An Apple A Day

Yesterday our friends in the Apple orchard unveiled some new features for their upcoming iOS12 operating system which will be released sometime in the fall. Among the enhancements will be improved presentations of health information. It is not known from the information available if any of these enhancements are directly related to diabetes such as a user’s glucose information but we suspect they will be. Apple has been very public about their relationship with Dexcom (NASDAQ: DXCM) and it is also well known the company has been working on a non-invasive continuous glucose monitoring system that would be part of a future Apple Watch.

Although we don’t believe the company’s effort in non-invasive will yield anything of substance this news is just part of a continuing trend of transforming a smartphone into the patient’s health care hub. As we have noted in the past it’s just a matter of time before the smartphone becomes the center of the patient’s health care. There are already thousands of apps which collect glucose data, perform various analytics and provide coaching.

Yet as we noted yesterday many of these apps will become obsolete for insulin using patients thanks to the many sophisticated insulin dosing algorithms available. Algorithms which learn and soon will make insulin dosing very simple.

The question is what’s being done for patients who do not use insulin or a GLP-1. It should be noted that the current group of GLP-1’s do not require glucose information; the patient injects a fixed dose each time.

Now as we have noted in the past for patients taking just oral medications life should be blissful as all they have to do is take their meds as prescribed. However, the problem is and has always been patients aren’t being adherent with their meds even though they are not subject to “painful” injections. Given this is by far the largest group of patients one would think that someone would develop a way cool whiz bang app which helps these people become adherent.

Try as they might to position themselves as apps for all patient’s systems such as Livongo, OneDrop or WellDoc are used mostly by insulin using patients. Most of the apps related to patients taking pills only are what we call reminder apps. The patient tells the app which pills they take, how often they are supposed to take them and then the app reminds them to take the pills.

We have also seen non-app approaches to improving medication adherence. One of our favorites is a putting all the patients meds in individual pouches the theory being less work for the patient. Another is pills containers that send a signal to a patient’s smartphone every time the container is opened. Very cool except for the fact that neither approach confirms that the patient actually takes the medication.

Now one would think at this point someone would come along and point out that none of these approaches have worked all that well and it might just be time to think of a different approach. That maybe, just maybe it’s time to think out of the box. That perhaps this is a problem that cannot be easily solved with way cool whiz bang technology. Technology can part of the solution but technology alone has been unsuccessful. And the reason why technology alone hasn’t worked is actually quite simple, patients aren’t robots they are human.

Now here is where we are going to leave the reservation and talk about something that is considered radical to everyone in this wacky world. For years the diabetes world has been dominated with what we call clinical thinking. Nearly every company we have talked with that has some sort of way cool whiz bang approach believes these pill taking patients care about things like outcomes. That these patients understand that diabetes is a serious chronic condition that when not controlled leads to serious complications.

Well we hate to break the news to these people but in the real world these pill takers don’t care. This is not to say they do not understand that diabetes is a serious chronic condition, they do. This is not to say they don’t understand that diabetes can lead to serious complications, they do. However, these pill takers have chronic disease which requires work to manage properly and there are no immediate, tangible rewards for doing all this work.

Until outcomes matter to the patient nothing will change. For the past 20 plus years we keep hearing the same thing from physicians, that the shortest distance to better outcomes for pill takers is for these patients to take their damn pills or put simply if they were adherent with their meds things would be different.

In a few weeks we’ll be in steamy Orlando for the annual ADA confab and there will be as always, all this talk about how to get patients adherent. Studies will be presented, ideas will be thrown around and old solutions will be repackaged as something new. What won’t change is results in the real world. Until these companies view patients as PEOPLE nothing is going to change. Until they understand that for these pill takers diabetes is NOT their main priority nothing is going to change.

Folks there is boatload of money to be made here if these companies would LISTEN to patients, if they understood that patients are PEOPLE, people who have lives to live, households to run and lives outside of diabetes. That until outcomes matter to these pill takers and matter in a tangible way not a damn thing will change.