A crowded pool

A crowded pool

According to a story on the MassDevice web site Nest is jumping into the healthcare pool which by default means that diabetes care will be part of the effort. Per the story;

“Connected home device maker Nest, which was bought by Google (NSDQ:GOOG) in 2014 for $3.2 billion, acquired smartphone-based health monitoring system developer Senosis Health last year in a hush-hush deal that may mark the business’ first steps towards an entry into the healthcare market, according to a GeekWire report.”

Keep in mind that Verily, Google’s life sciences unit is partnered with Dexcom and has OnDuo a joint venture with Sanofi. So, it’s not a major leap to believe that with all these units under one roof they would find a way to work together.

Each day it seems there is another story about yet another company entering the digital health arena. That poor dead cat is working overtime. Which begs the question how will all this activity impact smaller players such as Livongo and OneDrop. One could argue all this activity enhances their value as while they lack scale they have experience in the space others do not. On the flip side an equally strong argument can be made that these large cash rich companies don’t need to buy their expertise and can develop coaching internally.

Given all this activity it’s time to look at the real opportunities in diabetes and it’s not where many thinks it is. Everyone seems to believe that insulin using patients will be the early adopters of this technology. There is some truth in this but thanks to other technology in particular insulin dosing algorithms combined with CGM they will not need this technology. We’ve said it before and will say it again it won’t be long before being an insulin using patient will be pretty easy.

Next you can eliminate the growing number of patients using a GLP-1. It won’t be long before we have a monthly version and/or the Intarcia micropump. In many respects’ physicians will have an easier time prescribing a GLP-1 then any digital platform. GLP-1 therapy requires no glucose monitoring, dosing is fixed and there is the added benefit of weight loss.

Which brings us to the largest yet most difficult patients to help, non-insulin using Type 2’s. This group is easily reachable yet that isn’t the problem. The problem lies in getting these patients to adopt CGM technology. This will happen, but it will take time and lots of heavy lifting. As we noted just the other day these patients do respond very well when they have a vested interest in better outcomes. However, as well as incentivizes work this incentivization of better outcomes has not been widely adopted.

The reality here is the digital health space in terms of diabetes as popular as the space has become is still in its infancy. We know that coaching/education works. We know that when incentivizes are added into the mix it works even better. What we don’t know yet is which platform patients will respond to. There is no question a patient’s smartphone will become the hub or delivery portal for all this data collection/analytics and coaching but all this technology can’t make the patient respond. Even when incentivizes are added into the mix this only takes patient motivation so far.

It will be interesting to see how this all plays out. The market is huge and while we do make fun of all the way cool whiz bang cloud enabled toys the fact is when used as designed they can help a motivated patient achieve better outcomes.