May 14-15, 2019; San Francisco, CA; Day #1 Highlights – Draft

Greetings from San Francisco, where we bring you our Day #1 coverage from the Digital Diabetes Congress. Below, we have our top Six highlights from the day. Check out the agenda for what’s in store tomorrow.

Top Six Highlights

1. IDEO’s Mr. Dennis Boyle Gives Tips (and Examples) for Thinking Like a Designer; Specifically Calls Out Lilly’s Trulicity Auto-Injector, Ascensia’s Contour Next One BGM/App, & PillPack for Good Design

IDEO co-founder Mr. Dennis Boyle delivered a trademark entertaining talk, rife with tips about how to think like a designer and countless examples of particularly good (and bad) design.

• Recommendation #1: Immerse yourself in the problem first – surveys and focus groups come later as validation steps. He told the story of how an IDEO team got permission to admit themselves to an NYU hospital that had poor ratings in admissions. They were put through the whole process of admission, including diagnostic tests. During the course of this immersion, IDEO members were left out in middle of the hallway for hours, staff who were supposed to stop by did not, members were given the wrong tests, a meal went “completely wrong,” etc. This classic story in the annals of IDEO research resulted in a report that was fed back to the NYU faculty with all of these issues. Though Mr. Boyle truncated the story there for the sake of time, we imagine the next step was working together to address these pain points.

• Recommendation #2: Cultivate an awareness of what is good design, and what is not. Take pictures! A litany of good and bad design followed – we captured these examples in the following table.

• Recommendation #3: Make notes about workarounds (“People are trying to invent things right before your eyes”). Examples included: Countless makeshift doorstops; “vertically-challenged” people standing on objects in the workplace to reach high places; a blood vial used to keep a supply door open in the hospital; a hospital intern taking a picture of an X-ray with his cellphone to send to his attending because it’s too onerous to do so through the hospital system; a surgical team using a towel as a holster for tools or using a patient’s toes as a cable management system; a man using a flashlight to see his blood glucose level on his BGM; and a 90-year-old woman using a meat cutter to open her pill bottles. These examples make clear the value of immersing oneself in the end users’ life before setting out to design a product.

• Recommendation #4: Watch for signs (“If you see lots of signs, it’s often a design opportunity. Sometimes symbols are not enough to communicate a message. As one of my colleagues used to say, ‘A word is worth a thousand icons’.) Examples included: People doing activities right next to signs prohibiting those activities (“You can’t dictate behavior if there are no other good options”); confusing shower controls (he showed an example of one that was so complex that it had the owner’s manual taped to the wall next to it); and parking payment machines that have lots of stickers on them to make sense of the confusing controls. This last example is a hobby horse of Bigfoot’s Lane Desborough, who often espouses the importance of user interface simplicity.

• Mr. Boyle also included quick portraits of IDEO-designed products that have been successful in healthcare and consumer health, including: (i) Lilly’s Trulicity autoinjector (“We performed hundreds of tests in the field to understand where people make mistakes, what makes sense to them…now, physicians are recommending this medication in particular because of its user experience”); (ii) Ascensia’s Contour Next One Bluetooth BGM and paired app (calling attention to the color LED light to indicate if the blood glucose level is above-, below-, or in-range, app features that nudge people toward better glucose management habits, and pattern detection);  and (iii) PillPack, an Amazon-acquired pharmacy that pre-sorts medications by dose and time of day for customers.

2. Evidation Health’s Achievement App Drives Patient Engagement and Democratizes Clinical Trial Participation; Panelists Discuss Value-Based Care, Prevention and the Role of CGM, and Importance of Engaging PCPs in Digital Health Uptake

Evidation Health’s Ms. Leslie Oley described how Evidation is leveraging its Achievement app to not only drive healthy patient behaviors, but also to recruit a diverse patient population for clinical research. More than three million individuals now use Achievement, which integrates Dexcom CGM data (via API) and pulls data from over 30 other health apps, including Apple Health, Samsung Health, Strava, Fitbit, myfitnesspal, and Garmin. Users are compensated for contributing their data with points, which can be redeemed for cash or donated to health-related charities. The applications are virtually infinite – just last December, Lilly and Evidation Health announced an expanded collaboration to provide Lilly with data from smartphones, connected sensors, wearables, and voice to determine novel methods of evaluating a patient’s health across therapeutic areas. Achievement has been incredibly successful as a tool for clinical trial recruitment. Ms. Oley shared that 900,000 users, of which “many tens of thousands” live with diabetes, have participated in research, driving a 67% responsiveness rate to offers. As Ms. Oley pointed out, the primary reason most people have never participated in clinical research is because they were never asked. Evidation is trying to change that, with 79% of its members expressing desire to participate in research and over 90% granting permission for their data to be used retrospectively. Asking people to participate in clinical research, Ms. Oley explained, can help to increase clinical trials’ diversity. She shared one example of an Evidation-partnered diabetes study that boasted a 71% female, 25% black or Hispanic, and >45% without college degree patient population. Time spent on study recruitment is also accelerated by this approach, serving to cut down costs. We’re very excited to see how the democratization of clinical trial participation improves our understanding of underrepresented groups’ health. This was a major topic of discussion during the ADA Symposium on Real-World Data in November. See below for key themes that emerged from the subsequent panel discussion.

• On value-based care and the future of digital health. There was strong interest among the panelists in type 2 diabetes management – this was absolutely fantastic to see. PRI’s Mr. Peter Rule (former MiniMed President, COO and former CEO of Optiscan, and Therasense co-founder) was especially adamant that “type 2 diabetes is the new frontier,” given type 2s predominately receive care from general practitioners. We were also intrigued by the panelists’ take on which players will be running the digital health space in the next four to five years. Onduo’s Dr. Ron Dixon sees potential in Google and Apple, as they “have the most access to the consumer,” whereas Vida Health’s Ms. Stephanie Tilenius maintained that it would be best “if there’s innovation across [payers and startups] and everyone disrupts.” See below for our favorite quotes on the topic.

  • “The most important thing we do is provide claim analytics on what we do. We will back our results with dollars. We tell insurance companies, ‘for your highest risk patients, if you pay a certain amount and we don’t save you a certain amount, you’ll get your money back.’ It’s nice to say you can reduce A1c but it’s another thing to say you can save dollars. That’s where we have to go.”– Dr. Ron Dixon (Onduo, Newton, MA)

  • “Type 2 diabetes is the new frontier, if you will, as patients are served by people who are extraordinarily distracted. Primary care providers see a wide variety of individuals and to reach them you have to embrace digital solutions and partner with them, which is an innuendo for relinquishing a percentage of your revenue line. And that’s ok as long as you have cost structure to do that. Many today don’t have that cost structure.” – Mr. Peter Rule (PRI, San Francisco, CA)

  • “We won’t have specialists in type 2 diabetes, it’s not realistic. We have to accommodate a broad network that will see type 2 diabetes patients. The only cost-effective solution there is is digital health; I think CGM is a part of it.” – Mr. Rule

  • “The future includes more than a single-analyte system. That future isn’t as far away as one might think. The obvious analyte in addition to glucose is lactate, but there are others as well.” – Mr. Rule

• On prevention and the role of CGM. Many panelists agreed on the benefits of CGM, but believe it is not yet cost-effective for prediabetes. While we agree that a lower-cost CGM is necessary for widescale implementation in prediabetes, we were surprised by the commentary on prevention in general. Dr. Dixon asserted that chronic disease is inevitable with aging, and that by tackling prediabetes, costs would only be shifted farther down the line. Aging is certainly the biggest risk factor for most chronic conditions, but there is certainly something to be said for the legacy effect, expanding healthy and productive life-years, etc. One of the more sustainable long-term tactic lies in Vida Health CEO Ms. Stephanie Tilenius’s suggestion to focus more on improving social determinants of health. Regarding her quote, “I’m a big fan of CGM, but I still think we have underlying nutritional issues” – we don’t think anyone would disagree with this and the question is how the social determinants of health are addressed, short- and long-term.

  • “One area in which there could be more focus is how do you identify people on the road to a chronic condition before it becomes severe? How do you find biomarkers and telltale signs in people’s digital fingerprints to do something earlier?” – Ms. Oley

  • “For prediabetes, a great way to improve outcomes is CGM, but it’s not cost-effective. What is the price point at which prediabetes can be addressed? If you want to save society a lot of money, address prediabetes. You can say there’s a CGM for prediabetes, we know that, it’s out there. What is not out there is a CGM specifically for prediabetes – this will have a different set of requirements, accuracy, form factor, cost structure, etc., because it’s not going to be used to administer insulin. We’re talking about patient motivation – part of motivation is money – you have to figure out a different paradigm. We don’t think of the creational aspect as much. We think next year, some of us think the next two years, but very few think about creation of an actual market, but it’s where some of these technologies have to head.” – Mr. Rule

  • “I do agree there will be a low cost CGM produced in the next 4-5 years applicable in prediabetes, but it doesn’t necessarily change the arc of chronic disease. It prolongs the arc, and we will end up spending the same amount at end of life. With chronic disease, there’s only one way and it comes with aging. Unless we have some kind of policy where we reduce costs associated with aging, it’s difficult to say that if we detect prediabetes we’ll reduce healthcare costs. We’ll just spend it later.” – Dr. Dixon

  • “You could give a CGM to every human, and even then you will still have socioeconomic determinants of health. Look at the Geisinger study showing cost reductions by giving the most expensive patients very healthy food. We underspend in these areas like food deserts. In Europe, they spend a lot more on social determinants of health, and less on healthcare. I’m a big fan of CGM, but I still think we have underlying nutritional issues.” – Ms. Stephanie Tilenius (Vida Health, San Francisco, CA)

• On driving patient engagement and consumer power. We were very interested to hear statistics from Dr. Dixon on Onduo’s recruitment rate. Returns are substantially higher when patients are referred to Onduo by their primary care provider vs. when they are referred by their insurer, demonstrating the importance of partnering with clinicians. How can physicians be further incentivized to enroll participants in programs such as Onduo’s?

  • “When we try to attract patients with the help of an insurer, the return rate is about 8-10%. If we’re working with an employer, it’s 12-14%, and when working with a primary care provider, it’s moving into the 30% realm. This suggests that if you include primary care providers into the equation of recruiting people, then patients are much more likely to follow through and participate and engage. This is part of our hypothesis that we’re testing right now.” – Dr. Dixon

  • “As we move towards consumer-driven healthcare models and start to put the consumer at center and say, ‘what matters to you?’ you begin driving behaviors for long term health implications.” – Mr. Ed Liebowitz (BD, Franklin Lakes, NJ)

• On partnering with employers. Employers were positioned as a useful entry point for startups. Ms. Tilenius emphasized that employers are “forward-thinking” and often do not require the same degree of rigorous analysis as insurance companies when evaluating solutions. Company culture appears to play a significant role in both the employer’s willingness to offer a solution, as well as employees’ trust in messaging from the employer.

  • “From the employer perspective, it’s a difficult challenge. In many ways, they feel like their hands are tied. A lot of it is about engaging people. If there are digital devices that help do that, employers will be all in. Engagement is such a difficult area for employers to deal with. Different demographic groups are engaged by very different triggers. There’s also tremendous impact resulting from company culture – do employees trust messaging coming from the employer? This is also all over map.” – Mr. Jeffrey Klonoff (Aon, San Francisco, CA)

  • “I think the employer market is the easiest for startups to talk to. Employers are forward-thinking. Employees typically have a tenure of 8-10 years, so employers are trying to do everything they can to drive productivity and reduce absenteeism because then they benefit. I’ve been really impressed with how forward-thinking employers are. Payers are looking to analyze every piece of the outcome (they do pilots more often) whereas for employers, if you have case studies and good data, they will deploy.” – Ms. Tilenius

  • “Big employers are likely to have different philosophies on how involved they should be in healthcare. Some believe it’s not their business and others go so far as to hire clinicians within company. The best approach I’ve seen is: (i) a startup tries to find a very hands-on employer; (ii) they run a pilot to generate actual data; and (iii) the employer partners with organizations trying to solve a range of health transformation issues.” – Mr. Jeffrey Klonoff

3. Insulet Perspective on Challenges Presented to Industry by Interoperability, and Q&A Concerns over Data Interoperability (While FDA Pushes “Physical” Interoperability)

Though she is “100% supportive” of patient choice, Insulet’s Ms. Brittany Bradrick highlighted some of the challenges to manufacturers presented by interoperability: “It creates new complications. We need to validate each component, look at the trial data for each, customer service needs to be greater, and how we reconcile patients across components is something we are having to look through … We also need to make sure that healthcare providers and patients can both get the data, so sources need to be taking in the same file language. We need portable data across all platforms.” This point on data interoperability (or lack thereof) seemed to resonate with the audience. Dr. Barry Ginsberg noted that data interoperability has been worked out in other industries (e.g., financial), but healthcare is slow to change. In fact, in the early 1980s, he tried to work with AdvaMed to get all BGM companies to agree on a standard software that worked with all BGM devices, to no avail (third-party Glooko/Diasend and Tidepool are now filling this gap). He concluded that “when manufacturers realize that interoperability will lead to a bigger pie, their piece of the pie will grow, and that’s better than a bigger piece of a smaller pie.” The highly respected Dr. Saleh Adi, former UCSF clinician, put Dr. Ginsberg’s question into a practical frame, noting that data is all out there, but it’s really hard to collect and aggregate – “right now I need to talk to five different people to get it.” Two panelists – Rice University’s Dr. Ashutosh Sabharwal and Ascensia’s Ms. Kripa Gaonkar – agreed that this is indeed an issue and that the remedy will require a shift in policy and culture.

• “Connected injections is a massive opportunity. I see my friend Sean Saint from Companion Medical here, they’re on the market, leading the charge. We have a development program for that as well. It’s a huge opportunity for making an impact on the preponderance of people taking insulin today. These are incredibly underserved people. We’re working on solutions to enable the vast majority of PCPs supporting people to be able to dose insulin in more relevant, personalized, and safer and effective way.” – Mr. Bryan Mazlish, Bigfoot Biomedical

4. Digital Health Investment Panel: Models that Excite Investors, a Downside to Value-Based Care, and Tailwinds from FDA/CMS Innovation

Following a talk from Rock Health’s Mr. Bill Evans where he asserted that digital health is not in a bubble (see report here), a handful of investors and Lark CEO Ms. Julia Hu joined him on stage to discuss trends. The wide-ranging conversation touched on investments and models that the speakers believe to be promising, the pros and cons of value-based care, and more. Read on for quotable quotes from the conversation in these three verticals!

Investments and Models that Excite the Panelists

• “We’ve spent more time on the back end of diabetes: the complications. Someone who is a normal beneficiary for a Medicare Advantage plan costs $10,000-$12,000 a year. Someone with type 2 diabetes is immediately $20,000-$30,000 a year. We invested in a company in Nashville that looks at the transition from CKD to dialysis. That patient who goes on dialysis is instantly a $100,000 per year patient. Anything to slow that down, prevent peritoneal dialysis in the ER, can make a lot of money. It’s important to segment in diabetes.” – Mr. Casper de Clercq (Norwest Venture Partners)

• “Providers are having trouble buying applications from several companies – it’s a big problem. It’s part of the bumps and grinds of the market during growth. But I’m looking for companies that have a grand plan for how to solve that. One of the key things they can do is partnering. With the environment we are in, a company’s ability to partner with others and not feel the need to be everything to everybody is going to be important to the success of the company.” – Ms. Leslie Bottorff (GE Ventures)

• “I’m excited about our investment in Verana Health – the ‘data exhaust’ model is a win-win. They partner with physician groups, which have data registries, but they’re non-profits and don’t have a good way to build that data into what it could be. It’s a partnership where the physician societies get the data back for their purposes to run their practices and do research, and Verana uses the licenses to help pharma companies improve the whole development cycle. If pharma companies can take six months or a year out of their development program, that’s worth huge amounts of money. For example, Roche bought Flatiron Health for $2.5 billion. I’ve heard that Roche has already made that money back in taking money out of development cycle. I’m excited about that. Drug prices are a real problem. How do we take money out? Take it out of the development process, that could be very impactful.” – Ms. Bottorff

• “I don’t think my favorite company [to invest in] exists yet. There’s a lot going on with data integration in type 1 diabetes. Everyone has gone at this in type 2 diabetes – Telcare, Livongo, Glooko, Welldoc – but there needs to be logic around moving care out of the high-acuity to the low-acuity environment. The technology is there. We know for type 2 diabetes, it’s about three, six months between clinic visits. There’s no way a healthcare provider can manage patients during the gaps.” – Mr. de Clercq

• “I think there will be a time when a company can raise $200-$300 million. Livongo will go that direction, I think.” – Mr. de Clercq

Value-Based Care Pros/Cons

• “A lot of our business is value-based care. We only bill when we are engaging patients and when we are providing outcomes. For prediabetes, it’s 5% body weight loss, the clinical threshold for reducing the onset of diabetes for ~60% of the population. We’ve found a lot of alignment with health plans. There’s no risk, and we get paid if you see benefits. That’s worked really well for us and allowed us to scale quicker. There’s a trend in that direction. It’s easier, they say put your money where your mouth is. Health plans also have said, ‘Now we know you can scale, and now you did, and our budget was blown faster, so now we want to do a PMPM plan.’ We’re moving a little bit slower toward the value-based care model that everyone’s been dreaming about.” – Ms. Julia Hu, Lark

• “Omada can predict who will lose weight and who can’t. Companies can double down on people who will lose weight, and people who we don’t think we’ll change behavior, we won’t spend time on – that’s capital-efficient, the model makes sense. Someone will have to pay significantly more for people that are intractable.” – Mr. de Clercq, responding to an audience question about the incentive in value-based care to focus resources on patients most likely to succeed

• “We don’t want to restrict users. We take them at different levels of willingness to change, so we’re getting a much larger population. Yes, our overall outcomes as a population do suffer a bit. We’re not #1 in terms of outcomes for specific populations of people we try to attract, but at the end of the day, what matters is population impact. For us, it’s a great benefit. We just published a study: within one year, our DPP clinical outcomes as we scale improved 26% because of all of the AI training that came from such a diverse population.” – Ms. Hu

Bill Evans on Tailwinds From FDA/CMS

• “Just last week, I was in DC at a Rock Health event, and I had the Director of Digital Health from FDA and the CMO from HHS on stage at the same time. I couldn’t help myself, and asked: on the one side Bakul [Patel], you’re asking for data resulting in approval, and on the other side, CMS is asking for information to validate economic benefit. When will you guys get together? It’s killing the industry. We want to one answer. They said we’re so glad you asked, we’re talking about it. I said great, when will you be done talking, knowing how long those conversations take.” – Mr. Evans

• “I want to touch on how critical government reimbursement is for the mobile DPP. There was a ruling that virtual DPPs won’t be reimbursed, almost setting up a party that no one will attend, since the best DPPs are all virtual. That’s slowly looking like it might change.” – Mr. Evans

5. Connected Pens Are Well-Suited for Regimented Senior Lifestyles; Loop + Tidepool Connectivity through Apple Health; New CGM CPT Codes Set Stage for Improved Reimbursement

A panel moderated by Joslin’s Dr. Robert Gabbay featuring UCSF’s Dr. Saleh Adi, Mary & Dick Allen Diabetes Center’s Dr. David Ahn, University of Nebraska’s Dr. Andjela Drincic, AADE’s Ms. LaurieAnn Scher, and ADA’s Ms. Sacha Uelmen probed clinicians’ perspectives on diabetes technology. Panelists identified improving reimbursement, diverse options for diverse populations, and AADE’s DANA (diabetes tech resource hub) as bright spots, while interoperability and access to DANA remain pain points

• Dr. Ahn challenged the stereotype that older people with diabetes are less likely to do well with diabetes technology, noting that their regimented lifestyles lend well to using connected pens, in particular: “In our study with Companion Medical’s InPen, I’ve been impressed with how the older folks are doing. Across the board, most MDI users do not actually calculate their dose using carb ratios and correction factors, and this is made even harder in older populations where numeracy or memory issues might be more common. One might expect smart pens to be more helpful for younger patients, but I’ve been pleasantly surprised by adoption in older patients. They do quite well because they use their smartphones serially in a very regimented way. Every day, before every meal, they type in what they’re eating and their blood sugar, then do exactly what the app says while the provider can work on the back end to make advanced adjustments to their insulin dosing ratios.

• All panelists lamented data and workflow challenges associated with diabetes technology, especially regarding interoperability. Dr. Drincic very eloquently broke down the barriers for each of the three steps of data management: (i) data download; (ii) data presentation; and (iii) data integration. Currently, patients in her practice are required to complete a questionnaire prior to their appointment to ensure all devices are accounted for and properly downloaded, which can set back the clinical schedule; automatic uploading into an interoperable system would be Dr. Drincic’s ideal fix. To this end, she extolled Tidepool and Glooko for their standardized formats (removing the “Where’s Waldo” portion of each patient visit when the clinician must locate the actionable data), which allow clinicians to focus more on the patient and less on data administration. Ms. Scher added that the FHIR (Fast Healthcare Interoperability Resources) specifications should allow the seamless integration of this data into EHRs in the next 3-5 years. Notably, Apple has already started working through FHIR to integrate patient records and test results onto iPhones, which Dr. Ahn identified as a “fairly successful model,” if only a stopgap solution for now.

  • Dr. Adi noted that data from DIY Loop systems can be automatically uploaded into Tidepool through the Apple Health app if configured correctly. He believes such automatic data uploading will significantly improve telemedicine, allowing clinicians to seamlessly follow their patients without the need for in-person downloads. Ultimately, we think these processes will also enable clinicians to better identify high-risk patients and allocate time and resources accordingly. For example, if a patient’s CGM profile is in good shape, suggesting that little would be gained from a face-to-face encounter, the time saved could be reallocated to help higher-risk patients. However, this approach would necessitate tweaks to reimbursement. To this end, Ms. Scher underscored three new CPT codes for CGM onboarding and data interpretation as a “very important bright spot” in the rapidly evolving payment reform landscape for diabetes technology. While these codes don’t ensure full reimbursement, as we learned from both Dr. George Grunberger and Dr. Dan Einhorn at AACE 2019, they do represent an important step toward CGM access, particularly since they are approved by Medicare and since 95251 in particular does not require an in-person visit.

• While AADE’s Diabetes Advanced Network Access (DANA) system was highlighted by multiple speakers as a reliable resource for sifting through the myriad diabetes applications and technologies, its limited access (currently only for AADE members) was challenged. Ms. Scher shared that AADE has been in discussions with other member organizations about extending access, and that the audience should “stay tuned, because [DANA] is going to be available to other groups.” DANA is supported by a $2.6 million grant from the Helmsley Charitable Trust in a three-year funding commitment. The platform, positioned as a “one-stop healthcare resource that helps navigate the many technologies people with diabetes and prediabetes can use to get and stay healthy” debuted at AADE in August. DANA could be a particularly robust resource for educating PCPs (who account for 90% of diabetes care delivery according to panelists) on diabetes technology, making widespread access especially imperative.

6. Welldoc’s BlueStar Wins Inaugural Diabetes App Contest over Glooko, GlucoseZone, and MyDoseCoach; DiabetesAdvisor (Pediatric Sick Day Advisor out of Children’s Medical Center in Dallas) Named Best “Up-and-Coming” App

Welldoc’s BlueStar (real-time, in-app coaching with connected care for patients with type 2 diabetes) was named the winner of the Diabetes Technology Society’s inaugural diabetes app contest. BlueStar is rated an impressive 4.4/5 stars (29 ratings) on iOS, and 4.0/5 stars (124 ratings) on Google Play. Welldoc has published a flurry of press releases in the past two months, announcing a partnership with Validic to integrate data from 375+ connected devices with BlueStar, a six-month study of BlueStar-powered LifeScan OneTouch Reveal Plus with LifeScan and Healthagen (Aetna), submission of BlueStar to FDA to add CGM integration and type 1 diabetes support, and Health Canada licensing of OneTouch Reveal Plus. The esteemed panel of judges included Mary & Dick Allen Diabetes Center’s Dr. David Ahn, ADA’s Dr. Stephen Ponder, UCSF’s Dr. Aaron Neinstein, Stanford’s Dr. Korey Hood, and AADE’s Ms. Chris Memering. BlueStar was chosen from a group of four established finalists (see details below). Comparing these apps is a bit like comparing apples to oranges, and each brings its own important piece to the equation. Six “up-and-coming” apps (no outcomes data) were also evaluated in a separate category.

• Established apps:

  • Glooko (3.1/5 with 67 ratings on iOS, 4.1/5 with 955 ratings on Google Play) – Interoperability hub for decision support and data sharing, free for patients as of March.

  • GlucoseZone (4.2/5 with 5 ratings on iOS, 4.2/5 with 43 ratings on Google Play) – Personalized exercise recommendations based on blood glucose values, medication, and physical constraints.

  • MyDoseCoach (3.7/5 with 3 ratings on iOS, 4.5/5 with 17 ratings on Google Play) – Basal insulin titration from Sanofi. Data was recently presented at ATTD (-2.7% A1c from baseline 9.9% in 137 type 2s initiating basal insulin in India).

• Up-and-coming:

  • WINNER: DiabetesAdvisor (iOS) – Curated resources for families of children recently diagnosed with type 1. “Sick day advisor,” which is only available to patients at Children’s Medical Center in Dallas via an enrollment code, generates personalized protocols based on child’s age, height, weight, insulin dose, etc. Users are prompted to call their provider if any vitals (e.g., ketones) are out of range. The app went live in October 2018, now has 600 downloads and 130 registered users. This does not seem like that many users, but seems like a wonderful idea.

  • Control:Diabetes (not on iOS or Google Play stores) – Prompts users to record reasons for disparities between predicted and actual BGM measurements in order to elucidate the internal and external factors affecting blood glucose. This seems like it may appeal to the real data geeks in diabetes.

  • diafyt (Google Play) – Insulin dose calculator based on blood glucose levels, insulin injections, type of insulin used, carbs, and time of day. Machine learning software purportedly learns in “less than 10 days” the proper individual dosing calculation.

  • Happy Bob (not on iOS or Google Play stores) – Predictive glucose measurements and suggestions based on CGM. Geared toward kids with type 1.

  • mAID (Multivariable Automated Insulin Delivery; not on iOS or Google Play stores) – AID hub: connects to CGM, pump, and physical activity wearable to provide fully automated insulin delivery.

  • MetaCardio (not on iOS or Google Play stores) – Three-month lifestyle coach, 10-20 minutes per day in 3-minute segments.

-- by Brian Levine, Peter Rentzepis, Maeve Serino, Adam Brown, and Kelly Close