CES Second Impressions

Well we don’t have any BIG news today although being here with all these “smart” devices does make us long for the days when it was ok to be dumb. Everything from vacuum cleaners, toothbrushes and yes even vibrators are “smart” now. It does make one wonder how us older folk were able to survive, raise families and manage our diabetes without every toy in the toy chest being so damn smart.

Speaking of which the Digital Health summit here is generating lots of buzz, shocking we know, as every employer is seeking that magic bullet which will lower their healthcare costs for employees with chronic conditions and of course diabetes is on top of that list. The problem as we see it is several fold. First and yes, we know this is a toy fair but it’s not the toy that solves the problem. The toy, whether it is a cloud enabled conventional finger stick monitor or cloud enabled CGM (and yes, we found yet another non-invasive CGM) merely provides data. This data in the hands of trained professionals or algorithms is then transformed, hopefully, into actionable information. Simply put most of these toy companies are taking far too much credit for any improvements in outcomes.

The second problem we have is simple, the more successful of these digital health programs are very labor intensive. This create a paradox of sorts as it is the programs who employ all these coaches must prove the cost of the program is offset by the “savings “ they generate. While it’s true we have seen short term improvements in outcomes few if any of these programs have demonstrated their results are sustainable over the long term.

Diabetes unfortunately is labor intensive for the patient. There is no question education combined with coaching helps makes this heavy lifting a little easier, but it does not take away the heavy lifting. Additionally it can be argued all this help increases the heavy lifting for the patient. Simply it goes back to what we have said before with people who have lost weight, unfortunately after losing the weight many go back to their old habits and regain the weight they lost. The same is true with diabetes management which is why most of these programs focus so heavily on short term results.

From day one we have always said that the hard part is not telling the patient how they should be managing their diabetes. No the hard part is keeping them engaged so they want to manage their diabetes. Not to get on our soapbox but until the patient has real skin in the game, has a real vested personal interest in achieving better outcomes we fear that not much will change. It’s no accident that the many toys in the toy chest aren’t played with as much as the toy companies would like them too. Hence the reason that here we are and still the majority of patients are not achieving anywhere near good control.

Switching gears there are as one might imagine a plethora of wearable devices here. So many it makes one wonder if now patients will own multiple wearables switching between them depending on which particular aliment they have. This is another reason we aren’t overly impressed with all these so-called non-invasive CGM’s, most of which aren’t worth a damn. Non-invasive or not diabetes management is not a part time thing. Most of these co-called are modeled on the old GlucoWatch but now look like the way cool Apple Watch. Simply put the patient has to wear the watch to get readings. The Libre and Dexcom G6 are easy to slap on, last for 10 days or two weeks and deliver readings ALL THE TIME. (Ok the Libre has to be scanned to get readings but the sensor itself is worn for two weeks.) Listen we don’t want to be overly harsh on these so-called non-invasive CGM wannabes but where not exactly sure it’s a good idea to build a business modeled after a product that failed, just saying.

So as we relax a little in Sin City and finish prepping for JPM next week in that beautiful, we have several pressing questions we hope get answered. First and foremost what’s the real story why Libre2 isn’t approved yet. Is it really still a year away? Second will the digital diabetes companies Livongo and Verily get any tough questions about whether or not they ever make money. Or will investors be so enamored with whiz bang and way cool they forget these are for-profits companies and it’s hard to make money in digital diabetes. Third, will Novo Nordisk, Sanofi or Lilly provide any clarity on when Tyler will become a reality.

Given the nature of JPM we can almost guarantee the unexpected. Perhaps this year it will be Sanofi announcing they intend to exit diabetes completely selling off their struggling franchise. Maybe a deal will be announced or maybe Medtronic will be the one who says they are exciting diabetes. Whatever it is we’ll be there to cover it all, can’t wait.