Digital Diabetes Still Alive

While shares of Livongo continue to struggle as we predicted deals in the digital diabetes space would go on. Just this morning we learned that Bayer is investing in … wait for it … OneDrop. Per the press release;

“One Drop, a leader in the development of digital therapeutic solutions for diabetes and other chronic conditions, today announced $40 million in Series B financing, led by Bayer, one of the largest pharmaceutical companies in the world. Bayer has also entered a commercial licensing agreement to use One Drop’s platform in Bayer’s global bio-digital efforts in therapeutic areas such as oncology, cardiovascular disease, and women’s health. Stefan Oelrich, the President of Bayer Pharmaceuticals, will join One Drop’s Board of Directors.”

Notice how OneDrop is following the Livongo playbook adding diseases outside of diabetes to its platform. What’s that old saying about imitation being the sincerest form of flattery. Listen the folks at OneDrop are many things but stupid isn’t among them. They know that digital health even with Livongo shares struggling is still the hottest thing going and as Momma Kliff said so often best to iron when the iron is hot.

The fact is everyone and we do mean everyone remains convinced that digital health is the answer. Only problem is no one seems quite sure what the question is. As we have said often in theory digital health looks great but as our professors used to say, and yes, we did occasionally go to class, in theory an elephant can stand on a coffee table without it collapsing. Yet so for no one has proved that this theory actually works in the real world.

This pesky fact won’t stop from deals being done which is why we expect even more of them. It’s the same reason millions have been wasted on the pursuit of what used to be the Holy Grail in diabetes technology a non-invasive glucose monitor which has now morphed into a quest for a non-invasive continuous glucose monitoring system. Yep back in the day everyone believed that the reason patients did not regularly monitor their glucose was because of the “pain” associated with fingersticks. The theory was take away this pain and patients would test regularly.

The theory with digital diabetes is patients will respond favorably to all this help they are getting. In the case of Livongo and OneDrop they believe this coaching will overcome the “pain” factor associated with glucose testing as both companies rely on old outdated conventional fingerstick meters to gather glucose data. Never mind that CGM offers better data without finegrsticks nope Livongo and OneDrop think their coaching is so good patients will do what they have never done with conventional fingerstick meters, test regularly.

We can’t speak to other disease states but when it comes to diabetes behavior change is not sustainable over the long term no matter how much encouragement these patients get. Both Livongo and OneDrop have attempted to extrapolate short-term gains to imply long-term success. Never mind that neither company has any hard real data to back up these claims. Our contention is that after the newness factor wears off what happens, will patients continue to respond? History tells us they won’t, that they will go back to their old habits.

We aren’t surprised that all the investors are impressed with these shiny new toys. And quite honestly, they aren’t even new toys they are old fashioned disease management programs updated with new technology. Programs which didn’t work back when they were all the rage and programs which won’t work repackaged using new technology. But this won’t stop the companies from raising more money as the investors either weren’t around when disease management was all the rage or like so many have fallen in love with the shiny toy.

Just to compare and contrast so that everyone fully appreciates where technology works and where it doesn’t let’s talk about the second hottest area in diabetes technology, Tyler. Tyler isn’t asking the patient to change their behavior he’s helping them more effectively dose their insulin, instead of the patient doing all the math Tyler does it for them. Tyler takes the readings from whichever sensor the patient is using combines it with data from the connected insulin pen then throws it into the insulin dosing algorithm and spits out a recommended dose.

Now Tyler cannot do everything for the patient as the patient will have to tell Tyler what their target glucose range is and how many carbs they are eating but they will not have to tell him things like insulin to carb ratios or duration of insulin action. Thanks to all the sophisticated insulin dosing algorithms the system does the majority of the heavy lifting once done by the patient. Even better the patient remains in complete control as the system merely recommends a dose it does not deliver the dose.

Put simply Tyler makes the patients diabetes management easier.

Compare that to what Livongo and OneDrop are offering. First the patient is being asked to do something they aren’t doing today to test their glucose regularly with an old fashioned outdated conventional fingerstick monitor. They are being asked to change their behavior. Now should they change their behavior and start testing regularly they are then bombarded with text messages telling them what they should do next, more behavior change. And in the end what does the patient get out of all this?

A very strong argument can be made that these systems do NOT make the patients diabetes management easier and actually more complex. That it makes the patient think MORE and not less about their diabetes management which is counterintuitive to what the patient wants. While Tyler creates less thinking these systems create more. While Tyler provides information which is ACTIONABLE IMMEDIATELY, these systems do not.

The fact is and yes, we know these pesky facts get in the way is patients want diabetes management to be stupid. They want to think LESS about their diabetes management NOT more. Hence the reason they tend to get annoyed with all these text messages which are rarely actionable. Messages which if followed creates more work when they want less work. Hence the reason why behavior change fails to be sustainable.

Tyler works because he isn’t asking the patient to change their behavior, he’s enhancing a behavior they are already doing. Livongo and OneDrop are asking ADULTS to do something no adult wants to do change long established behaviors they have become comfortable with. All the coaching in the world cannot and will not change this. It might work for a little while, but human nature and history tell us it won’t work over the long term and DIABETES MANAGEMENGT IS NOT A SHORT-TERM PROBLEM.