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Digital Therapeutics for Diabetes: How prescription digital therapeutics solve a growing global health problem

Nisha Gopinath Menon
January 29, 2020

More than 60 percent of the world lives with chronic diseases, and about 99 percent of disease management is in the hands of the patient and their families. Take a moment to digest this. Chronic disease like diabetes, heart disease, and respiratory disorders accounts for 87% of the $3.5 trillion the U.S. spends on healthcare. The healthcare systems of the world won't be able to sustain costs like this for much longer. This is now an issue of national competitiveness.

The term healthcare itself is a misnomer since our systems are designed to treat diseases. Globally on average, doctors, in general, spend only about 20 minutes/session advising a patient. For the rest of the time, in between appointments, patients are expected to keep on top of their health. Here is where most of the damage happens. Healthcare providers have only limited influence at a distance, and largely chronic diseases develop outside the healthcare setting. It's becoming clear to healthcare providers that we need to look at chronic diseases as a lifestyle-related ailment, in which somebody's lifestyle choices such as stress levels, activity, and diet become the most effective medicine. This is where digital therapeutics enter the frame to help counter the epidemic.

The cure for diabetes is an ongoing but straightforward one. While other ailments like malaria or tuberculosis have quick-fix solutions, diabetes can be a lifelong ailment for most patients. Here, digital therapeutics, which are tools, such as mobile apps, telemedicine platforms, and wearable devices, can replace or complement traditional therapeutics. These tools help people make positive and sustainable behavior changes that can even be more effective than taking medication in some cases. This efficacy is possible with prescribed medications supported by continuous monitoring of vitals and the ability to constantly encourage the practice of healthy lifestyle behaviors.

The digital therapeutics space in recent years has been making great strides. By 2025, the market is estimated to reach upwards of $9B. FDA has already approved quite a number of firms in the past couple of years like WellDoc and Canary Health that are digital prescription programs working towards helping diabetes patients manage their condition with mobile apps. These early players have paved the way and set the stage for incredible innovation in the space.

Let's take a closer look at how companies are tackling diabetes by leveraging the tools available today to facilitate behavioral change and improve health literacy and the role CognitiveClouds plays in all this.

We've worked on apps consisting of 5-6 month programs designed to promote healthy habits and monitor closely patient diet, weight, activity levels, and pair them with peer support groups, live health coaches, and doctors. Early results have shown that patients can self-manage with these tools and demonstrated the possibility of "reversing" the condition without surgery or drugs. The key features of the app include:

  • Daily log where users can enter data about their meal monitor blood sugar over time and track medicines.
  • Weight and activity monitoring: The app can provide weekly analysis of activity and includes 'daily hacks' to help users stay active. It also provides information about patterns like the rise of your blood sugar from your last log and the fluctuation of your weight.
  • A real-time personal nutritionist: Helps users better manage their blood sugar levels by learning their patterns and providing smart, easy-to-do hacks.
  • More insight for your doctor: It analyses and stores users' data so that they can show it to their physicians at their next appointment, which gives doctors better insights on where the patient is going wrong and what they are doing right.
  • Can interact with a helpful chatbot.
  • Gamification in the form of levels or badges to keep patients motivated.
  • Structured as a 4-5 month intervention program to help people develop and maintain the right habits and then go on "cruise control."

Some features, like activity monitoring and food tracking, were easy to work on and explore. Other features required external tools like a glucometer to enter data. All the features are designed to help you meet your goals on an everyday basis. After a 24-week dose of the 'digital drug,' users can use some of the features of the product for free and opt-in and pay for additional support for a longer period as needed. In our initial study, done over 4 months, the app helped the patients drop HbA1c levels, without any change in prescription, by an average of 0.61 percent. The aim was to help patients reduce HbA1c levels (90-day average of blood sugar levels). And the mean drop, out of those who dropped their HbA1c, was 1.03 percent. Through just digital intervention, the app was able to clinically improve the outcomes of the patients better than other entry-level prescription diabetes medication.

All of us are optimistic that in a few years, with IoT becoming more commonplace across the world, collecting data from users will be far more seamless and completely digitized. And while working on such solutions, we approach this as a healthcare solution provider solving a technical problem, rather than as a software company trying to solve a healthcare problem. We're not curing diabetes. What we do is help improve lifestyle metrics by taking a high-risk patient to lower risk and reduce the medication that people need to be on. Coming to the question, can digital therapeutics solutions afford a reversal of diabetes, the data clearly reveals that it can.

Our team at CognitiveClouds is very excited about the personalization of health and health care experiences and even more excited about the data it's starting to accumulate. The potential to enhance patient experience and outcomes is clear. So if you're looking to embark on this journey, we can't wait to partner with you.

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Nisha Gopinath Menon