It’s not just about systems

It’s not just about systems

As today’s news proves with BioTelemetry buying Telcare the interconnected diabetes management (IDM) space is alive and well. That everyone believes that they have the magic potion for improving patient outcomes and ultimately lowering costs. That one day, in the not so distant future, outcomes will truly matter, that companies in this space will not be paid for selling stuff but for producing better patient outcomes.

This is why we keep stating that the hardware, the components that make up these systems are commodities. That what really matters is taking all this data and turning it into patient relevant, patient actionable information. Information which will help the patient better manage their diabetes and ultimately lead to better outcomes.

The one problem we see with most of these systems is their continued reliance on humans. That after the data has been gathered and the analytics have been applied to this data set, a human becomes involved. This intervention may begin with a text message or email but ultimately a human is communicating with the patient. And let’s face facts humans are expensive.

To Diabetic Investor the real promise of IDM is bringing artificial intelligence (AI) into the system, to minimize the need for human intervention. This is not to say humans will be totally replaced by AI, rather they will be used in a more cost effective manner. That they will only be brought in when they are needed. Again, let’s face some of those pesky facts, when AI does its job there is no need for human interventions.

Think of how an auto pilot system works on an airplane, once in flight the plane isn’t being flown by the pilot or co-pilot but by a computer. Yes, these humans get the plane off the ground and back on the ground but in between the computer takes over. The humans only get involved when the computer cannot adequately or safely perform a function or when the computer malfunctions. The same principal applies to IDM.

As we have stated many times for the majority of patients with diabetes improving outcomes isn’t as complex as it seems. That if these patients took their medications as directed they would experience improved outcomes. The real complexity comes for intensively managed patients most of whom use insulin. This is what makes the quest for a real artificial pancreas so difficult. Yes, the 670G is a major advancement but it is not by any means a real artificial pancreas.

Given this set of circumstances which companies stand the greatest chance at being successful in the IDM market. What attributes must they have to not just compete but to win. With hardware becoming a commodity and data analytics becoming commonplace, what do they need beyond hardware and data analytics. We can think of three things – time, money and patience.

Look at the Google/Dexcom (NASDAQ: DXCM) partnership and Medtronic’s (NYSE: MDT) partnership with Watson Health. These partnerships have the hardware and data analytics, that the easy part. The real promise lies in their ability to take all this data and turn into patient relevant, patient actionable information. Something they will do using AI.

Just today a story was published on the First Pharma web site entitled; “Study: Google’s deep learning algorithm detects diabetic retinopathy, macular oedema”. The story states;

“Study results published in JAMA suggest that Google Brain’s deep learning algorithm had high sensitivity and specificity for detecting diabetic retinopathy and macular oedema in retinal fundus photographs. Google Brain’s product manager Lily Peng and research engineer Varun Gulshan noted that interpreting such images often requires specialized skills that are not available in enough numbers to screen all patients at risk. “Our algorithm performs on par with the ophthalmologists, achieving both high sensitivity and specificity,” Peng said.” The full story can be read at

What has the Google Brain done? It’s replacing humans.

Like it or not this is going to be the future of diabetes management. As we have noted all too frequently the supply of Certified Diabetes Educators and endocrinologists cannot fill the demand of an exploding patient population.  That with diabetes growing at epidemic rates and becoming not just a healthcare but also financial crisis, computer enhanced systems are not just cost effective but urgently needed.

A word of caution here for as much as we believe this is the future there is one thing none of these systems can do. These systems can provide the how to, but they cannot provide the want to. Again, we hate to be redundant but diabetes is not that complex to manage for the majority of patients. The problem again as we have stated for years is that managing diabetes is job, a job that must be done each and every day. A job that most patients don’t want to be doing at all.

Ultimately with all this way cool whiz bang cloud enabled AI enhanced technology it is a human, a real person who must act upon what these systems tell them to do. No matter how cool and whiz bang these systems are they are worthless if the patient, the human does not do their part.

As Momma Kliff used to say; “I can give you the best advice possible. Advice based on years of experience. Advice based on learning from past mistakes. Advice that is in your best interest. But advice is all I can give you, ultimately it is up to you to act on this advice.”