How about smarter patients?

How about smarter patients?

“Product development firm Cambridge Consultants has designed an injection pen for diabetes patients that aims to make daily management of the disease an easier, more accurate task. The KiCoPen device is designed to capture the exact dose delivered – and send the information to an associated smartphone app. And all without a battery – the action of removing the injector cap powers the device. There is currently no injector pen on the market that combines these capabilities.”

This quote comes from a story posted on the Doctor Pulse web site.

As many may have guessed by now Cambridge isn’t the only company working on a “smart” insulin pen, far from it. Yes besides a smattering of smaller less known companies the big boys and girls in the insulin world have sniffed around this space too. And just like “smart” insulin pumps and “smart” glucose meters these “smart” insulin pens send information … wait for it … to the cloud. (Although we’ve never brought it up before we have to wonder how the FDA, other government agencies and privacy advocates feel about all this information going to the cloud. Yet we digress.)A cloud that thankfully has an unlimited amount of space with all this information getting stored there. A cloud which thankfully allows all this data to be shared, seen on a patients smartphone and used to help the patient achieve better outcomes. Or at least that’s the theory behind interconnected diabetes management (IDM) which frankly could not exist without the cloud.

What all these smart pens have in common is the company’s developing them seem to believe that patients will be able to better dose their insulin and ultimately …wait for it…achieve better outcomes. Yet in order to achieve this goal the patient must truly understand insulin therapy and be well aware of a wide range of data. Keep in mind that while in theory a “smart” insulin pen would work with a long-acting insulin most are designed with short-acting insulin in mind, insulin which is taken with a meal or snack.

So let’s take a look at all the information other than insulin dose that is taken into account BEFORE a patient injects.  First there is the target glucose level or range which the patient wants to stay within. Next there is the current glucose level, followed by insulin on board (that is insulin still active in the patient’s body), duration of insulin action (how long does the insulin work once inside the patient’s body, something that is different for each patient and can vary depending on outside factors such as stress and exercise) and carbohydrate intact (here too not all carbs are created equal, a patient who eats a deep dish pizza has a much different experience than one who eats a ham sandwich). This is what a patient needs to know BEFORE they dose.

Now the good people who are developing “smart” pens will say that while this is a lot of information most of it needs only to be entered once into the app that comes with the “smart” pen. An app which is basically a bolus calculator. They will also point out since meters now communicate with the cloud that patients won’t have to enter this information either. Basically all the patient needs to do is enter the amount of carbohydrates and the app does the rest. Since the “smart” pen communicates with the app it already knows when and the amount of insulin taken before.

What’s even better, again according to everyone developing anything “smart” is that all this information can be shared with the patients’ healthcare team, who can them send the patient – through the app of course, tips so they can better manage their diabetes. This is the supposed beauty of IDM, that data will be transformed into actionable information.

That is until one considers the realities of insulin therapy. Just by way of example something like duration of insulin action or insulin to carbohydrate ratio is not a number most patients know or for that matter understand. It’s information that the patient learns over time and requires a fair amount of effort. Thankfully patients today have access to continuous monitoring systems which makes getting this information easier but even with a CGM it requires work.

Many of the IDM true believers seem to believe that since all this data is in the cloud and being shared it won’t be the patient but their Certified Diabetes Educator (CDE), physician or the physician’s nurse who will calculate all these numbers and ratios. That these same people will actually enter all this information into the patient’s app and all the patient has to do is follow the instructions delivered via the app.

This sure sounds great until one looks at one little issue, who’s paying for all this data analysis and data entry. Yes we know that such things aren’t factored into the equation by the true believers but it’s not called the business of health care by accident. CDE’s, nurses and physicians want to and should be compensated for their time.

Let’s be clear here IDM does have huge POTENTIAL, but at this point that all that it has POTENTIAL. The fact remains all these “smart” devices won’t do a damn bit of good unless they are actually used as intended. That all this data swimming in the cloud is just that data and nothing more, until we can figure out a cost effective method for turning this data into actionable information. That the only way this information becomes actionable is if the patient understands and agrees with the advice they are given. Put simply, the patient still needs to be educated.

Folks this is 2015 and today’s patients are not sheep who blindly follow a shepherd. Patients today are far more sophisticated, have access to information and aren’t afraid to question their physician.  It’s equally important to note the downside of patients having access to all this information, information combined with education leads to knowledge. However misinformation, and there is plenty of that, is rampant particularly when it comes to health. Take a look at the recent measles outbreak in California, which occurred only because some very stupid parents did not have their children vaccinated. While every supposed serious side effect associated with vaccinations have been debunked, there is plenty of misinformation being spread and sadly many people believe the misinformation.

While Diabetic Investor does believe that at some point in the future IDM will become the standard of care, the only way this leads to better outcomes is when the patient understands the advice they are being given. The simple fact is as much as we may need “smart” devices we need smarter patients more.