Technology and Diabetes – The Real Problem
In this morning’s Wall Street Journal John Goodman penned an excellent piece entitled “Perverse Incentives in Health Care.” While Mr. Goodman’s focus was not diabetes but the entire health care system, he pointed out some relevant information that goes along way towards explain why we have a long way to go towards integrating technology into diabetes treatment regimens. Mr. Goodman states, “Yet only 21% of patients exchange email with their physicians; of these, slightly more than 2% do so on a frequent basis.” He goes on – “At last count, there were 7,500 specific tasks Medicare pays for. Telephone consultations are not among them. Nor are email consultations or electronic record keeping.”
Over the past few years we have seen an explosion in diabetes technology. Today patients can choose from “smart” insulin pumps, glucose meters that can download information to personal computers and continuous glucose monitors. Recently Lilly (NYSE:LLY) introduced a new insulin pen that one day may have the ability to download dosing information to a computer. All of these tools have opened doors that were previously closed to patients and their physicians. Armed with this information physicians have been able to design more appropriate treatment regimens. However, all of this advanced technology has not lead to better outcomes for the majority of patients. Nearly 75% of the patients with Type 2 diabetes are not achieving good control.
Diabetic Investor has pointed out that all the information is basically useless when the majority of patients have no idea what to do with all this data. This is one of the reasons why the average number of glucose tests per day has barley budged over the years. It also one of the reasons why Diabetic Investor believes that even if glucose testing was completely pain free average testing frequency would not increase much beyond where it is today.
Some have suggested that advanced technology, in particular the internet, is the answer. The theory is that instead of the patient analyzing all this data it could be sent via the internet to the physician who would then analyze the data and provide the patient with treatment suggestions. Lost here are two very important items; time and money. It is a well known fact that nearly 80% of patients with diabetes are treated by a primary care physician who on average spends less than 15 minutes with a patient during a regular office visit. These same primary care providers’ typical warehouse patients just to pay the bills and even with sophisticated software programs have little spare time to spend on analyzing the volumes of data a patient with diabetes generates.
Even if the physician did have the time, they have no incentive to do so as they are not paid for their time.
Take a patient using a continuous glucose monitor which when working properly can generate nearly 300 data points in a single 24 hour period. Over the 3 day life of a sensor that’s almost 900 data points, almost 9,000 in a single month. However, all this data even when downloaded into a software program only provides a partial picture of what’s really going on with the patient. To provide an accurate assessment the physician also needs to know when and what the patient ate, the patient’s physical activity and medication delivery. For patient’s using a “smart” insulin pump this data is readily available, however there are less than 300,00o insulin pump patients in the United States and only a handful also use a CGM.
There is no question that patients would benefit from professional data analysis however only on rare occasions are patients willing to pay for this analysis.
Like so many theories in the diabetes market, the use of the internet to improve care is another whose time is here but money isn’t. The reality is hard to accept here, especially when there is clear evidence that our current system is failing badly. Diabetic Investor does not blame the government or even the insurance companies for this sorry situation. In our opinion every company in the diabetes market is contributing to the problem by not making patient education a bigger issue. Study after study has shown that patient education increases medication compliance and increases glucose testing frequency. Not surprisingly these same studies also show that patients who receive even minimal education achieve better outcomes. Still companies in the market continue to pour millions into developing more advanced technology, while waiting for the government or health insurers to take action on patient education.
Over the past few years the industry has taken steps in the right direction and Diabetic Investor is encouraged. However, Diabetic Investor also believes that unless the industry’s voice becomes stronger and louder all we will have is a lot of great ideas that never get implemented.