera.

(2A) Question Asked: How likely are you and/or other members of your practice to prescribe or recommend Exubera (Inhaled Insulin) to diabetes patients over the next 12 months?

Doctors
Very Likely / 15%
Somewhat Likely / 33%
Somewhat Unlikely / 9%
Very Unlikely / 10%
Don't Know/NA / 32%

The findings on Exubera –the only form of inhalable insulin currently available – were positive, with 48% of doctors saying they’re Very or Somewhat Likely to recommend it to their patients over the next year. We note that 19% say they’re Very or Somewhat Unlikely to recommend it.

(2B) Question Asked: What is the number one reason why are you likely or unlikely to prescribe/ recommend Exubera over the next 12 months?

(a)Very/Somewhat Likely to Prescribe/Recommend Exubera

Doctors (n=55)

Doctors
Patient Preference / 40%
Ease of Use/Administration / 27%
Need More Information / 13%
Cost / 9%
Other / 11%

(b)Very/Somewhat Unlikely to Prescribe/Recommend Exubera

Doctors (n=20)

Doctors
Need More Information / 20%
Cost / 15%
Lung Risks / 15%
Not on the Formulary / 15%
Short Acting Effects / 5%
Other / 30%

Doctors cite Patient Preference (40%) as the number one reason why they are likely to prescribe or recommend Exubera.

(B) Byetta (Exenatide)

(3) Question Asked: The injectible diabetes drug Byetta (Exenatide), marketed by Eli Lilly, is used to improve glycemic control in patients with type 2 diabetes. Are you familiar with Byetta (Exenatide)?

Doctors
Yes / 60%
No / 39%

Byetta (Exenatide). Three-in-five doctors (60%) say they're familiar with Byetta by Eli Lilly.

(3A) Question Asked: Have you and/or other members of your practice ever prescribed or recommended Byetta (Exenatide) to diabetes patients over the past 12 months?

Doctors
Yes / 26%
No / 40%
Not Applicable / 33%

Current Recommendations. One-in-four (26%) haveprescribed or recommended Byetta to diabetes patients over the past 12 months.

(3B) Question Asked: How likely are you and/or other members of your practice to prescribe or recommend Byetta (Exenatide) to diabetes patients in the next 12 months?

Doctors
Very Likely / 13%
Somewhat Likely / 18%
Somewhat Unlikely / 12%
Very Unlikely / 12%
Don't Know/NA / 44%

Likelihood of Recommendation. Looking ahead, 31% say they’re Very Likely or Somewhat Likely to recommend Byetta to their patients over the next year. On the down side, 24% now say they are Very Unlikely or Somewhat Unlikely to recommend Byetta.

(3C) Question Asked: What is the number one reason why are you likely or unlikely to prescribe/recommend Byetta (Exenatide) over the next 12 months?

(a)Very/Somewhat Likely to Prescribe/Recommend Byetta

Doctors (n=34)

Doctors
Effectiveness / 29%
Weight Loss Effects / 21%
Glycemic Control / 6%
Cost / 3%
Other / 41%

Effectiveness (29%) was cited as the top reason among those likely to recommend or prescribe Byetta over the next 12 months. Weight Loss Effects(21%)ranked second.

(b) Very/Somewhat Unlikelyto Prescribe/Recommend Byetta

Doctors (n=24)

Doctors
Lack of Information / 25%
Cost / 13%
Use/Time Concerns / 8%
Other / 54%

Doctors cited Lack of Information (25%) as the top reason why they are unlikely to prescribe or recommend Byetta in the next year.

(3D) Question Asked: What percentage of the type 2 diabetes patients in your practice/work environment currently use Byetta (Exenatide)?

Doctors
0% / 23%
1%-10% / 30%
11%-20% / 5%
21%-30% / 3%
31%-40% / 1%
41%-50% / 0%
51%-60% / 0%
61%-70% / 0%
71%-80% / 0%
81%-90% / 0%
91%-100% / 0%
Don't Know / 18%
Not Applicable / 20%
Other / 0%

Consensus Estimate = 9.4%

(3E) Question Asked: What percentage of the type 2 diabetes patients in your practice/work environment do you believe will begin using Byetta (Exenatide) over the next 12 months?

Doctors
0% / 4%
1%-10% / 20%
11%-20% / 15%
21%-30% / 7%
31%-40% / 1%
41%-50% / 2%
51%-60% / 1%
61%-70% / 0%
71%-80% / 0%
81%-90% / 0%
91%-100% / 0%
Don't Know / 27%
Not Applicable / 16%
Other / 2%

Consensus Estimate = 15.3%

Usage of Byetta. The consensus estimate among doctors is that 9% of their type 2 diabetes patients currently use Byetta. Looking ahead 12 months, they believe 15% of patients will begin using it.

(4) Question Asked: The oral diabetes drug Januvia, by Merck, is also used to improve glycemic control in patients with type 2 diabetes. Are you familiar with Januvia?

Doctors
Yes / 51%
No / 49%

Januvia. One-in-two doctors (51%) say they’re familiar with the oral diabetes drug Januvia by Merck.

(4A) Question Asked: What percentage of the type 2 diabetes patients at your practice/work environment have inquired about Januvia?

Doctors
0% / 38%
1%-10% / 18%
11%-20% / 2%
21%-30% / 1%
31%-40% / 1%
41%-50% / 0%
51%-60% / 0%
61%-70% / 0%
71%-80% / 0%
81%-90% / 0%
91%-100% / 0%
Don't Know / 11%
Not Applicable / 26%
Other / 0%

Consensus Estimate = 8.2%

(4B) Question Asked: What percentage of the type 2 diabetes patients in your practice/work environment do you believe will begin using Januvia over the next 12 months?

Doctors
0% / 8%
1%-10% / 19%
11%-20% / 21%
21%-30% / 6%
31%-40% / 1%
41%-50% / 1%
51%-60% / 1%
61%-70% / 0%
71%-80% / 0%
81%-90% / 0%
91%-100% / 0%
Don't Know / 28%
Not Applicable / 19%
Other / 1%

Consensus Estimate = 13.9%

Patient Interest in Januvia. The consensus among doctors is that 8% of patients have inquired about Januvia. Looking ahead, they think14% of patients in their practice will begin using Januvia over the next 12 months.

(4C) Question Asked: Within your own practice/work environment, which of the following treatment(s) – if any – are most likely to be displaced by Januvia? (Choose No More Than Three)

Doctors
Glucophage / 12%
Glyberide / 11%
Glucotrol / 10%
Glipizide / 9%
Metformin Hydrochloride / 8%
Avandia / 7%
Actos / 5%
Amaryl / 5%
Byetta / 3%
Insulin / 3%
Prandin / 2%
Rezulin / 2%
Avandamet / 1%
Glucovance / 1%
Precose / 1%
Starlix / 1%
Avandaryl / 0%
Duetact / 0%
Glyset / 0%
Gulmetza / 0%
Metaglip / 0%
Don't Know / 36%
Not Applicable / 25%
Other / 2%

Treatments Most Likely to Be Replaced by Januvia. Doctors say Glucophage (12%), Glyberide (11%) and Glucotrol (10%) are the treatments most likely to be replaced by Januvia within their practice.

(D) Obesity

(5) Question Asked: Within your practice or institution, have you seen an increase in the number of Obese patients, a decrease, or has the number of Obese patients remained the same over the past year?

Doctors
Significant Increase in Obese Patients (More Than 10% Increase) / 33%
Moderate Increase in Obese Patients (1%-10% Increase) / 42%
Decrease in Obese Patients / 0%
No Change in the Number of Obese Patients / 22%
Don't Know / 0%
Not Applicable / 2%

(5A) Question Asked: Within your practice or institution, have you seen an increase in the number of Dangerously or Morbidly Obese patients, a decrease, or has the number of Dangerously or Morbidly Obese patients remained the same over the past year?

Doctors
Significant Increase in Dangerously or Morbidly Obese Patients (More than 10% Increase) / 19%
Moderate Increase in Dangerously or Morbidly Obese Patients (1%-10% Increase) / 45%
Decrease in Dangerously or Morbidly Obese Patients / 4%
No Change in the Number of Dangerously or Morbidly Obese Patients / 27%
Don't Know / 2%
Not Applicable / 3%

Numbers of Obese Patients Keeps Rising.Three-quarters (75%) of doctors report an increase in the number of obese patients over the past year (33% Significant Increase and 42% Moderate Increase.

Moreover, 64% say there has been an increase in the number of dangerously or morbidly obese patients over the past year.

(6) Question Asked: Which of the following pharmaceuticals for weight control does your practice or institution recommend to obese patients? (Note: If you prescribe the generic form, please check the brand name.) (Check All That Apply)

Doctors
Xenical (Orlistat) / 28%
Meridia (Sibutramine Hydrochloride) / 22%
Ionamin (Phentermine Hydrochloride) / 15%
Adipex (Phentermine Hydrochloride) / 15%
Tenuate (Diethylpropion Hydrochloride) / 9%
Bontril (Phendimetrazine Tartrate) / 2%
X-Trozine (Phendimetrazine Tartrate) / 1%
Didrex (Benzphetamine Hydrochloride) / 0%
Not Applicable / 36%
Don't Know / 12%
Other / 9%

Top Weight Control Drugs Recommended.Xenical (28%) and Meridia (22%) remainthe top weight controldrugs doctor respondents recommend to obese patients, followed by Ionamin (15%) and Adipex (15%)

(6A) Question Asked: And based on your own clinical experience, which one of the following weight control drugs do you consider to be the most effective?

Doctors
Xenical (Orlistat) / 11%
Adipex (Phentermine Hydrochloride) / 9%
Meridia (Sibutramine Hydrochloride) / 8%
Ionamin (Phentermine Hydrochloride) / 5%
Bontril (Phendimetrazine Tartrate) / 1%
Tenuate (Diethylpropion Hydrochloride) / 1%
X-Trozine (Phendimetrazine Tartrate) / 1%
Didrex (Benzphetamine Hydrochloride) / 0%
Not Applicable / 2%
Don't Know / 30%
Other / 8%

Most Effective Drugs. Doctors consider Xenical (11%) to be the most effective weight control drug they recommend, followed by Adipex (9%) and Meridia (8%).

(6B) Question Asked: Why?

A Sample of Alliance Member Responses:

(a) Xenical (11%)

Doctor DR.32051 writes, “Clinical trial results.”

Doctor JOH89542 writes, “I find it a very good product which gives significant results.”

Doctor MED63234writes, “Compliance and degree of weight loss.”

Doctor BOY70648 writes, “Easy compliance.”

Doctor NAL80131 writes, “Forces patients into a low fat diet.”

Doctor STE3218writes, “Stops absorption of fat, but time to meal sensitive and causes diarrhea. None of the treatments overly effective.”

Doctor NIN8017 writes, “Actually none really, all put weight on again after stopping, minimal weight loss on rx and horrid GI side effects with Orlistat, there is no real substitution for eating less and exercising more.”

(b) Adipex (9%)

Doctor LEO7024 writes, “Suppresses appetite more smoothly and effectively.”

Doctor AFA3665 writes, “Suppresses appetite leading to significant weight loss along with fewer side effects.”

Doctor RBH82876 writes, “Part of the previously wildly successful Phen-Fen regimen of years past.”

Doctor DOC03757 writes, “Most effective weight loss; few side effects. Limited by length of treatment.”

Doctor REP44662 writes, “Patients seem to be the most compliant with this med.”

Doctor DR.4072 writes, “Adipex for individuals without cardiac issues or with GI issues and Xenical for individuals without GI issues and with cardiac issues – decreases appetite over the long term although Fastin does develop a tolerance and Xenical in addition to the fat soluble binding does teach patients how much fat they can safely eat over their body weight – based on personal prescribing experience and research studies.”

Doctor YOR67603 writes, “Seems to control appetite better.”

Doctor OCE43646 writes, “Decreased appetite continues if Meridia continued long term, but better drugs in pipeline, and GI bypass remains gold standard for morbidly obese.”

Doctor PAU3772 writes, “We have seen significant weight losses.”

Doctor SMC61289writes, “Meridia's better tolerated, however all of the treatments are much less effective than bariatric surgery.”

Doctor BUC85235 writes, “Good compliance.”

(d) Ionamin (5%)

Doctor FRU28890 writes, “Cheap, well-tolerated, and safe.”

Doctor MIK3319 writes, “It inhibits appetite and increases metabolism, or so it seems.”

Doctor MJB75931writes, “Despite stimulant risk people lose weight they just can’t keep it off.”

Doctor MES04968 writes, “Patients report appetite suppression and exhibit weight loss over the short term.”

(7) Question Asked: Over the past 12 months, which of the following weight control products or diets – if any – have you recommended to Obese patients? (Check All That Apply)

(7A) Question Asked: And looking ahead 12 months, which of the following weight control products or diets – if any – do you think you'll recommend to Obese patients? (Check All That Apply)

Past 12 Months
Weight Control
Products or Diets
Doctors
Recommended / Next 12 Months
Weight Control
Products or Diets
DoctorsPlan
toRecommend
Weight Watchers / 44% / 42%
Low Carb Diet / 35% / 36%
Low Fat Diet / 32% / 32%
Jenny Craig / 12% / 9%
Nutrisystems / 12% / 13%
Slim-Fast / 7% / 7%
L.A. Weight Loss / 4% / 1%
Medifast / 4% / 4%
None / 7% / 4%
Don't Know / 1% / 7%
Not Applicable / 15% / 14%
Other / 13% / 12%

Weight Control Products. Weight Watchers (44%) is the top weight control product/ diet that doctors have recommended to obese patients over the past 12 months. A Low-Carb Diet (35%) ranks second, followed by a Low Fat Diet (32%). Similarly, these remain the top products/diets doctors say they’ll recommend over the next 12 months.

II. ChangeWave Research Methodology

This report presents the findings of a recent ChangeWave Alliance healthcare survey on on trends in diabetes treatments and obesity, including the drugs Exubera, Byetta (Exenatide) and Januvia. The survey was conducted betweenJanuary 17-23, 2007, and a total of 137 doctors participated.

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 (56%) have advanced degrees (e.g., Master’s or Ph.D.) and 93% have at least a four-year 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.

III. 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 10,000-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 10,000Alliance 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