Everything you know about diabetes care is wrong

May 20, 2021

I’m not diabetic. I have never experienced first-hand what diabetics go through on a daily basis, but I do have a good understanding of the disease and its progression thanks to both my professional career, as well as my personal life. Growing up in the United Arab Emirates, where 20% of the population has diabetes and another 20% are estimated to be pre-diabetic, we were always aware that diabetes is a widespread issue but for people not touched by the condition, it can seem quite abstract and foreign. For me however, diabetes hit close to home. My father is a type 2 diabetic (T2D) and as with most T2D elderly Emirati patients, he was not compliant, nor did he ever mention to me what he was really doing to manage his condition.

Knowing his condition, I never saw him measure his glucose, he never really asked for any special foods during mealtimes, and I never saw him get into any kind of an exercise regime. To me, considering the seriousness of the disease, it was as if he wasn’t living with the condition; diabetes simply seemed like an inconvenience to his overall normal life.

Almost a decade passed since my dad was diagnosed with very little change to his overall behavior towards the disease. That is, until the complications started due to his uncontrolled diabetes. One day, he broke his foot without actually realizing it due to a lack of circulation. That led him to discover that this was due to several blocked arteries in his lower limbs. Next came the numerous vascular bypasses around those limbs. Doctors unfortunately could not save his toe and had to amputate. Diabetes also led to him having Charcot foot, a rare but serious complication that makes bones and joints weakened. He spent months in and out of hospitals.

At first, it was easy to blame him for not taking care of his diabetes. Often, whilst waiting in hospitals and during visits feeling sad and helpless about what happening, I would react with: ‘Dad, you eat what you want, you never exercise, you never keep track of your glucose levels- what did you expected the result would be?’ His response was the typical response most patients who simply do not understand their disease give: ‘I took the medications given to me and I felt fine. No one followed up with me on such things.’

With time, I realized that the issue was not the fault of my dad, or any patient managed by traditional diabetes providers for that matter. It was actually with the healthcare system that was supposed to help him manage his diabetes, through education and coaching. When it comes to diabetes, the main arsenal in a traditional provider’s current stockpile is medication. Everything else is out of scope and herein lies the problem for not only my dad, but the estimated 422 million people with the condition globally.

To understand the failure of healthcare systems, lets summarize how an established diabetic patient would currently be managed by most healthcare providers:

  • Patient walks in
  • Patients see a physician for 10 minutes
  • Patients get sent for laboratory tests
  • Patients get a call back the next day (or two) informing them of the results and gets prescribed (for the most part) medication.
  • Patient asked to return in 3 months. They may be given some education in the form of leaflets.
  • If the patient has other co-morbidities (around 70% of diabetics suffer from other conditions such cardiovascular, ophthalmic, nephrology and podiatry), the patients will need to visit those separately. There is usually no coordinated care model and that information does not sit in a single database.

My dad was managed by a diabetes center in Abu Dhabi. I used to accompany my dad sometimes to his clinic visits. He would generally spend 10 minutes with his endocrinologist. Of those 10 minutes, 9 of those minutes would comprise of the physician typing information into the electronic medical record. Around one minute of the physician’s time would be spent looking into my dad’s eyes and actually connecting with him. In that valuable minute, the physician would typically ask routine questions such as his exercise regiment, his diet, his medication adherence, what his last glucose readings where etc. Most of the information provided by my dad would be fairly generic or inaccurate- ‘Yes doctor, I exercise sometimes (he doesn’t), I test sometimes (he doesn’t), I eat healthy (not really), etc.’

Let’s think about that interaction. What we now have is an imperfect exchange of information between patient and physician. You have a patient, unengaged, providing generic, mostly inaccurate information. On the other end, you have a physician, which is essentially his coach, also unengaged, not really getting to know their patient’s concerns, their lifestyle or the factors that could help or hinder their health, and unable to create a therapeutic plan based on the information given to them by the patient.

Why have we not evolved the patient-physician interaction in the last 50 years?

Surely this can’t be the most optimal way in managing a patient with a chronic condition, especially when the condition is one that requires so much self-management.

Herein lies the bigger problem. Diabetes is a management disease. The more compliant you are managing it, the better your outcomes. Considering there are over 40 factors that can affect blood glucose levels, it’s almost as if the patient waves the white flag as soon as they leave the physician office.

How is a patient supposed to manage their condition, and why is their self-management in isolation of the provider? Are physicians and care teams no longer responsible for patients when they leave the clinic? It has become very obvious to me the reason why we are losing the global fight against diabetes and metabolic diseases: the system in which we manage our diabetic patients is broken.

Diabetes is a 24/7 condition, yet the healthcare system treats in as if diabetes is episodical. The ‘Visit’ to your healthcare provider every quarter for a checkup and ‘we shall get your diabetes under control’ model is simply not working. Populations are getting more diabetic, and they are becoming worse at self-managing their condition a fact highlighted tragically by the pandemic.

Diabetes does not stop between doctor’s visits, yet the current medical system acts as if it does. Doctors’ visits capture just a snapshot in time. Despite the vital importance of a patient’s ongoing behavior, what happens between visits is not captured. For doctors and clinicians, the time between patient visits is essentially an informational black hole. For patients, there is little to no support between visits with their care falling solely on their shoulders. While there has been innovation with medical devices patients use, there has been little to no real innovation to the model of care for decades.

This is why we established GluCare. To fix the broken model and help people like my father. We re-invented the existing model of care to become continuous and more human. If diabetes management essentially happens 99.9% of the time outside the healthcare facility, then providers need to be part of that process.

When looking at all the ways patients have been managed since COVID, and the increased adoption of telemedicine, I believe that implementing a telemedicine solution alone will NOT solve the issues a chronic disease patient suffers from. We need data to allow us to understand what happens to patients, and we need it all the time. Data needs to be streamed back to the provider for there to be meaningful insights on how best to manage the patient in real-time. Recalling how blood glucose has so many parameters directly affecting its value, we need all types of data that affect this biomarker- sleep, movement, diet, glucose readings, stress, etc. Only then are providers able to manage patients effectively in a remote environment.

To use a different analogy, when a passenger plane leaves from destination A to B, data is continuous sent by the plane/pilots to ground control. The industry would never accept a scenario where data only gets received once the plane arrives at destination B, and ground control would only ever get to know of the flight details after the plane has arrived. The healthcare system has essentially been acting like this for decades. Providers do not see what happens to their patients until the day of the visit. The patient journey, and all data points associated with that journey, until visit time, is unknown.

We also need this continuous model of care to be integrated with electronic medical records (EMR). Only when care teams have access to both remote data and EMRs can real decision-making pathways for the patient work. Care teams now have a complete picture of the patient’s history in addition to real-time data. Back to the aviation analogy, engineering teams know about the history of the aircraft in order to service it correctly.

Finally, the amount of streamed information back to providers can be overwhelming. No physician anywhere on earth would be able to make sense of the data in its raw form, and this will not lead to any actionable insights.

Introducing artificial intelligence. Technology has evolved so much that we can now create the tools like we did at GluCare to correlate data into predictive disease risk scores, allowing the human care team to act on this information beyond a single biomarker.

Here is the artificial intelligence calculated predictive risk factors for my dad. His care team can now monitor other risks such as obstructive sleep apnea and hypertension, common co-morbidities suffered by diabetics but usually managed in isolation of their endocrinologist. We use machines to provide continuous information to our care teams about so much more beyond diabetes. This is the future of medicine being practiced now.

GluCare was built to close the feedback gap that currently exists in diabetes provider management. We built a holistic, multifaceted approach to diabetes management that takes into account large data sets and provides actionable insights to improve outcomes and quality of life. For our patients, they now have wearable and connected technology, a dedicated app that provides useful information and a way to speak to our team all the time. For our clinicians, they have valuable insights on each and every patient and can make interventions if and when necessary, between clinic visits.

The results show not just vastly improved outcomes, but outcomes that are better than any other traditional or other tech-enabled healthcare providers. Our initial results have demonstrated an average HbA1c reduction of 1.7% points in just 90 days of management. For those unfamiliar, HbA1c is a key measure of how well controlled one’s blood sugar has been on average over a 3-month period. Studies have shown that a reduction of just 1% point in HbA1c results in a 21% decrease in end-point diseases related to diabetes, a 21% reduction in diabetes-related deaths, a 14% decrease in heart attacks, and a 37% reduction in microvascular complications. This is big, really big.

Oh, and my father, a totally non-compliant patient in the old model of care, upon enrollment into the GluCare model, has reduced his HbA1c by 1.18% points, seen a 31% reduction in LDL, 34% reduction in triglycerides, 65% reduction in Uric acid and 8% reduction in weight. Considering none of these parameters ever improved over the last decade under his previous provider and the fact that many of those included in our outcomes have similar stories, I believe we are the cusp of a new novel way of managing diabetes. One that uses digital therapeutics as part of a holistic disease management program to bring back many of the human aspects lost in the practice of medicine.

As an entrepreneur trying to affect real change, I’m of course excited, but as a son, I am beyond elated.

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