Hate to say we told you so

Hate to say we told you so

Yesterday we wrote about some of the issues facing interconnected diabetes management (IDM), one of which was as part of corporate health and wellness program would the companies offering these programs give them time to work. There is a mountain of evidence which shows that companies can save boatloads of money when their employees with diabetes achieve better control. Just as important these companies also can see a rather dramatic increase in employee productivity when their employees with diabetes are under good control.

However, as we noted yesterday when it comes to diabetes rarely does a patient see improvements quickly. The question was would companies offering these programs have patience, would they be willing to wait to see better outcomes. Based on the results from Scripps Translational Science Institute’s Wired For Health study we’re not so sure they will.

Scripps recruited 160 patients with either hypertension, diabetes, or arrhythmia and randomized them into an intervention group and a control group. Members of the intervention group were issued an iPhone 4 and a connected device: for those with hypertension, a Withings blood pressure monitor, a Sanofi IBGStar blood glucose meter for those with diabetes, or an AliveCor ECG for those with arrhythmia. The study took place in 2013 and 2014.

The study looked at claims data, to see whether one group cost more than the other, as well as outcomes data like blood pressure and HbA1C. They found no difference between the two groups. The only meaningful difference the study found was related to health self-management. Patients who monitored their health were less likely to attribute health outcomes to chance than those who didn’t monitor their health.

According to study author and STSI Director Dr. Eric Topol; “It was a bit disappointing, but remember, this was the first multisensor trial that’s ever been reported, so in that respect it was a pioneering effort. And you know, it was very difficult because we had these three different sensors, glucose, blood pressure, and heart rhythm, and a lot of patients had all three problems or two of them, and had to have a dashboard created. There are a lot of logistical challenges there.”

Dr. Topol added; “We learned a lot, but the fact that it wasn’t a positive trial, with respect to reducing economic burden is probably not so surprising because we only followed the people for six months, and many would project that you need much more follow-up and a much larger sample size to be able to show the burden. The good part is we didn’t add any burden economically. A lot of people thought, if people have access to their data they’re going to end up tapping more into medical resources. Well, we certainly didn’t see that. So that was encouraging, but obviously we would have liked to reduce the need for emergency rooms and office visits and hospitalizations. That could still be out there, but this is just the beginning of studying that question.”

First we should note that we agree with Dr. Topol in that six months is a short period of time and that further studies are needed to truly gauge the value of IDM. Still the study does point out many of the issues facing IDM. The simple fact is as we have said many times for all the promise of IDM this technology how it is used remains a work in progress.

Ironically on the heels of this news comes word that GlaxoSmithKline (NYSE: GSK) is teaming up with Qualcomm to develop medical technology. Glaxo would just be the latest to join this effort. Google Life Sciences is teamed up with Sanofi (NYSE: SNY) and Dexcom (NASDAQ: DXCM). Medtronic (NYSE: MDT) and Johnson and Johnson (NYSE: JNJ) are teamed up with IBM Watson Health. And it is well known that Lilly (NYSE: LLY) and Novo Nordisk (NYSE: NVO) are venturing into this space as well. Let’s not forget Apple, the maker of all things way cool who remains active in the space. Besides the big boys you have iHealth, TelCare, Livongo, OneDrop and Dario just to name a few of the smaller lees well known players. Suffice it to say you can’t swing a dead cat in the diabetes space and not find IDM type projects being worked on.

With the amount of money being thrown around here IDM is not going away. The question is will this money be well spent and actually yield results or will it be like the continuing quest to develop a non-invasive glucose monitor and yield nothing of substance. Diabetic Investor for the moment believes that eventually IDM will become more widely adopted. However, we don’t see this happening anytime soon as there are just too many kinks to work out.

Additionally, IDM will need to evolve just as diabetes management has evolved over the years. Yes, we sound like a broken record but diabetes management is not one size fits all, the needs of a non-insulin Type 2 are dramatically different than an intensively managed Type 1. IDM systems will have to acknowledge and adapt to not just the different types of diabetes but the subsets in each group. The needs of a 54-year-old insulin pump patient are different than an 18-year-old insulin pump patient. It is these nuances that need to recognized.

The reality is given the current dynamics of the diabetes market IDM besides having potential to improve outcomes can also drive sales. Studies have proven that educated patients test their glucose more frequently and are more compliant with their therapy regimen. Simply put educated patients use more of the products these companies make.

Finally, what’s needed most is for everyone to acknowledge the limitations of IDM. The reality is IDM is not for everyone. While it’s sad to say there is large segment of the diabetes population who just don’t give a damn. The way we see it IDM must reach those patients who want to live their lives with their diabetes and not for their diabetes. It must make diabetes management part of their daily routine and not let diabetes management dominate this routine.

The central fact is there is large segment of the diabetes population which understands they have diabetes and it must be managed, these people aren’t idiots. Yet it’s surprising how many companies in the business of diabetes treat these people as if they were idiots. As Momma Kliff used to say don’t talk at these people, talk to them and most importantly SHUT UP AND LISTEN when they talk back.