Real-Time Guidance to Improve Diabetes Self-Management

Type II Diabetes has become a national scourge, one that is expected to affect one in three Americans by mid-century. Currently, there are about 29 million people in the US with diabetes, and nearly 2 million more are being diagnosed each year. This disease is quite a management nightmare for both patients and physicians.

The use in humans of beef and pork insulin in the 1920s, and the first sulfonylureas developed in the 1950s, revolutionized the treatment of diabetes. But, despite the approval of literally dozens of medications for diabetes and the development of advanced molecular technology to constantly monitor glucose levels, fewer than 4 in 10 people with diabetes are controlled to national guidelines per the NCQA report card.

To control this lifelong disease, constant attention needs to be focused on diet, exercise, (oftentimes numerous) medication(s), and blood glucose levels periodically throughout the day and adjust their insulin based upon their results, current activity, and food consumption. This is quite a task, and one that few actually master.

A small company called Welldoc aims to change this with a technology they have named BlueStar; the first-of-its-kind Mobile Prescription Therapy cleared by the FDA. BlueStar provides patients with real-time guidance to improve their diabetes self-management. It also provides clinical decision support to help their doctor optimize their diabetes treatment plan. BlueStar provides personalized healthcare advice that other products cannot provide without the supervision of a licensed healthcare provider.

Using patented algorithms, BlueStar analyzes diabetes data entered by the patient, including blood glucose and medications. It compares past data trends to deliver automated, customized, contextualized, specific reminders for care and supports daily self-management decisions. BlueStar can also provide summarized, curated data and analytics to the healthcare team to improve decisions and drive efficacy in the healthcare analytics market.

This device received FDA clearance based on a statistically significant reduction in HbA1c levels. It is available only with a physician’s prescription.

This BlueStar device is one of a number of first generation apps or coaches (some with FDA clearance and some without) designed to improve the health of people with diabetes and prediabetes and for general wellness. They collectively combine the functions of data collection, activity tracking, sleep monitoring, condition education, skill building, support, monitoring, coaching, behavioral adherence support, patient-provider communication and patient engagement.

The essential behavior support provided by the various devices includes medication adherence, problem solving, reducing risk, healthy coping, sleep hygiene and a variety of lifestyle improvements.

Their effectiveness is in the proof stage, but their dissemination will accelerate as people become more comfortable with computer driven health care, physicians gain trust, and additional clinical trials prove engagement and efficacy.

Future developments will include gamification, social connectivity, more advanced analytic capability, and more sophisticated behavioral modification, a necessity for controlling this massive disease load.

But the turning point will come when these devices can talk—the so-called “bot” revolution.

The near future holds expansive uses of “bot” technology; think of a “smart” SIRI for health care. By adding natural language understanding, and not only more creative algorithms but true artificial intelligence, these devices will soon become true virtual health assistants (VHA).

By that, I mean they will be capable of actually entering into conversations with a person with an illness to not only answer tens of thousands of questions but also ask pertinent questions about the patient’s condition; do a variety of clinical assessments; measure mood, activity, and food intake; and become personalized health coaches. They will communicate with the EMR and other large databases and, eventually, with regulatory approval do much of what physicians and nurses do. Numerous academic studies have demonstrated that people actually treat “bots” like a human and develop human relationships with them. In fact, studies have shown that people are actually more honest with a bot than with a human!

I could go on and on, but I have to go now; my VHA has just started my exercise music and is telling me to go for my walk…