Getting the domino’s to fall

Getting the domino’s to fall

Whether it’s called integrated or interconnected, there is no question that the trend in diabetes management is to provide the patient with more and better tools so they can more effectively manage their diabetes. What everyone sees is people constantly talking, texting or surfing on their cell phones and asking why we can’t turn this device into a diabetes management tool. They see the same thing with iPads and tablet PC’s and ask the same question.

These visionaries see the Telcare glucose monitor which is basically a cell phone that does everything but make an actual phone call. Or they look at the iBGStar from Sanofi (NYSE:SNY) and realize that once the readings are transferred from the monitor to the app, it’s really no big deal to have these readings sent to a physician or diabetes educator. They see a company like Dexcom (NASDAQ:DXCM) jumping into this interconnected world with their acquisition of SweetSpot Diabetes Care, Inc. Like everyone else Dexcom knows it’s not just about collecting and transmitting the data but turning all this data into meaningful patient interventions; interventions which will ultimately lead to better patient outcomes and the lower healthcare costs that come when patients with diabetes are properly controlling their diabetes.

While everyone talks about how the patient benefits from these systems, let’s not kid ourselves what’s really driving this move towards interconnected diabetes management systems is money. Employers know that male patients with diabetes miss almost 11 days of work due to their diabetes, female employees 9 days. They also know that for each 1 point drop in HbA1c the employees’ healthcare cost drops by $1,000 per year. Add in the many costly complications that can be avoided when a patient properly controls their diabetes and it’s easy to see why everyone and we mean everyone is trying to develop some sort of interconnected diabetes management system.

These companies, like Diabetic Investor, believe that one day physicians and/or healthcare plans will be incentivized (compensated) when the patient is under good control.  This is one of the dominoes that must fall before these systems become a reality. As it stands today physicians are not compensated to analyze all this data, nor can they spend enough time with a patient explaining what this data means.  This will change once a physician earns more money not from treating the patients’ diabetes but actually helping the patient better manage their diabetes. For all the talk about how patients will use these systems the reality is there is no way the FDA will approve any system that tries to replace the physician.  It’s also worth noting that the American Medical Association (AMA) is fairly powerful lobby, so anyone who believes that an interconnected diabetes management system will eventually replace a physician, think again.

The second domino that must fall is someone has to figure out a way to get patients to monitor their glucose on a regular basis and not just insulin using patients. This is the Achilles heel of almost every system, with the exception of what Dexcom is working on. This is also something Diabetic Investor has been stating since these systems first started popping up; this is also why we have consistently stated that the initial versions of these systems will be targeted at insulin using patients as these patients actually monitor their glucose levels. The fundamental fact is these systems become worthless without glucose data and there is no getting around that fact.

There are some who seem to believe that HbA1c readings will be sufficient for non-insulin patients, that this easy to understand test which is supposed to be done each quarter will provide the patient and their healthcare team with enough information to make informed recommendations. While there is some validity to this school of thought and it is certainly cost effective, the fact is HbA1c readings do not tell the whole story. This is particularly true for non-insulin using patients as regular glucose readings are critical in determining several factors including therapy compliance and therapy effectiveness. While there may be some disagreement in the diabetes community over which treatment regimen is best, there is universal agreement that no treatment regimen works if the patient isn’t following their regimen. Regular glucose readings provide the first indication of whether the patient is taking their meds and whether these meds are effective.

The third domino in reality is not a domino but a major obstacle to broader adoption of interconnected diabetes management systems- what happens when patients do not need to monitor their glucose and achieve solid control from their therapy, a therapy that is administered either once a day, once a week and in the not so distant future once a month. This is the promise of GLP-1 therapy and one reason this therapy option is gaining traction.

In the real world where physicians see firsthand the impact of therapy non-compliance and understand that while their insulin using patients may use an interconnected system, it’s highly unlikely their non-insulin patients would use one. They know from experience that while oral meds may be preferable to injectable meds, those patients aren’t swallowing all their pills. They know that besides their diabetes medications these patients are also taking a host of additional pills for a variety of other conditions.

This is the ultimate promise of GLP-1 therapy, it’s so damn simple. No need for glucose readings, no worries about when to inject, little chance of hypoglycemia and the added promise of possible weight loss. GLP-1’s are not the perfect therapy and they do carry with them some possible side effects, however it would difficult, if not impossible, to find another therapy option that is as simple as GLP-1 therapy.

That being said Diabetic Investor does believe that interconnected diabetes management systems will ultimately become the valuable tool their proponents believe they will be the only thing is that day is not yet here and won’t likely get here until some of the dominos begin to fall. As we have stated all long technology by itself will not improve patient outcomes, technology is merely a tool that has the potential to help patients more effectively manage their diabetes. The fact remains that great technology in the hands of an uneducated, unmotivated, disengaged patient is worthless.

The best real world example of this what Diabetic Investor likes to call the January effect. Anyone who works out regularly at a health club sees this effect every January, when all the newbies who made a new year’s resolution to work out or lose weight hit the health club floor.  These motivated newbies hit the treadmills; attend spin classes only to realize that working out on regular basis is major commitment and lifestyle change. This once highly motivated workout fanatic soon loses their motivation as their daily workouts begin to interfere with their life before they started working out. Pretty soon they go from working out every day, to five days a week to three days to once in a while to never.

Diabetic Investor sees this same effect for newly diagnosed Type 2 patients who go from monitoring their glucose levels three times a day, to once a day, to once every few days;  patients who are never educated as to what these readings mean or how to use this information. This newbie quickly realizes that they are doing all this work and getting nothing in return, so why do it in the first place?

The bottom line here for any diabetes related technology is technology may be able to give the patient the how to, technology cannot give them the want to.