Digital Deluge

Digital Deluge

This Friday the new Apple iPhone 8 and 8 plus will become available to be followed by the super expensive X version. Now it cannot be understated that Apple and the iPhone has forever changed how we live our lives. What used to be called a mobile phone has transformed into a mini-computer held in our hands managing nearly every aspect of our lives including our health. This proliferation of smartphones has naturally extended into our wacky world with thousands of way cool whiz bang apps.

Correspondingly this digital avalanche has extended to our friends Alexa and Siri. Yes, it seems it is no longer good enough to develop diabetes devices if they do not communicate with cloud.

Now to be clear here we are not against this digital revolution and I believe we speak for thousands of insulin pump patients who would like nothing better than to have their pump controlled by our smartphone. (Are you listening Insulet (NASDAQ: PODD)?) And there is no question that for the millions of patients who use insulin these way cool whiz bang apps can help them better manage their diabetes. But what about the millions of patients who do not use insulin or use insulin plus orals what about them.

One of the biggest problems with this digital revolution is it’s not benefiting the masses or at least not yet. As we have been stating when it comes to these way cool whiz bang apps insulin using patients whether they use an insulin pump or follow multiple daily injection (MDI) therapy are the low hanging fruit. These patients can experience an immediate and noticeable benefit from using these apps. But this is not the case for less intensively managed patients.

Say for example you have a mother with Type 2 diabetes who in addition to being a Mom must also manage her job and her diabetes. Or what about that Dad with Type 2 who in addition to helping Mom with the kids must manage his job and his diabetes. More than likely they have been told by their physician, who is likely a primary care provider, to test their blood sugars, take their meds, lose some weight and eat right. They know diabetes is a serious condition and they are no way ignoring it. However, there is no immediate or tangible benefit they experience from properly managing their diabetes. How do all these way cool whiz bang apps benefit these patients?

Do they have the potential to benefit these patients? Of course, they do. However, all these way cool whiz bang apps could in the real world have the reverse impact and make their lives harder instead of easier. These patients may not have to worry about things like insulin time to action, duration of action or insulin to carb calculations but they still have plenty to worry about. But the worse part is that unlike intensively managed patients it takes much longer to see positive results.

Think about it this way let’s say that Mom and Dad are both using Lantus plus orals. Their physician has instructed them to take X units of Lantus each morning before they head off to work, then during the day they must remember to supplement the Lantus by taking some pills. For a way cool whiz bang app to help Mom and Dad think of all the information they must collect and enter into the app so it has data to analyze. Even if they use a way cool whiz bang conventional meter that sends readings to the app they must use it and we all know they aren’t.

But glucose readings alone as valuable as they are does not provide enough data. See this is the fallacy or trap so many falls into, that if these patients just measured their glucose as they are supposed to everything would be just fine. What about food intake, what about exercise, what about the time they actually took their oral meds assuming of course they remembered to take them. All this additional data must be manually entered into the app which increases the patient’s workload.

Even if they do all this heavy lifting the work is not done, not by a long shot. Let’s assume for a moment that Mom and Dad have slightly elevated HbA1c’s and let’s further assume they are doing all the heavy lifting. Their PCP based on the data analysis recommend a change in therapy perhaps increasing the Lantus dose or maybe adding yet another pill. The work doesn’t end as it must be repeated to see if these changes work or not.

And just what does Mom and Dad get from all this hard work? What is their reward other than the possibility their HbA1c may go down? What will keep them motivated and engaged so that once they are in range they stay in range? Do they save time? Are they saving money? Have their lives REALLY become easier? Has their EXPERIENCE with their diabetes management improved?

This is the burden facing every one of these way cool whiz bang apps when it comes to non-intensively managed patients. They can provide the how to but they cannot provide the want to. Until these patients get something real and tangible this is an exercise in futility.

Now to all my fellow tribe members Shana Tova may your New Year be filled with good health and happiness.