New tools old problem

This morning FitBit unveiled a slew of new way cool whiz bang apps that are .. wait for it … designed to help users … wait for it … better managed their health which of course includes …. wait for it … more effectively managing their diabetes. Per a press release issued this morning;

“Fitbit, Inc. (NYSE: FIT) the leading global wearables brand, today introduced new apps and clock faces to help people better manage their health, directly from the wrist. Built using Fitbit’s software development kit (SDK), the apps and clock faces will give Fitbit smartwatch users new options to improve wellness and help manage conditions, like diabetes and some types of cancer. Additionally, the apps will give health plans, employers and clinical researchers new opportunities to better support their users outside of a clinical environment, helping lead to positive health outcomes.“

Now we hate to burst FitBit’s bubble, but does not the way cool whiz band Apple Watch also do this? Or is this not what every other wearable device does now? Is it not true that nearly every device used by a patient with diabetes communicates with a smartphone? Are there not hundreds, perhaps thousands, of apps for patients with diabetes? Do not every one of this way cool whiz bang apps promise the same damn thing?

Let’s go back to our favorite peanut butter and jelly analogue as it’s so appropriate here. There are three elements to this sandwich – peanut butter – jelly and bread (being a traditionalist we’d say white bread). Yes, we know its true that today someone can choose from hundreds of peanut butters – chunky -creamy – low fat – etc. There are also hundreds of jellies – personally we prefer grape but heck just like peanut butter there are hundreds of choices. As we noted while we prefer white bread there is nothing illegal using wheat – rye and if someone wants to go off the reservation they can use a bagel which opens even more possibilities – but we digress.

Yet no matter which type of peanut butter – jelly and bread is used at the end what you have is a peanut butter and jelly sandwich. One of the simplest sandwiches to make other than a plain American cheese sandwich which only requires two elements American cheese and bread. Yet in the diabetes world it’s amazing that these companies have a unique propensity to screw up what it is a simple thing.

However, what gets lost here is not that all these companies are over complicating what is a simple thing, no what gets lost here is with all these way cool whiz bang new tools we have the same problem exists. Getting the patient to use the damn thing. Listen we understand it’s a unique concept for these company’s top grasp but all the toys in the world don’t mean much when they sit in the toy box. Nor does help much when the toy is played with, does not provide the pleasure the toy maker anticipated and is not played with again.

How many of us have bought something we thought was way cool whiz bang, used it for a while and then never or rarely used it again. The reality is diabetes toys should be akin to a toothbrush, something that isn’t just simple to use but used every day without any thought given to it. Yet come to think of it if a toothbrush was being designed by a diabetes company they’d over complicate that too. These people just can’t help themselves.

Here some news that may shock all the toy companies – diabetes management for most patients isn’t that complex and while all the toys could help it would help a lot more if these patients took their meds as they are prescribed. It would be even better if these patients who have a disease they don’t want, don’t understand were given something anything tangible for the effort they do put in.

See the biggest problem here is that all these toys are not designed with the patient in mind. They are deigned to impress physicians, educators, the non-profits, researchers, academia and investors. Notice that patients are nowhere on that list.
Each of these toys SHOULD be designed with the following factors in mind;

1. THESE PATIENTS HATE THE FACT THEY HAVE DIABETES AND WANT AS LITTLE INTERACTION WITH THEIR DIABETES AS POSSIBLE.

2. Most patients will NOT measure their glucose regularly. They will NOT tell the way cool whiz bang app when or if they take their meds, when and what they eat and when and how they exercise. Put simply they will NOT provide much of the data this way cool whiz bang app needs.

3. THEY NEED TO BE REWARDED WITH SOMETHING TANGABLE FOR ALL THE WORK THEY PUT IN. THEY NEED CONSTANT POSITIVE REINFORCEMENT.

EACH AND EVERY DIABETES MANAGEMENT TOOL SHOULD BE AS SIMPLE TO USE AS A TOOTHBRUSH. SO SIMPLE THAT EVEN A FIVE-YEAR-OLD CHILD GETS IT.

Look at a disposable insulin pen- slap on a needle and inject.

The G6 – insert sensor – snap in transmitter – hit button on smartphone.

The Libre – insert sensor -wave receiver.

No code conventional glucose meter – insert test strip – prick finger – place blood on test strip.

These are some examples of simple diabetes toys yet even these toys as simple and valuable as they are, are not being used by most patients. What does that say? To us it says maybe its not the toy that’s the problem, maybe just maybe the patient either A) does not see a reason to play with the you or B) they do not value or understand what to do with the data provided by the toy.

This is where the app makers say well the app will do all that. To wit we say without data there is nothing to analyze and even when there is data getting the patient to interact with the app on a CONSISTENT basis has proved elusive. In other words, WITHOUT AN ENGAGED MOTIVATED PATIENT WHO IS WILLING TO DO A LITTLE WORK it don’t matter much.

Folks we do have some great tools today and in theory these apps can help IF they are used. Yet the reality is the tools have never been the problem. The problem has always been transforming most of the patient population from disinterested bystanders to at minimum semi-active participants in their diabetes management. Sure, we have better tools than we did 10, heck even 5 years ago but the tools aren’t the problem.