Memorandum

DT&T Highlights Connected Diabetes Care in Review from Brian Levine, Kelly Close, and Dr. Robert Gabbay – October 28, 2019

Article; Terrific overview of 12 connected care diabetes players; first paper to synthesize similarities/differences among growing connected care providers; recs for future research

Diabetes Technology & Therapeutics recently published a fascinating review article, “Reviewing U.S. Connected Diabetes Care: The Newest Member of the Team,” authored by Close Concerns’ alum Brian Levine, our own Ms. Kelly Close, and Joslin’s Dr. Robert Gabbay. This article  provides a valuable snapshot of 12 connected diabetes care players, including a consolidated list of similarities and differences. The paper provides an organized structure to think through the growing list of offerings based on: (i) health conditions managed (e.g., diabetes, prediabetes, hypertension, etc.); (ii) peer support availability; (iii) prescribing healthcare providers on the care team (e.g., in-house doctors?); (iv) provision of connected medical devices (CGMs, BGMs, BP monitors); (v) degree of curation and personalization; and (vi) evidence.

Companies covered include Canary Health, Cecelia Health, Lark Health, Livongo, mySugr, Noom, Omada Health, Onduo, One Drop, Vida Health, Virta Health, and Welldoc. Table 2 (see below) is a real gem, offering a side-by-side look at all these players. The authors note that in the subtle differences among these companies also lies their strength: “patient and payer choice.”

We also appreciated the summary of gaps and predictions:

  • Administering care and coaching remotely through horizontal expansion – e.g., moving from diabetes into hypertension);

  • Establishing relationships among connected care companies, primary care providers, employers, and clinics to prevent fragmentation – currently, many of these programs exist outside of a patient’s traditional healthcare relationships;

  • Integrating electronic health records (EHRs) between traditional healthcare providers and connected care companies;

  • Acquisitions and mergers to increase financial stability and access to patient populations;

  • Integrating diabetes treatment with care for other conditions like mental health and obesity;

  • Greater use and completion of randomized controlled trials;

  • Increased use of continuous glucose monitoring technology, especially to reach people with type 2 diabetes through novel models;

  • Finding the appropriate balance between human vs. automated coaching; and

  • Navigators to help patients select the appropriate connected care program for them.

The article is a reminder of the growing connected diabetes care arena, as well as some of the biggest challenges: these programs often standalone, but at some point they need to work with the existing face-to-face healthcare system. It goes without saying at this stage that the existing brick-and-mortar model is inadequate to cope with growing unmet needs in diabetes care and prevention, and technology will have a critical role in the puzzle. We very much appreciated it that the authors not only encouraging RCTs, but also more standardized methodology in all studies. While all may not be possible, they’d like to see longer studies, use of time in range metrics, measured vs. eA1c (estimated A1c) as an outcome, inclusion of beyond A1c outcomes, control group intervention, etc.

The full article is surely worth reading for anyone interested or working in the diabetes field.

 

--by Ani Gururaj, Albert Cai, Adam Brown, and Kelly Close