Using fractal-inspired therapeutics to help large populations of patients with metabolic disease.
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Improving Outcomes for Type 2 Diabetes with Margaret Borys, Chief Commercial Officer at Fractyl Laboratories Inc. was automatically transcribed by Sonix with the latest audio-to-text algorithms. This transcript may contain errors. Sonix is the best way to convert your audio to text in 2019.
Welcome to the Outcomes Rocket podcast, where we inspire collaborative thinking, improved outcomes and business success with today’s most successful and inspiring health care leaders and influencers. And now your host, Saul Marquez.
Saul Marquez:
Welcome back to the Outcomes Rocket. Today, I have the privilege of hosting Margaret Borys on the podcast. She’s the chief commercial officer of Fractyl. Margaret has more than twenty six years of industry experience and she has held various positions in corporate strategy, commercial operations, global brand management, business technology, finance and business consulting. Most recently, she was with Sanofi, where she led the multi-billion dollar U.S. diabetes biologic business, which included both basal and mealtime insulin, plus a novel basal fixed dose combination product. Prior to Sanofi, she worked for Pfizer, Wyeth and Arthur Andersen. She’s got an MBA from Columbia University. And today, as astutely focused on this problem of diabetes with the work at Fractyl to do it in a new and more impactful way to cover the work that’s being done at Fractyl. And some of the insights that she’s gained over two decades of experience dealing with diabetes. So, Margaret, such a privilege to have you here with us today.
Margaret Borys:
Thank you so much Saul, pleasure to be here.
Saul Marquez:
So tell me a little bit more about your journey, Margaret. What got you into health care?
Margaret Borys:
So it was actually a very circuitous journey for me. I didn’t go into the business with the intention of being in health care. It sort of just happened based on the first 10 years of my experience with Anderson and being generally involved in consulting. The areas that I was focused on initially were pretty broad and diverse and eventually led into more and more of a focus on health care is a certainly a growing piece of the business at the time. And in fact, upon leaving Andersen, I joined a pharmaceutical company that really solidified my engagement in the healthcare space.
Saul Marquez:
Wow. It’s interesting to hear how careers take their shape and form. And it sounds like from very early on, your business management career sort of led you to health care and you’ve stuck with it since. What do you think today is a focus that health leaders need to be thinking about our on this topic of diabetes?
Margaret Borys:
Well, certainly, I think both for diabetes as well as for general health. One of the things and I’ll liken it back to sort of my career progression is I’ve had the privilege of having done consulting and having done a little bit of animal health and consumer health care products and then our pharmaceutical products. And the one thing I think whether it be diabetes or any other disease area, is the ability to take lessons learned and best practices from like analog businesses that may be sort of outside of the traditional area. It’s the one thing you learned you learn acutely when you’re in consulting is how to look at benchmarks and analogs from near in or like businesses that I don’t know. Sometimes when you grew up in just one part of pharmaceuticals, you tend to be very, very focused in that one space without stepping back and looking at the broader picture business and finding similarities whether they be Uber or the Net, whether it be other types of models that you can apply to your own specific space.
Saul Marquez:
Yeah, that’s neat. And just being able to do that, I’m sure has has given you quite the the advantage. And we had a chance to connect before recording this, Margaret, and so that’s kind of what we’re doing here at Outcomes Rocket, right, where we’re wanting to see those, you know, the analogs and be able to provide insights for the people listening. And so I love your model. I love how you think about business. Tell us a little bit more about how Fractyl is doing things differently to solve for Type 2 diabetes.
Margaret Borys:
Absolutely. So what was really interesting to me about Fractyl was its unique angle in terms of the science of the duodenum and the duodenum’s role in its signaling of hormones in the body. It’s science that has been around for a long time. It’s science that frankly started with bariatric surgery. Our CEO Harith Rajagopalan got interested in the science around this by studying bariatric surgery and learning that the patients who had gastric bypass would actually see remission of their Type 2 diabetes before they ever lost an ounce of weight. And it sort of really sparked an interest in him around the fact that there must be something going on in the duodenum. And over the past several years, we’ve been very fortunate to not only have uncovered a lot of meaningful science, but also having had the opportunity to actually develop a catheter console procedure that doesn’t ablation procedure on on that part of the duodenal and has a real effect on insulin resistance.
Saul Marquez:
So, Margaret, that and this is kind of a one to one question. The duodenal is in the gut, correct?
Margaret Borys:
It is the upper 10 centimeters of the gut, if you will.
Saul Marquez:
Interesting. Fascinating. So there is this subset of patients that were going in for a gastric bypass and just saw one of the side effects was remission of their diabetes before even a weight loss.
Margaret Borys:
Correct.
Saul Marquez:
Light ball, bright like that’s a side. There’s something there.
Margaret Borys:
There is something going on. Absolutely.
Saul Marquez:
So now with the work that you guys have done, you develop a therapy to address that through ablation.
Margaret Borys:
Correct. So what we’ve discovered is by bleeding the mucosa, which is that the upper lining of that, the first 10 centimeters of the duodenal, it actually able to mimic the effects of that gastric bypass. So in a sense, by doing that ablation, we’re able to improve that insulin resistance and really help patients improve their metabolic health.
Saul Marquez:
That is just fascinating.
Margaret Borys:
Yes. Like I said, it is one of the most unique ways of managing diabetes that I’ve seen to date. And I love the fact that patients are burdened enough with medicines. Most often Type 2 diabetes patients are on roughly seven to eight medications because they have a lot of co-morbidities. Usually on statins and various type 2 diabetes medications. What I love about this procedure is that not only does it help change the trajectory of disease, but is not another yet another medicine that they’re adding to their arsenal. It is actually using that medication.
Saul Marquez:
That is so, so fascinating. And so with the work that’s being done on this procedure, does it currently have a reimbursement pathway?
Margaret Borys:
So we are ahead of pivotal trials in the US. However, we have a SEAMARK in Europe.
Saul Marquez:
Nice. Outstanding. So it’s in the works, but very promising.
Margaret Borys:
Exactly. I’m very excited.
Saul Marquez:
Now, that is very exciting and it is fascinating. Right.. I mean, so much is being done in the area of the microbiome, the gut Right. like a lot of things are originating here. Fascinating that you guys are taking a therapy there. Love to hear from you about some of the early results that you’re seeing.
Margaret Borys:
Yeah. So we’re super excited about some of the results that we’re seeing earlier this year. We presented at A.D.A a poster through an investigator initiated study where we were excited to show that we were able to actually work on patients where they were on insulin and we’ve withdrawn them from insulin. So this is the first product on the market that is able to take patients off of insulin. So we are super excited about those results. We’ve published results of liver forms around our fatty liver data where we’re showing up to 36 percent. That fraction reduction. So we are extremely excited about that. And then, of course, A1C reduction, we’re showing almost the point decline in A1C as well. So I’m just a wide variety of benefits all related frankly to that because we’re targeting the root cause of insulin resistance. We’re able to see all of these metabolic health effects.
Saul Marquez:
Wow. That’s that’s impressive. And there’s definitely huge promise to a lot of the people listening, whether you be a provider, a payer or even an individual in industry thinking about what the future is of treating diabetes. It’s incredible work and really outside of the box. So I really want to give you guys a lot of credit for what you’ve done so far.
Margaret Borys:
Thank you. So, I mean, we’re very proud of the fact that we are really a very science based organization. We’re very mission based. We believe very strongly in changing the trajectory of this disease. And we’re very focused on having the best possible outcomes for our patients at this time.
Saul Marquez:
I love that. So give us an example of maybe a setback you had, whether it be with Fractyl or one of your other ventures. We learned a lot from mistakes. And tell us about that and maybe a learning that came out of that.
Margaret Borys:
Maybe I’ll talk a little bit about sort of learning just the general learnings around sort of early adoption. I’ve mentioned that the book Crossing the Chasm earlier with you. Yes. And one of the things that is always extremely important when you have something that’s new and innovative, whether it be a new drug that you’re bringing to market in a new space or whether it be a new and novel procedure such as the one that we had is sort of really being keenly focused on the positioning of that product. Who are you really trying to help? What does that ideal patients look like? And I think in terms of lessons learned. I think a lot of. Times companies tried to go very broad with their products and their solutions, as opposed to really being very narrowly focused on the issues that can help the most. This is one thing I’m probably the most proud of with Fractyl, though, is that as our science has developed and as we’ve been able to learn more and more about our responders and just the multitude of metabolic health benefits we’ve really stayed true to, let’s be really careful about those patients that we serve. Let’s get the best outcomes for those patients and not trying to sort of overreach in terms of the promise of the product. And so it’s a lesson that I would recommend for anyone in terms of really specific to you’re treating.
Saul Marquez:
I love that. Yeah. The outcomes matter. The people that were working to help matter, and that’s both patients and clinicians. And how are clinicians taking this option?
Margaret Borys:
Yeah. So endoscopes and gastroenterologists absolutely love this concept. They understand it. They’re the treating physicians and they tend to see a lot of fatty liver and the overlap of fatty liver and type 2 diabetes. Today is over 70 percent. So it’s really an emerging problem that is coming to light. But unfortunately to date, companies think treat the liver. And so this presents a very unique new how you proposition for and for those patients, for endocrinologists the endocrinologists are now starting to really embrace science. It’s very science driven segment of the market. And with more and more of our clinical data coming out, we’re starting to see a turnaround in endocrinologists adoption of this concept. They’re starting to your point. They’re starting to understand with the micro volume of the science and in signaling of the duodenum. And so the science is now up to where we’ve been over the past few years.
Saul Marquez:
Wow. That’s great. Yeah. And you know, the point that you made a market about crossing the chasm and thinking about all the stakeholders involved, the end user, some people jump on faster than others. So I think it’s a great message to share with the folks listening about new technology adoption. So you guys are moving pretty quickly. What would you say is the most exciting project you’re working on today?
Margaret Borys:
Well, we are looking to launch commercially in Europe. And so I would say without getting into too many of the specifics, that’s probably the most exciting thing, is really changing the company from being very science oriented and now becoming a true commercial organization and treating patients in that commercial setting. So it’s taking a lot of the science that we’ve built up and a lot of the data that we’ve built up and now really applying it to changing people’s lives.
Saul Marquez:
Wow. Yeah. Now it’s time for the rubber to meet the road.
Margaret Borys:
Exactly. And we’re excited.
Saul Marquez:
That is very exciting. So if you folks are curious, the website is fractyl.com. That’s F R A C T Y l . com. Go learn some more about this innovative therapy to treat type 2 diabetes. So the book that we keep referencing is your favorite or at least one of your more recent favorites, right, Margaret?
Margaret Borys:
That is correct.
Saul Marquez:
Tell us about it.
Margaret Borys:
So crossing the chasm is really about innovative technology and how to look at the marketplace and having that innovative technology really being adopted. It’s about not mistaking those initial early adopters as the only segment that you need to cater to, but really about how do you look at different segments along the way as you get past your early adopters, how do you essentially cross the chasm, if you will, to the broader market? And the needs of that early group can vary quite differently from the needs of that second group. And then the group they’re asked for. And so it’s really all about ensuring that your technology is adopted by each of those segments and really catering to the specific needs of each one of those.
Saul Marquez:
I love it. It’s a great recommendation for all of you listeners looking for innovative approaches to the market. And again, to get that link and as well as the entire transcript to today’s interview, just go to outcomesrocket.health in the subject line, just type in fractyl and you’ll see all of our show notes there. Wow. This is up and super interesting, Margaret. I love if you could just leave us with the closing thought and then the best place for the listeners could continue the conversation.
Margaret Borys:
Sure. So I guess in terms of a closing thought, I would just say being mission based is extremely important. It’s always good to know the why of what you’re doing as opposed to just the what and the how. You know, I think for me, the why of really putting Type 2 diabetes into remission is a big part of what I am and what Fractyl was all about. So I would just really encourage you to focus on that why.
Saul Marquez:
Love it, Margaret, a great message to everybody. And I just want to welcome you folks to check out the Web site for additional information. Anything beyond that that you’d recommend for them to learn more?
Margaret Borys:
No. Just check out our Web site at fractyl dot com. And that should give you all the information.
Saul Marquez:
Outstanding. Margaret, thanks again for spending time with us and wishing you and your team incredible success.
Margaret Borys:
Thank you so much, Saul.
Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at www.outcomesrocket.com for the show notes, resourses, inspiration and so much more.
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