Digital Diabetes Coaching Competitive Landscape – January 11, 2021

Comparative Overview

The table below offers a comparative overview of the user bases and program offerings of eleven major digital health coaching companies. “X” indicates that the company has a coaching program to address that health need or chronic condition.

Note that companies measure user base differently (e.g., paying members only vs. all users). We use publicly disclosed numbers here, which may include members across all programs or members in diabetes programs only, which we note. For more detail on user numbers, see details on individual companies below.

Individual Company Details

1. Noom

• Members: >50 million across all programs (vast majority in weight management)

• Size/stage of funding: $58 million Series E in May 2019

• Business strategy: Direct-to-consumer first; also selling to pharma and device companies, employers, payers, and health systems

Programs/Offerings

• Weight management (“Healthy Weight”). Healthy Weight is Noom’s flagship offering. Pricing for the program ranges from a 1 month subscription ($59 monthly) to a 12 month subscription ($199 annually) with the most popular subscriptions ranging from 4 months to 12 months. The program includes 16-weeks of curriculum, in addition to regularly updated articles and challenges for users. The program also allows users to log weight and food, track calories and exercise (using a built-in pedometer), and access support from peers and a coaching team.

• CDC-certified Diabetes Prevention Program. Noom was the first mobile app to receive CDC-certification for its DPP (2017) and the only mobile program clinically proven in a peer-reviewed journal. Noom's DDP is a yearlong personalized course that will help you reduce your risk of developing type 2 diabetes by focusing on healthy habits.

• Diabetes management. Noom announced a pilot diabetes management program in partnership with LifeScan in May 2020. The program includes access to the OneTouch Reveal app and Noom’s Diabetes Management Program for users of LifeScan’s BGM users.

• Medication + Noom. Pharmaceutical partners offer Noom’s behavior change service to patients who are taking medication for chronic conditions. Noom’s offering helps bring about lifestyle changes that boost the effects of medication and have demonstrated the ability to increase patient engagement. The most notable partnership is with Novo Nordisk for patients taking the anti-obesity medication Saxenda.

• Behavioral health (“Healthy Mind”). Noom’s Healthy Mind program includes a 12-week curriculum on education and motivation designed to help users manage stress and anxiety. The program also includes 1:1 coaching, daily logging, and reminders for “engagement and commitment.” The program is priced at $99 for four months and only available for iOS users.

Selected clinical studies

• Relationship Between Age and Weight Loss in Noom: Quasi-Experimental Study (Apr 2020)

• Diabetes Management: Significantly more patients using Noom DBM achieved target A1c of < 6.5% (47.1%) when compared to a control group (11.1%) (Jan 2020)

• Noom digital DPP publication shows weight loss maintained at 65 weeks: 53% of competitors achieved >5% weight loss (May 2018)

• Successful weight reduction and maintenance by using smartphone application in those with overweight and obesity (Nov 2016)

• Weight loss efficacy of a novel mobile Diabetes Prevention Program delivery platform with human coaching (Sept 2016)

Selected Close Concerns coverage

• LifeScan and Noom announce pilot digital diabetes and weight loss management program (May 2020)

• Weight-loss app Noom reports 2019 revenue of $237 million, according to Forbes (Jan 2020)

• Novo Nordisk and Noom partner to provide digital health solutions for weight management (Oct 2019)

• Noom digital DPP publication shows weight loss maintained at 65 weeks: 53% of competitors achieved >5% weight loss (May 2018)

• Noom Health’s digital Diabetes Prevention Program becomes first mobile DPP app to achieve CDC’s full recognition (April 2017)

2. One Drop

• Members: >4.1 million (app downloads)

• Size/stage of funding: $35 million Series C, led by Bayer (August 2020)

• Business strategy: Available to consumers, insurers, employers, and healthcare providers

Programs/Offerings

• Supplies and tracking. One Drop’s diabetes supplies subscription includes One Drop’s Bluetooth connected BGM along with test strips and lancets shipped monthly. Readings from One Drop’s Bluetooth-enabled glucose meter automatically sync with the One Drop app, allowing users to track their glucose levels over time and share reports with their healthcare team. Users can also track A1C, medications, blood pressure, activity, and food for free in the app. Monthly subscriptions are available for 50 test strips ($20.99/month), 100 test strips ($40.99/month), and unlimited test strips ($79.99/month). 

• Chronic condition "Digital Membership." One Drop packages its program for people with diabetes, hypertension, and high cholesterol into a single machine learning and behavioral science-based "Digital Membership." The One Drop platform (available on iOS and Android) combines asynchronous coaching with certified health professionals (including DCESs), an interactive learning experience, health predictions, goal setting, data tracking, and more. The One Drop platform is available direct-to-consumer via subscription to the Digital Membership ($19.99/month) as well as to enterprise clients around the world.
  

• Planned expansion into cardiology, oncology, women’s health, and more. One Drop plans to bring its AI-powered approach to prevention and health management to even more therapeutic areas including women’s health, cardiology, oncology, pulmonology, renal health, ophthalmology, and radiology. The expanded programming will be created with the support of Bayer, but will remain One Drop designed, developed, and branded.

Selected clinical studies

• People With Diabetes Using One Drop & Afrezza Significantly Lower A1c In 3 Months (2019)

• Long-Term A1c Benefit from Using One Drop (2019)

• Diabetes mobile app with in-app coaching from a Certified Diabetes Educator reduces A1c for individuals with type 2 (2018)

• One Drop Mobile on iPhone and Apple Watch: an evaluation of A1c improvement associated with tracking self-care (2017)

• One Drop Mobile: an evaluation of A1c improvement linked to app engagement (2017)

Selected Close Concerns’ coverage

• DTM 2020: One Drop’s Dr. Dan Goldner: “Yes, glucose monitoring can predict the future;” presents One Drop’s near and long-term glucose prediction models (Nov 2020)

• DiabetesMine Innovation Days 2020: Holistic diabetes care through technology: leaders from One Drop, Vida Health, January.ai, and Healthfirst talk CGM, telemedicine, coaching, artificial intelligence, and more (Nov 2020)

• One Drop closes $35 million Series C, led by Bayer; expanded agreement with Bayer worth up to $64 million (August 2020)

• Jeff Dachis announces “new One Drop,” adding cholesterol and blood pressure management, personal coaching from certified health professionals, and improved data tracking (August 2020)

• One Drop acquires CGM startup Sano; no financial terms or launch timelines shared (April 2020)

• One Drop BGM now available in hundreds of Walmart retail stores, including one year of free in-app CDE coaching (Oct 2019)

• One Drop raises $40 million in Series B, led by Bayer pharma; expansion into oncology, CVD, women’s health (Sept 2019)

• One Drop Chrome now available in select brick-and-mortar apple stores (June 2019)

3. mySugr

• Members: ~3 million (includes both paying and free registered users)

• Size/stage of funding: acquired by Roche in 2017

• Business strategy: Selling to companies/payers and direct-to-consumer

Programs/Offerings

• Diabetes management. mySugr is primarily focused on diabetes management, through its mySugr app (available in 78 countries and 24 language) and its mySugr bundle (available in the US, Germany, and the Netherlands). The mySugr app enables people with diabetes to collect relevant therapy data in one place through a growing number of connected devices (e.g., Accu-Chek meters), integrations (e.g., Apple Health), and manual entries (e.g., carb info). In the US, the mySugr app can also record data from connected blood pressure monitors, which users and coaches can use to address hypertension-related issues.

  • The mySugr bundle ($49 in the US), a monthly subscription service, includes for example in the U.S. an Accu-Chek Guide Me BGM (+ lancet and unlimited test trips) and mySugr PRO with CDE coaching, which was accredited by ADCES in February 2020. New members, who subscribe to the starter kit of supplies and support for just 3 months, will receive it free of shipping costs.

  • There are two versions of the app (Google Play, App Store): mySugr Basic and mySugar PRO. mySugr Basic is free for Android and iOS and includes personalized logging, overview reports, estimated A1c insights, an insulin dosing calculator, and basic challenges and tags.  The mySugr Pro app includes all the basic features, as well as smart log searches, multi-BGM syncing, express support, PDF and Excel reports (vs. CSV only), basal rate for pump users, and meal photos. Due to COVID-19, Roche has offered members free access to the PRO version of the mySugr app through January 31, 2021, extending the offer from its original end date of September 30, 2020.

Selected studies

• Real-world assessments of mySugr mobile health app (DT&T 2019)

• High risk population using mobile logging application shows significant reduction in LBGI (ADA Poster 2017)

• Significant improvements of blood glucose control in high risk population of type 2 diabetes using a mobile health app – a retrospective observational study (ATTD 2017)

• Sustainable Improvement in Quality of Blood Glucose Control in Users of mySugr’s Integrated Diabetes Management Solution (ADA 2019)

Selected Close Concerns coverage

• Roche 3Q20 (Oct 2020), 2Q20 (July 2020), 1Q20 (April 2020), 4Q19 (Jan 2020)

• Roche and UK-based pharmacy chain Boots partner to promote free access to mySugr app during COVID-19 (July 2020)

• Roche offers mySugr Pro for free during COVID-19 (April 2020)

• Roche mySugr receives ADCES (f.k.a AADE) accreditation as diabetes education accredited program (Feb 2020)

4. Lark Health

• Members: “nearly” 2 million people “managed” on its platform (October 2020)

• Size/stage of funding: $55 million Series C (October 2020)

• Business strategy: selling to payers – employers, health systems, health plans

Programs/Offerings

• Diabetes management. The diabetes care program consists of text-based AI coaching, a connected BGM and unlimited strips, and ongoing education. The program also offers medication and appointment reminders. In situations of severe blood sugar shifts and problems with medications, a member’s care is escalated to a telephone conversation with a diabetes specialist. Some eligible members also receive a connected scale. Members can also choose to work on weight loss or tobacco cessation while engaging in the program. Lark’s diabetes care program is available for purchase through the Lark 24/7 Health Coach app (Apple Store; Google Play) as an in-app purchase under the name “Diabetes Care.”

• Diabetes prevention. Lark provides those at risk for type 2 a connected scale, AI-driven text-based personalized coaching on a Smartphone app (iOS and Android), educational content, and data integrations with Google Fit and Apple Health Kit to promote lifestyle changes. The CDC-certified program presents the CDC’s Type 2 curriculum through a series of 26 standardized “weekly missions” that consist of daily check-ins relating to a weekly topic of the Prevent Type 2 curriculum.

• Hypertension. Lark provides those with hypertension blood pressure management tools, AI-based personalized coaching, nutrition therapy, and daily education programming. Program members receive a connected blood pressure cuff as part of the program. Weight loss or tobacco cessation coaching can be integrated into the programming. When crises arise related to hypertension arise, members can escalate their care to speak with a provider over the phone.

• Behavioral health. Lark’s behavioral health programming focuses on addressing issues like anxiety, stress, quitting tobacco, and weight loss. For example, the tobacco cessation program includes medication coaching, CBT, 24/7 craving counseling, mindfulness coaching, and social support. The other behavioral health programs offer similar tools that are tailored to the specific behavioral health issue.

Selected clinical studies

• Lark for Diabetes Prevention publishes long-term weight loss results (2020)

• Lark Releases Clinical outcomes for DPP in Older Adults (2019)

• DPP Scalability: Urgent but Possible (2019)

• Omron Healthcare (2019) – Lark for Hypertension reduced risk of heart attack & stroke after 6 months in an uncontrolled population

• Lark’s DPP’s impact on underserved populations (April 2020)

Selected Close Concerns coverage

• Lark Health raises over $70 million from $55 million Series C and $15 million in venture debt (October 2020)

• One-year study of Lark Health’s Digital DPP (n=610) finds 4.2% Body weight reduction (March 2020)

• Lark Health AI-based coaching pilot study (n=22) shows 1.1% A1c reduction over 4 months (July 2019)

• Lark Health and 23andMe partner to integrate genetic data into Lark’s Wellness Diabetes Prevention programs (January 2019)

• JMIR observational study (n=70) finds Lark AI app users with obesity/overweight lose 2.4% of bodyweight after ~15 weeks (March 2018)

5. Livongo (now part of Teladoc Health)

• Members: “over 442,000” members in Livongo for Diabetes; 1,402 clients (as of October 2020)

• Size/stage of funding: merged with Teladoc Health (announced August 2020; closed in October 2020); went public in July 2019

• Business strategy: selling to payers (employers, health plans, health systems)

• Additional notes: Livongo’s “merger” with Teladoc may change the company’s programming in the near future.

Programs/Offerings

• Whole-person solutions. Livongo’s “Whole Person Solutions” program supports users with a wide range of conditions all on one platform. Presumably, this would include diabetes, pre-diabetes, weight loss, hypertension, and behavioral health. Whole Person Solutions is available for $180/month.

• Livongo for Diabetes. The diabetes management program includes a connected BGM with customizable alert and reminder settings, test strips (+ “quick & easy” refills), and 24/7 expert support from a certified DCES via text, phone, or email. Through the program, users have access to shareable reports and real-time personalized insights both on their BGM and in their private account. The diabetes management program is available for $75/month or for free through Livongo clients. Notably, this is the only Livongo program that can be purchased directly by the consumer.

• Diabetes prevention and weight management. Livongo offers a merged diabetes prevention and weight management program, which includes CDC-approved lessons, 24/7 DCES coaching, activity tracking, and a connected smart scale that sends weight managements to a tracking app. The program is free with health plan or employer coverage and is not available for direct purchase by consumers.

• Livongo for Hypertension. Livongo’s hypertension program comes with a connected blood pressure monitor which sends readings to the Livongo app. Like Livongo’s diabetes management program, the hypertension program offers shareable reports, customizable reminder settings, real-time insights and tips after each reading, and 24/7 coaching from expert coaches. The program is available through employer or health plan insurance.

• Behavioral health (“myStrength”). Through Livongo’s myStrength program, members can focus on behavioral health needs including reducing stress, improving sleep, increasing mindfulness, balancing emotions, managing depression, pregnancy and early parenting, managing chronic pain, and controlling anxiety. After signing up, members take a short quiz to customize the program to their particular needs and difficulties. The customized program then includes interactive lessons (quick activities, articles, videos), 1:1 messaging with a dedicated coach, and daily inspiration (quotes and stories).

• Telehealth. With the merger with Teladoc, we might see a more direct telehealth integration into Livongo’s programming in the future.

Selected clinical studies

• BMJ: driving weight loss through DPP

• Jefferson Health: case study of cost effectiveness and clinical outcomes

• ADA case study: retrospective medical claims analysis of 2 self-insured employers

• Dean Foods: medical claims analysis

Selected Close Concerns coverage (full list as of closed merger available here)

• Teladoc completes $18.5 billion “merger” with Livongo (November 2020)

• Teladoc/Livongo 3Q20 (October 2020)

• Livongo executives Zane Burke (CEO), Dr. Jennifer Schneider (President), and Lee Shapiro (CFO) to depart company following Teladoc “merger” (October 2020)

• Livongo 2Q20; Teladoc “merger” announced (August 2020) (+ preliminary 2Q20)

• One-year retrospective study of Livongo’s digital DPP (n=2,037) finds mean 5.1% body weight reduction (~10 pounds), 6.6% reduction (~13 pounds) in “highly engaged” group (August 2020)

• Livongo 1Q20 (May 2020)

• Livongo added to CVS Health Point Solutions Management (March 2020)

• Partnership with Dexcom G6 (Jan 2020)

• Partners with MDLine and Doctor on Demand to add telehealth (Oct 2019)

• Livongo for Diabetes to be covered for federal employees (Oct 2019)

• 2019 quarterly updates: 2Q19 (Sept 2019), 3Q19 (Nov 2019), 4Q19 (March 2020)

• Livongo goes public on Nasdaq, compilation of all previous coverage (July 2019)

6. Omada Health

• Members: “more than 400,000” participants across all programs; we believe the majority is in its digital DPP (Nov 2020)

• Size/stage of funding: raised $57 million from Perceptive Advisors in May 2020; closed $73 million Series D round in July 2019

• Business strategy: selling to payers (employers, health plans, insurance companies, etc.)

Programs/Offerings

• Diabetes prevention/weight loss. Omada’s weight loss and diabetes prevention program offers participants access to (i) small group support; (ii) personalized health coaching; (iii) digital tracking tools; (iv) approved behavioral change curriculum; (v) 12 weekly sessions focusing on initial weight loss; and (vi) 36 weeks of weight management sessions. The program is CDC-certified, and we believe that it has the largest userbase of any digital DPP, including the majority of its “more than 400,000” participants.

• Diabetes management. Omada’s type 2 diabetes management program includes coaching on shopping, meals, exercise, and self-monitoring, weekly interactive lessons, access to groups and an online community, and connected health devices including a smart scale, a connected blood pressure monitor, a connected BGM with unlimited test strips. While users can connect their Dexcom CGM to the app, Omada has an exclusive partnership with Abbott to make Abbott’s CGMs a part of Omada’s programming.

• Hypertension. The hypertension program offers coaching, weekly interactive lessons, an online community, and connected health devices including a connected scale, blood pressure monitor, and if it is suggested for a patient’s personal needs, a blood glucose meter.

• Behavioral health. First announced in January 2019, Omada’s behavioral health program focuses on depression and anxiety. The programming utilizes cognitive behavioral therapy software from Lantern, includes coaching from CBT-trained coaches, and the Omada Mind app (App Store; Google Play), which offers interactive techniques, audio for in-the-moment relief, goal-setting support, and messaging with coaches.

• Musculoskeletal health and physical therapy. Through its acquisition of Physera in May 2020, Omada now offers physical therapy and musculoskeletal health programming. Physera’s programming includes virtual diagnosis and treatment from licensed physical therapists, application animations, voice prompts, and digital exercise therapy.

Selected clinical studies

• American Journal of Preventative Medicine: Superior engagement compared to in-person DPP (2018)

• Contemporary Clinical Trials Communications: Medicaid population receptive to Omada (2018)

• BMJ Open Diabetes Research & Care: Validated 3-year outcomes (2017)

• Journal of Occupational and Environmental Medicine: Proven effective in nationwide workforce (2017)

• Journal of Aging and Health: Success with Medicare Advantage (2017)

• Journal of Diabetes Research: Successful translation to underserved populations (2016)

Selected Close Concerns coverage

• Omada’s Diabetes Prevention Program associated with 0.2% A1c reduction and 5% weight loss at 12 months among patients with prediabetes (Nov 2020)

• Omada’s Diabetes Program reduces mean A1c from 8.9% to 8.1% after four months 9 (n=195 type 2s) (Sept 2020)

• Omada raises $57 million from perceptive advisors and acquires musculoskeletal digital health startup Physera Health (May 2020)

• Abbott and Omada partner to bring FreeStyle Libre CGM & personalized coaching to type 2 diabetes (Oct 2019)

• Omada raises $73 million in Series D, bringing total valuation to ~$600 million (per CNBC) (July 2019)

• Omada adds cellular telecare BGM (with unlimited strips) and cellular BP monitor to chronic disease programs (March 2019)

• Omada will launch depression and anxiety programs, Utilizing CBT software from Lantern (January 2019)

• Two-year study shows >4% weight loss with Omada’s adapted digital DPP for underserved populations (Nov 2018)

• Cigna to expand Omada Program into its existing health services for diabetes prevention (Sept 2018)

• Omada launches diabetes and hypertension management programs with connected BGM and blood pressure cuff (June 2018)

7. Cecelia Health

• Members: >200,000 members

• Size/stage of funding: $13 million Series B co-led by Rittenhouse Ventures and Endo Investors in August 2020

• Business strategy: selling to “care partners,” such as health plans, pharma, medical devices, self-insured/employers with own health plan

Programs/Offerings

• Diabetes management. Cecelia Health provides regular, multilingual educational interactions with CDCESs and other coaches through various remote modalities and formats (e.g., web, phone, email, text, video, articles, webinars, patient apps and portals).  Cecelia provides a personalized coaching model that begins with segmenting participant populations and automating the scheduling and delivery of coaching touchpoints based on each participant’s risk profile. Participants receive clinical coaching, remote device initiation, training and education, medication management, and specialty care interventions via a telehealth model. CDCESs can recommend dosage and titration changes directly to a patient with endocrinologists licensed in all 50 states. Participants who engage with Cecelia’s virtual Diabetes and Mental Health Clinic also receive behavioral health coaching to improve both their clinical and psychosocial wellness. Behavioral Health Coaches and Psychologists coach patients for diabetes fatigue, distress, fear of lows and other diabetes related mental health conditions. Cecelia also provides remote CDCES coaching and telemedicine services to augment services provided by diabetes clinics and hospital and primary care practices in order to increase geographic reach, frequency of care, scheduling options (evenings, weekends, etc.), and the overall number of participants who can receive services, particularly for participants located in rural areas.

• Cardiovascular Disease and Hypertension. Cecelia Health operates cardiovascular programs for pharmaceutical companies focused on providing expert clinicians who can help participants with initiation, adherence and persistency to increase time on therapy, as well as lifestyle and behavior change. Cecelia also offers a Healthy Heart program for health plans that is focused on reducing cardiovascular risk of participants by empowering them to better manage their multiple conditions, closing gaps in care, and reducing claims costs.

• Obesity. Cecelia Health offers obesity programs to pharmaceutical companies and health plans focused on providing expert clinicians who can help participants with initiation, adherence and persistency to increase time on therapy, as well as lifestyle and behavior change.

Selected clinical studies

• Personalized diabetes coaching in a Medicare population (access here)

• Virtual specialty clinic pilot (n=36) with virtual CGM onboarding (Feb 2020)

Selected Close Concerns coverage

• LifeScan and Cecelia Health announce partnership to bring CDCES coaching to OneTouch users via OneTouch Reveal app (Oct 2020)

• Cecelia Health closes $13 million Series B, Rittenhouse’s Saul Richter and Endo Investors’ Eric Edidin to join board of directors, number of members now exceeds 150,000 (August 2020)

• Helmsley Charitable Trust awards Jaeb Center ~$5 million for virtual clinic study (n=300) with remote CGM onboarding and insulin dosing support (August 2020)

• CH extends telehealth support, partners with Helmsley (May 2020)

• CH expanding capacity during COVID-19 pandemic (March 2020)

• ATTD 2020: Virtual specialty clinic pilot (February 2020)

• AADE 2019: Cecelia Health’s David Weingard and Teresa McArthur and Stanford’s Korey Hood: technology and care teams should create “light bulb moments” for patients (August 2019)

• ATTD 2019: Helmsley-funded Jaeb + Cecelia Health study investigates direct-to-consumer CGM in type 1 adults; participants choose FreeStyle Libre or Dexcom G6 plus CDE support (Feb 2019)

8. Canary Health

• Members: 75,000

• Size/stage of funding: Self-funded through revenue

• Business strategy: Selling to payers, hospitals, and employers

Programs/Offerings

• Diabetes, Hypertension, and Arthritis (“Better Choices, Better Health”). Canary Health’s Better Choices Better Health program offers participants a six-week online small group workshop with others living with the same chronic conditions, including diabetes hypertension and arthritis. The peer-to-peer and peer-lead program increases participants’ self-efficacy leading to sustained behavior change.  Participants receive peer support monitored by trained peer facilitators, 24/7 access to self-guided lessons and resources, tailored content, stories, education; small group interactions; action planning and goal setting and ongoing support after program ends.
  

• Prediabetes and Obesity (“Virtual Life Management”). Virtual Life Management is a year-long CDC recognized DPP program which focuses on weight loss within the context of overall health and well-being. Participants are assigned a healthcare professional who communicates with each participant via secure messaging, 1 on 1 telephonic calls, and group chats. Each week there are a variety of activities that engage the participants in health promoting activities and learning. Participants engage via PC, tablet, or smart phone, in 16-weekly self-guided sessions, followed by 8 monthly lessons with 24/7 support, proactive coaching by healthcare professionals, digital scale, and linkages to wearable activity monitors and online food tracking apps. 

• Caregiver Support (“Building Better Caregivers”). Canary Health also has a unique program to support caregivers of loved-ones with chronic physical and mental health problems including depression and PTSD. Participants, most of whom are US veterans, engage in a six-week peer-to-peer and peer-lead online workshop to help them better manage their own health and that of their loved one. They also receive peer support monitored by trained peer facilitators, 24/7 access to self-guided lessons and resources, and ongoing support after program ends.

Selected clinical studies

• Kaiser Permanente study compares workplace diabetes prevention programs delivered in-person and virtually (June 2020)

• Canary Health’s six-week diabetes management program saves $815 in one-year healthcare, pharmacy utilization costs (Aug 2018)

• Evaluation of Diabetes Self-Management Program: Claims Analysis of Comorbid Illnesses, Health Care Utilization, and Cost (2018)

• Positive topline data from Canary Health demonstrates a reduction in healthcare expenditures over one year with the “Better Choices, Better Health” digital diabetes self-management program (Dec 2017)

• A Diabetes Self-Management Program: 12-Month Outcome Sustainability from a Nonreinforced Pragmatic Trial (2016)

Selected Close Concerns coverage

• Kaiser Permanente study compares workplace diabetes prevention programs delivered in-person and virtually (June 2020)

• Canary Health’s six-week diabetes management program saves $815 in one-year healthcare, pharmacy utilization costs (Aug 2018)

• Positive topline data from Canary Health demonstrates a reduction in healthcare expenditures over one year with the “Better Choices, Better Health” digital diabetes self-management program (Dec 2017)

• Six-month data from largest eve study of digital diabetes self-management tool shows efficacy of Canary Health’s “Better Choices, Better Health” program (Sept 2016)

• Medtronic partners with Canary Health to sell digital self-management programs, beginning with online diabetes prevention program (June 2016)

• DPS Health rebrands as Canary Health to place greater emphasis on the emergent-risk population (May 2015)

9. Dario Health

• Members: “63,000 active paying users” as of November 2020

• Size/stage of funding: Became public company in 2013, current market cap of ~$130 million

• Business strategy: Previously focused on selling phone-based BGM hardware and supplies, but transitioning towards digital coaching sales (both direct-to-consumer and to payers/employers)

Programs/Offerings

• Diabetes management (“myDario”). Dario’s all-in-one BGM system (lancing device + meter + strip cartridge placeholder) syncs automatically with the Dario Smart Diabetes Management app to provide real-time, data-driven insights for users. Users can easily share their data with loved ones and their doctor, as well as count carbs and track activity. The app also has a hypo alert feature which will send a prepared message to up to four emergency contacts with the user’s GPS location when a severe hypoglycemic reading is entered. The app (Google Play; App Store) has pro and premium versions which include a personal coach. Members can also access telehealth services on the app through Dario’s partnership with MediOrbis.

• Hypertension. The app can also integrate hypertension management with diabetes management by pairing with the Dario Blood Pressure Monitoring System and allowing users to record and store their blood pressure management in their logbook alongside their blood glucose measurements.

• Behavioral/mental health. As of May 2020, Dario also offers coaching and support for stress, anxiety, and loneliness. The website offers little detail on this programming.

• Prediabetes and obesity. Dario Health is expected to add prediabetes and obesity throughout 2020 and 2021, but we are yet to see evidence of that expansion (see Dario 4Q19).

Selected clinical studies

• ADA 2020: Users with type 2 diabetes using a digital platform experienced sustained improvement in blood glucose levels (June 2020)

• AADE 2018: Decrease in estimated A1c for people in high-risk over a full year of users monitoring with a digital health system (August 2018)

Selected Close Concerns coverage

• Dario 3Q20 (Nov 2020), 2Q20 (August 2020), Dario 1Q20 (May 2020), 4Q19 (March 2020)

• DarioHealth retrospective study shows 27 mg/dl reduction in mean glucose after six months (n=298 users over the age of 65 years) (Nov 2020)

• Dario Health expands to include behavioral health coaching for stress, anxiety, and loneliness (May 2020)

• Dario Health partners with telemedicine startup MediOrbis to provide acute, chronic and specialty virtual care visits on Dario app (May 2020)

• Dario expands retail BGM distribution through Walmart.com (Dec 2019)

• Dario Health expands BGM + coaching “membership-in-a-box” bundle to Brick and Mortar Retail Stores (Nov 2019)

10. Onduo

• Members: Not publicly shared

• Size/stage of funding: Founded as a joint venture between Sanofi and Verily (Alphabet) and began with ~$500 million in funding; Verily remains committed to the project and to our knowledge, Sanofi remains financially involved (but no longer operationally involved)

• Business strategy: Selling to payers and employers

Programs/Offerings

• Diabetes management. Onduo provides diabetes management and has licensed endocrinologists in 49 states. Its program includes an app with integrated data logging (glucose, food, activity, sleep); personalized eating and exercise tips and coaching; smart tracking tools and supplies (i.e., connected Telcare BGM, at-home A1c test, unlimited test strips, and for some, a Dexcom CGM and/or a smart blood pressure cuff); coaching and telehealth care from CDE specialists, endocrinologists, and nutritionists.

• Hypertension management. Onduo for Hypertension provides a personalized program for individuals based on their risk and personal goals. The program includes an app with personalized digital support including exercise, diet and stress management along with virtual care and coaching. Smart blood pressure cuff for rising and high risk individuals. Integrated telemedicine support includes medication review and optimization.

• Diabetes prevention and weight loss. Onduo provides Healthy Weight program featuring the patented Good Measures Index (GMI) for Healthy Weight that helps individuals make the right eating choices, simplifying the science of nutrition through personalized recommendations.  Wireless digital scale and app tracking for food and activity. Evidence-based program is tailored to individual risk factors, conditions and preferences through app and 1:1 coaching with registered dieticians; access to peer and group resources.

• Preventive and well-being care. Included in the Onduo virtual care program are wellness horizontals that help individuals adopt healthy habits to support both condition-specific and overall health improvements. Leveraging evidence-based strategies, these programs provide self-guided and coach led activities focused on nutrition, activity, sleep, wellness and stress management.

• Multi-lingual support, starting with Spanish. Onduo app and care experience delivered in Spanish. Culturally specific content. Multi-lingual care leads.

Selected clinical studies

• ADA 2020: Use of Dexcom G6 with Onduo programming delivers 2x greater A1c improvements vs. connected BGM across all baseline A1c groups (1), Onduo virtual diabetes clinic drives significant reduction in diabetes distress among type 2s after 3 months (2)  (June 2020)

• ATTD 2020: Onduo delivers stellar real-world satisfaction: 80% of participants comfortable with CGM insertion purely from virtual education (Feb 2020)

• Onduo shares preliminary real-world data from 740 patients in Journal of Diabetes Science and Technology (Dec 2019)

Selected Close Concerns coverage

• Verily secures $700 million in funding (Dec 2020)

• DTM 2020: Onduo studies show the power of CGM + remote monitoring in type 2s: intermittent wear shows 1.6% A1c reduction in 4 months; separate study shows high satisfaction and educational value (November 2020)

• Onduo ADA recap webinar: KOLs summarize data among type 2s enrolled in Onduo’s virtual diabetes clinic, highlight importance of improving tech access (July 2020)

• ADA 2020: Use of Dexcom G6 delivers 2x greater A1c improvements vs. connected BGM across all baseline A1c group sin Onduo’s virtual diabetes clinic (1), Onduo virtual diabetes clinic drives significant reduction in diabetes distress among type 2s after 3 months (2)  (June 2020)

• Onduo appoints Dr. Vindell Washington as interim CEO, following departure of Dr. Josh Riff (June 2020)

• ATTD 2020: Onduo delivers stellar real-world satisfaction: 80% of participants comfortable with CGM insertion purely from virtual education (Feb 2020)

• Onduo shares preliminary real-world data from 740 patients in Journal of Diabetes Science and Technology (Dec 2019)

• Verily blog post re-affirms commitment to Onduo following Sanofi’s restructuring announcement (Dec 2019)

• Glytec and Onduo webinar: Onduo halves number with A1c >9%; makes case for connected care, frequent insulin adjustments (May 2019)

• Sanofi and Verily Life Sciences Launch Onduo, $500 million JV to develop diabetes solutions combining devices, software, medicine, care (September 2016)

11. Virta

• Members: Unknown

• Size/stage of funding: $65 million Series D at “over $1.1 billion” valuation (Dec 2020)

• Business strategy: Selling to employers and health plans

Programs/Offerings

• Diabetes reversal. Virta’s flagship diabetes management program aims to reverse diabetes (A1c <6.5%) and lower medication requirements through carbohydrate restriction. Participants receive support from a dedicated health coach, continuous medical supervision via an app, starter kit supplies (meter, strips, connected scale), engagement with a patient community, and educational resources (meal plans, videos, games). As of right now, CGM is not used in the program, but participants who have acquired a CGM outside of the program can use those insights in their Virta program.

• Diabetes management. Members in the diabetes management program will receive personal guidance from provider-led care teams with the option to eventually transition to the type 2 reversal program. Like the diabetes reversal program, the diabetes management program uses carbohydrate restriction and a continuous care model, but the program is less intensive and aims to reduce A1c below 8% or, for those with A1c values already below 8%, to reduce it below 7%. Again, as of right now, CGM is not used in the program, but participants who have acquired a CGM outside of the program can use those insights in their Virta program.

• Prediabetes reversal. First announced in October, the prediabetes reversal program will use the same therapeutic carbohydrate restriction tools, coaching, engagement, and education as the diabetes reversal program but will further reduce A1c to below prediabetes levels.

• Obesity reversal. First announced in October, the obesity reversal program will use the same therapeutic carbohydrate restriction tools, coaching, engagement, and education as the diabetes reversal program, but will focus on sustained weight loss instead.

Selected clinical studies

• Virta Health and Department of Veterans Affairs share positive 90-day outcomes from pilot study (n=104) (Nov 2019)

• Virta publishes full two-year results (n=262) in Frontiers of Endocrinology: 54% diabetes “reversal,” granularity on med elimination (June 2019)

• Long-term effects of novel continuous remote care intervention including nutritional ketosis for the management of type 2 diabetes: a 2-year non-randomized clinical trial (June 2019)

• Improvement in patient-reported sleep in type 2 diabetes and prediabetes participants receiving a continuous care intervention with nutritional ketosis (March 2019)

• Virta publishes 1-year improvements in NAFLD/NASH non-invasive scores, improvements in sleep (Feb 2019)

• Cardiovascular disease risk factor responses to type 2 diabetes care model including nutritional ketosis induced by sustained carbohydrate restriction at 1 year: an open label, non-randomized, controlled study (May 2018)

• Effectiveness and safety of novel care model for the management of type 2 diabetes at 1 year: an open-label, non-randomized, controlled study (Feb 2018)

• Novel intervention including individualized nutritional recommendations reduces hemoglobin A1c level, medication use, and weight in type 2 diabetes (March 2017)

Selected Close Concerns coverage

• Virta Health closes $65 million Series D at “over $1.1 billion” valuation (Dec 2020)

• Virta Health adds treatment for obesity, prediabetes reversal, and type 2 diabetes management programs to its virtual clinic; plus, an interview with CMO Dr. Bob Ratner (Oct 2020)

• In a major win, Virta Health names Dr. Robert Ratner Chief Medical Officer (April 2020)

• Virta Health closes $93 million Series C, adds six new advisors, including Drs. Martin Abrahamson, Francine Kaufman, and Alan Moses (Jan 2020)

• Virta HCP webinar on benefits of low-carb diet for type 2 and strategies for de-prescribing medications (Sept 2019)

• Virta publishes full two-year results (n=262) in Frontiers of Endocrinology: 54% diabetes “reversal,” granularity on med elimination (June 2019)

• Virta Health partners with US Department of Veteran Affairs to provide Virta treatment to 400 veterans at no cost (May 2019)

--by Hanna Gutow, Katie Mahoney, Albert Cai, and Kelly Close