What happens when …..
There will come a time when interconnected diabetes management (IDM) goes mainstream. With all the companies working in this area it’s inventible. Eventually some of these projects will yield a system that not just works but starts to be embraced by patients, physicians and payors. What then? Will we see a dramatic improvement in patient outcomes or more of the same? To be honest we have no idea what will happen.
Looking at this realistically these systems could go mainstream at the same time we have more than one hybrid closed loop insulin delivery system, more than one Tyler and a host of new drugs which alone make diabetes management simpler. Put another way IDM as useful as it could be may just be irrelevant when they finally get here.
Think about this just for a moment by looking at markets individually. As we keep noting thanks to CGM and insulin dosing algorithms insulin using patients will have it easier than ever before. Whether the insulin is delivered via a pump continuously or by a “smart” pen is almost immaterial. Pumps and pens are the least important links in this chain. When it comes to insulin using patients in the future either the pump will execute the delivery instructions for the patient or the patient will do what the system tells them to do. The algorithm will do all the heavy lifting effectually making the dosing decision for the patient.
Life is also getting easier for patients using GLP-1’s. Novo as we have noted will eventually get their oral GLP-1 onto the market while Intarcia should do the same for their exenatide micropump. Both products should increase GLP-1 usage which will make any IDM system unnecessary. GLP-1 therapy whether it’s injected once-daily, once-weekly, taken orally or pumped does not require glucose monitoring of any kind. The injectable versions, oral versions and pump are fixed doses. In other words, simply by the way the drug works the patient doesn’t have any decisions to make.
Which brings us back to where we always are, patients using orals alone. There is no question that IDM can benefit these patients the question is will they benefit. In theory an IDM can determine if the patient is therapy compliant, but it cannot make them take their pills. The data provided by the system could be valuable, but the patient still must do their part. There is no system that can make these patients take their pills when they are supposed to take them.
This is what everyone seems to forget the Achilles heel of IDM as valuable as it could be is the patients who would benefit the most are the ones who must also do the work. The reality is even armed with all this information life really doesn’t change all that much for patients on orals alone, no matter what the system tells them they still have to take their pills.
Now proponents of IDM will say patients will benefit from all this data, all the information they never had before, physicians will be able to make better decisions as they will know whether a patient’s therapy regimen is working or not.
This is true in theory but in the real world it’s whole different story. Let’s assume for a moment that someone develops a system that works, a system which includes a patient friendly easy to use CGM and an app. Let’s further assume that this system can collect data from other cloud enabled devices such as a scale or pedometer. Let’s go even further and assume the patients’ health insurer encourages use of the system and makes it affordable.
So, the patient slaps on the CGM which will not require calibration, puts the app on their smartphone and off they go. In the beginning the patient will likely play with the new toy. However, as time goes by the newness and coolness factor will wear off and the patient will soon discover even with all this information nothing much changes they still must take their pills. Additionally, all this information could become a burden as it’s a constant reminder they have diabetes. Throw in the fact they will not see any immediate improvements in outcomes and the system instead of being a benefit and making their diabetes management easier actually makes it harder.
The major benefit of a hybrid closed loop insulin delivery system, a Tyler or GLP-1 is the patient doesn’t have to think much about their diabetes management. The system and/or the drug does all the heavy lifting. This is not true when it comes to patients using orals alone instead of making life easier making them think less about their diabetes management it makes them think even more about it. This is the last thing these patients want.
What’s most misunderstood about these patients is they want to think less about their diabetes. They want diabetes to part of their lives but what they don’t want is their diabetes management running their lives. They want to live their lives WITH diabetes and not FOR diabetes. Even if the system sends them motivational messages and tells them they are doing a good job it doesn’t change their daily routine, it does not really change their lives in any substantial meaningful way.
The ONLY way this changes the ONLY way to truly engage this patient group is to make outcomes count in a meaningful way. A pat on the back for doing a good job is nice but unfulfilling. What would matter more what would hit home would be a lower premium, lower or elimination of deductibles. These are tangible benefits these patients care about. These are tangibles benefits patients can see and feel. These are tangible benefits which keep the patient engaged.
What continues to get lost with all this way cool whiz bang technology is the human factor. Patients are not computers they are humans with feelings and emotions. They have a disease they do not want, do not understand and even with help requires work to manage properly. Diabetes is not just a chronic disease it carries with it a huge psychological impact. Throw in the fact there are multiple variables which impact outcomes, variables which cannot be tracked by technology and it’s easy to understand why so many of these patients get frustrated with all this way cool whiz bang technology.