The Missing Ingredient

The Missing Ingredient

According to data gathered by, a unique web portal that incentivizes diabetes patient education, 43% of patients continue to log their daily glucose readings the old-fashioned way by writing them down in a log book. An almost equal number 42% download their readings to their computers while 13% do not keep a log of their readings. Diabetic Investor mentions this data as recently there has been a rash of companies who are jumping on the diabetes technology connectivity bandwagon.

Although each company has a slightly different platform the basic theory is that if we can get information into the hands of physicians and/or a certified diabetes educator they can better assist the patient in more effectively managing their diabetes. This is a great idea but unfortunately has one central flaw; it assumes patients are regularly monitoring their glucose levels and patients are willing to share this data.

The reality is the majority of patients do not test their glucose levels regularly and many do not test at all. Even the data provided by Healthy Outcomes is slightly skewed as 62% of Healthy Outcomes participants use insulin and it is well known that insulin using patients test more frequently than patients who do not use insulin to manage their diabetes. The reality is average testing frequency for the entire diabetes population is less than two tests per day. This data includes insulin pump patients who test the most on average eight times per day, followed by patients using multiple daily injection therapy (MDI), followed by insulin plus orals and so on. Basically the more intensive your diabetes management the more a patient monitors their glucose levels.

This is the reason LifeScan, a unit of Johnson and Johnson (NYSE:JNJ), focused their efforts at capturing insulin using patients. It is the same reason Sanofi-Aventis (NYSE:SNY) has entered the BGM market as they also sell the world’s number one insulin, Lantus. It is also the same reason so many companies want to enter the insulin pump market or work with an existing insulin pump company.

While Diabetic Investor whole heartedly supports any technology that helps a patient more effectively manage their diabetes, we are also realistic that technology itself cannot accomplish this and that technology that is data dependent is worthless if there is no data to analyze. This fundamentally is the flaw with all the programs that require patients to share data, what happens when there is no data or the data provided is not sufficient to provide a proper analysis?

Let’s assume for a minute that a type 2 patient using oral medications uses this new technology and let’s further assume they monitor their glucose levels twice a day, once in the morning when they wake up and once before they go to sleep. This data alone is then transmitted to a database where with the patients permission is shared with a certified diabetes educator. Finally let’s assume we have a truly motivated patient who does this for every day of the month, which means the CDE would have 60 data points from which they are supposed to perform their analysis and make recommendations. Keep in mind the CDE has no other data and just 60 glucose readings, the CDE does not know when or if the patient is taking their medications, when or if the patient exercised or what the patient eats. Simply put the CDE is being asked to make recommendations with an incomplete data set. This is like asking a person to bake your favorite cake without all the necessary ingredients.

This example also illustrates just how difficult it is to help patients manage their diabetes. There is no question that glucose levels are a critical element but they are not the only element. Ask any physician who treats patients with diabetes which they would rather see, a patient who monitors their glucose regularly or one who consistently takes their medications, and hands down they would prefer patients be complainant with their therapy regimen over monitoring their glucose levels.

We would also suggest that anyone who believes this technology is the answer go out and gather a group of 20 patients with type 2 diabetes who use oral medications to control their diabetes and ask them to explain what glucose test results mean and how they use this information to help them more effectively manage their diabetes. Although Diabetic Investor can’t state for certain what the numbers would be like we’re pretty sure the person asking the questions would see more than a few blank looks from these patients.

The harsh reality is even with great technology you need a highly motivated patient to effectively use the technology. Diabetic Investor knows of many patients, most of them insulin pump patients, who constantly monitor not just their glucose levels but carb intake, exercise, etc. They take all this data download it onto their computers and then use this collection of data to more effectively manage their diabetes. It should go without saying but the majority of patients are not this motivated and frankly do not have the time or knowledge to do this. The majority of patients live their lives with diabetes and not for their diabetes.

Diabetic Investor has said it a thousand times, the reason most patients do not regularly monitoring their glucose levels has nothing to do with the so-called pain of testing, it really has to do with the fact that most patients have no idea what the test result means or how they are supposed to use this information to more effectively manage their diabetes. Or put another way, the missing ingredient isn’t technology but patient education.

The bottom line is if you provide an educated patient with great technology you’ll see better outcomes. If you combine great technology with an uneducated patient you see a technology that isn’t used all that much. This is like the obese patient who buys a treadmill for their home so they won’t have to drive to the gym to exercise and ends up using the treadmill as place to hang their dirty clothes because they are not motivated to exercise. There’s nothing wrong with the treadmill it’s just missing a key ingredient; a person who is truly motivated to exercise.

The simple fact is it’s far easier to develop all this great technology than it is to educate the patient who is supposed to use the technology. Until these companies realize this all we’ll have is some really great technology used a mere handful of patients while the majority of patients will remain clueless as to what they are supposed to be doing and why. The missing ingredient for better patient outcomes isn’t better technology.