HIMSS and the future of diabetes care

At HIMSS last week, I was honored to be part of a HX360 Innovation Leaders Program panel discussion concerning innovation and the future of diabetes care. I was joined by Michael Payne, CCO of Omada Health, Dr David Moen, CMO of Healthy Interactions and Dr Anand Iyer, chief data science officer of Welldoc.

Rapid urbanization and changed eating habits, combined with progressively sedentary lifestyles, has caused diabetes type 2 to spread widely and increase dramatically in recent decades.  Today, both type 1 and 2 are part of a global epidemic, with one in 12 adults – almost half a billion people – live with this condition and a further 1.5 billion at risk of contracting it in the near future.  The impact of this chronic disease on the healthcare system would be difficult to underestimate. Large numbers numb the mind, but this is a topic of immediate importance to me personally: my daughter is affected by Type 1 diabetes.  

A diabetes patient typically needs to take more than 150 health related decisions every day…

With such numbers and dire predictions, it’s clear that there is work to be done to improve the condition of people living with diabetes, while at the same time advancing diabetes prevention. Not an easy task if you take into consideration diabetes is a highly complex condition to manage effectively. Many diabetics have co-morbidities.  It’s not unusual for someone with diabetes to deal with more than ten different care disciplines to work with, for instance the family doctor, the nutritionist, the internist, the cardiologist and eye doctor (ophthalmologist). A diabetes patient typically needs to take more than 150 health related decisions every day…

During the session we touched on our professional experiences with combating the illness, current reimbursement models, data interoperability, behavioral aspects and the need to inspire medical professionals skeptical towards digital technologies; but what really struck me during the debate is how far we’ve come. Over the past years, treatment and outcomes for diabetes have changed and improved dramatically. Today it can be safely said that the future of diabetes care shows the future of all chronic disease management.

The best examples of diabetes care pilots around the world already include self-management via wearable devices, connected glucose meters, insulin pens and pumps, validated apps, secure communication and personalized information with 24/7 support of integrated (virtual) care teams. In these systems data is integrated into medical work-flows, allowing care teams to intervene where and when necessary. All of this is undoubtedly a model of best practice that will provide a strong basis for all chronic illness management in the near future.

Having said that, there is still a long way to go before these deployments get scale and become reality for the majority of people living with chronic diseases. Coming from my own background in financial services and having stood at the cradle of Internet banking in mid nineties, when I started working in healthcare I was amazed at how little information technology was leveraged in chronic care. This is still the case for many patients but, as the case studies have proven, there is tremendous potential for technology to make a positive impact in the lives of those affected by diabetes.

How, if 90% of pre-diabetic people don’t know they are at risk of developing the disease, do you reach out, engage and motivate patients to change their lifestyle?

Another area where digital technologies can inspire and drive change is in prevention. One of the many barriers to this – and one that we touched on repeatedly during the panel - is (I quote Michael Payne) ‘the block-buster drug of this century’: patient engagement. As with any chronic disease, diabetes requires the strong engagement not only of the professionals dedicated to the treatment, but also that of the patients themselves. But how, if 90% of pre-diabetic people don’t know they are at risk of developing the disease, do you reach out, engage and motivate patients to change their lifestyle?

The panelists had several different points to make here but one of the most robust was the part medical professionals play in driving engagement. As trusted and respected experts, if they can invite patients in, encourage them to enroll into a program, use digitals tool and manage their condition, they can avoid deterioration. There was also a case to be made for allowing the family and friends surrounding the patient to help them manage their illness – in my own experience, I want to be a part of my daughter’s care team, helping to motivate and support her. 

To drive engagement we need to understand the patient

Before a doctor can inspire the former or encourage the latter, however, she needs to know and understand her patient. This is where data comes in and the fact we cannot rely on point solutions, but need holistic systems. Data-driven, evidence-based insights that are enabled by technology are undoubtedly the future of all chronic disease management. By combining the contextual data, the medical history and measurements into a full patient profile, a doctor will be able to understand who the patient is and provide them with highly personalized advice, backed up by population analytics. It’s not enough to use technology and apps to help a patient book an appointment, it’s vital that the doctors are also able to proactively reach out to their patients and intervene in a positive and constructive way, as and when needed. High tech enabling effective high touch…The diabetes prototype app Philips is developing with its clinical partner Radboudumc and patients is an example that aims to address not only holistic data integration but also boosts care collaboration and people-interaction. 

We need to integrate technologies that deal with all variables and multiple chronic conditions at the same time and deliver a highly personalized care plan. This dynamic plan is critical in modifying patient behavior and encouraging them to be healthy. As I mentioned during the panel, there is a $600 billion dollar industry devoted to modifying behavior: advertising. The healthcare community can learn a great deal from an industry that knows its consumers and knows exactly how to send the right message at the right time to inspire a reaction, specifically in a digital world.

Although the landscape of diabetes treatment and research has improved radically over the past years, physicians are still only able to manage the disease rather than cure it. Hopefully we find a viable cure in the coming years. In the mean time, if management methodologies and technologies continue to progress at the same rate over the next decade, and preventative measures are able to dramatically decrease the number of those at risk, who is to say what can be accomplished? The increased and very necessary investment into new treatments, pre-emptive measures and data-driven care for diabetes is a positive trend that is only set to continue. It’s my belief that diabetics of the future will not have their lives dictated by their disease.