Solving Problems That Matter -- Diabetes

Diabetes comes in two flavors -- type I is a genetic condition which means your cells do not produce enough insulin. Type II which is 90% of the cases is when you body goes insensitive to glucose due to repeated exposure. Type II is essentially a disease of lifestyle, it’s what this post will focus on, and is at the heart of a global crisis, from Ghana to India to the US.

In the US, per the CDC National Diabetes Statistics Report of 2017, over 100M of us should be concerned about diabetes. 84M Americans are pre-diabetic and another 30.3M who actually meet the definition of diabetes, of which 7.2M are undiagnosed. Translating the latter numbers -- just under 10% of US population has the disease and 1/4 don’t know that. The American Diabetes Association corroborates those numbers and found that diabetes cost $327B to the country in 2017 alone.

Technology has a fundamental role to play in solving this public crisis. Below are three key trends when it comes to startups focused on this space.

1) Lifestyle Management -- But The Long-Term For Startups Is Unproven

Diabetes is the hallmark of chronic diseases and the bane of human cognitive decision-making -- small decisions over a long time, with silent effects over years if not decades. Many startups have thus focused on helping people adopt better lifestyles to prevent, manage or even revert diabetes. Some prominent names that come to mind include Omada, Glooko, WellDoc, Livongo, Virta Health, and Vida Health. The natural assumption is with such a massive market there will be multiple winners and some of these companies might be stand-alone.

That said, there have been few exits so far. One example is Roche, which acquired mySugr for $84M in Jun 2017. That app provides a self-management package -- logbook, insulin calculator, diabetes coach, doctor reports, and a connected blood sugar meter with home-delivered test strips. But M&A is still an exception rather than a rule. Other companies are focusing on broader lifestyle management. Livongo for instance has branched beyond diabetes into other areas including blood pressure. Finally, legislation is still key for the economic model here to truly scale -- think of CPT codes reimbursing for digital lifestyle management.

2) Diagnosing Non-Invasively -- Still A Holy Grail

Short of installing a device in your body to measure insulin levels continuously, diabetes diagnostics today requires you to prick your finger. Here are some major techniques that are being experimented on:

• Tears -- Google has famously tried through contact lenses
• Light -- Shining a beam onto the skin and measuring the response (refraction, reflection, diffraction, absorption)
• Ultrasound
• Infrared -- Measuring natural energy waves emitted by the body
• Viscosity -- Checking the thickness of fluids in tissue underneath the skin (similar metrics as Light)
• Radio -- Applying radio waves to the fingertips

Many of these efforts are quite promising. But there is no FDA approval for a commercial non-invasive method as of writing this article.

3) A Forward-Thinking FDA -- Improved Regulation

The FDA has been showing promising signs in how they regulate technology. In 2017 the agency piloted a fast track for digital health apps, the idea being that companies that got certified would be able to launch future problems much more quickly. Just a year ago it authorized the first fully interoperable continuous glucose monitoring system -- the novelty in the approval is it allows the device to interface with other devices (automated insulin dosing systems, insulin pumps, blood glucose meters). And they are showing further acceptance of automation, having approved an AI-based diabetes decision support last year also. The pace of innovation is almost always faster than policy makers’ ability to adapt regulatory frameworks, but the industry consensus is the FDA is doing its part.

If you gleaned any insights from this article give a like. Any thoughts, comment away.

These are purposely short articles focused on practical insights (I call it gl;dr -- good length; did read). I would be stoked if they get people interested enough in a topic to explore in further depth. All opinions expressed here are my own.