End of era?

End of era?

This past weekend diabetes educators gathered in the heartland for the annual diabetes educators conference and although we were unable to attend we did speak to several people who were in attendance. Not unexpectedly these people basically said it was a dead show devoid of any buzz. Frankly we are not surprised by this as it’s just furtherance of an ongoing trend. Let’s be honest when Johnson and Johnson (NYSE: JNJ) killed the Irish Coffee the AADE would never be the same. Oh, for the good old days but we digress.

Interestingly a relative newbie to our wacky world asked a valid question is this profession dying? Truthfully the answer is yes, now this does not mean that CDE’s are not needed or valued, the opposite is true. However, we must be realistic and acknowledge a few of the those pesky facts;

1. The numbers tell the story there just aren’t enough CDE’s to handle the increasing patient load.

2. Human CDE’s cost money, have families of their own and all the demands that come with that.

3. While reimbursement is available the paperwork requirements make getting paid a bitch.

4. Patients love CDE’s but don’t have the time and motivation to meet with them regularly.

5. Technology is and will replace most of what a CDE does.

It is this last point that is most relevant here. As everyone knows you can’t swing a dead cat these days without hitting an app that helps patients dose their insulin. Using data gathered from a CGM and entered by a patient these apps using sophisticated algorithms make recommendations to the patient on how much insulin to dose. A process which will get even more sophisticated when “smart” insulin pens become common place.

We also see the role of the CDE diminished as insulin pumps become smarter. Right now, one area where the human touch is desperately needed is training patients to use an insulin pump. Pumps which with all their new features have actually become more difficult to use not simpler. Now this will change for several reasons but the biggest of course is money, pump training costs pump companies a fortune and given where reimbursement is going these companies will want to rein in that cost. We envision a future when pump patients are trained virtually, humans will still be involved but think FaceTime and you get the idea.

What’s hurting more than anything is of course the almighty dollar. Here is another example of how the business of diabetes is interfering with the management of diabetes. The fact is although CDE’s aren’t making a fortune, far from it, there cost is not seen as offering a measurable return on investment. Given the market dynamics for drugs and devices companies are looking for cost effective ways to increase share or usage and let’s be honest CDE’s are not cost effective. As we have been noting it’s just a matter of time before the patient’s smartphone becomes the hub of their diabetes management. A trend that will not just hurt CDE’s but also pharmacists who some see as replacements to CDE’s.

The reality is like so many other aspects of a patient’s life technology is replacing what a human used to do. Now this does not mean no humans will be involved rather they will utilized more cost effectively. Technology such as text messaging, live chat and FaceTime/Skype all of which are available today and used extensively by patients will play a bigger and bigger role in their diabetes management. Tasks once performed by CDE’s will be replaced by algorithms.

In one respect, we are saddened by this trend as we have great deal of respect for CDE’s and the valuable work they do. However, it would be foolish not to acknowledge the impact technology will have on this profession. While we would not say this is an end of era it is a changing of the guard.