Digital Health and Diabetes Online Communities are Transforming Diabetes Management
By Maria Karpenko
May 2012
These are excerpts from my master’s thesis titled, “Digital Health and Diabetes Online Communities are Transforming Diabetes Management,” published at Harvard University in May 2012.
Abstract
This review explores whether digital health and online diabetes communities are improving diabetes management and facilitating beneficial peer-to-peer and doctor- patient interactions. After cancer, diabetes is the second highest searched health topic on the Web. This is not surprising considering that diabetes was the seventh leading cause of death in the United States in 2011, according to the Centers for Disease Control and Prevention (CDC). The CDC estimates that one in three Americans will have diabetes in 2050. This shows that the American healthcare system lacks sufficient resources to provide care to people at risk for diabetes and people diagnosed with diabetes. It also explains why Americans are turning to the Web and health apps to manage their health. Eight in ten Americans looked online for health information in 2011. Out of all American cell phone owners, 17 percent have used their phone to look up health or medical information and 9 percent had software applications, or apps, that helped them track or manage their health in 2010, according to two reports by the Pew Research Center’s Internet & American Life Project. There will likely be slightly more than 13,000 health apps intended for use by consumers available for download on Apple’s AppStore by August 2012, according to a 2011 MobiHealthNews report. Do Web- and mobile-based technologies have the potential to reduce the prevalence of diabetes and help make managing it better? An analysis of statistical data from reports, surveys, and literature, and anecdotal evidence drawn from personal interviews and online diabetes communities suggests that digital health and online diabetes communities are empowering patients, making diabetes management a smaller part of life, facilitating beneficial peer-to-peer networks, and have a lot of potential to strengthen the patient-doctor relationship. While self-management made possible by digital health and diabetes online communities does not replace hospitals and medical professionals, studies show that it has potential to improve the quality of care and reduce complications, keeping patients out of doctors’ offices and hospitals, and as a result decrease healthcare cost. This is good news for the American healthcare system that is short on medical professionals and overburdened by chronic diseases.
Abstract
This review explores whether digital health and online diabetes communities are improving diabetes management and facilitating beneficial peer-to-peer and doctor- patient interactions. After cancer, diabetes is the second highest searched health topic on the Web. This is not surprising considering that diabetes was the seventh leading cause of death in the United States in 2011, according to the Centers for Disease Control and Prevention (CDC). The CDC estimates that one in three Americans will have diabetes in 2050. This shows that the American healthcare system lacks sufficient resources to provide care to people at risk for diabetes and people diagnosed with diabetes. It also explains why Americans are turning to the Web and health apps to manage their health. Eight in ten Americans looked online for health information in 2011. Out of all American cell phone owners, 17 percent have used their phone to look up health or medical information and 9 percent had software applications, or apps, that helped them track or manage their health in 2010, according to two reports by the Pew Research Center’s Internet & American Life Project. There will likely be slightly more than 13,000 health apps intended for use by consumers available for download on Apple’s AppStore by August 2012, according to a 2011 MobiHealthNews report. Do Web- and mobile-based technologies have the potential to reduce the prevalence of diabetes and help make managing it better? An analysis of statistical data from reports, surveys, and literature, and anecdotal evidence drawn from personal interviews and online diabetes communities suggests that digital health and online diabetes communities are empowering patients, making diabetes management a smaller part of life, facilitating beneficial peer-to-peer networks, and have a lot of potential to strengthen the patient-doctor relationship. While self-management made possible by digital health and diabetes online communities does not replace hospitals and medical professionals, studies show that it has potential to improve the quality of care and reduce complications, keeping patients out of doctors’ offices and hospitals, and as a result decrease healthcare cost. This is good news for the American healthcare system that is short on medical professionals and overburdened by chronic diseases.
Chapter VI
Digital Health Innovators and Entrepreneurship
The Potential of Digital Health to Scale Up
Until recently there was little assistance for someone who was diagnosed with prediabetes. The New England Journal of Medicine published results from the Diabetes Prevention Program (DPP) study in 2002, a 3-year study of more than 3,000 people diagnosed with prediabetes. The study showed that it is possible to reduce the progression of prediabetes to type 2 diabetes by 58 percent through lifestyle intervention that targets physical activity and weight loss. Treatment with the drug metformin reduced the risk by 31 percent overall. Research shows that lifestyle interventions are more cost-effective than medications.
Yet, many years since the DDP study was published, few people diagnosed with prediabetes are benefiting from its findings. Lifestyle intervention programs are only beginning to get traction within the wider healthcare community. Cost is the main reason for slow adoption and implementation. The direct medical costs of the metformin group were $2,542 and $2,780 in the lifestyle group per participant due to one-on-one counseling with clinical personnel and nutritionists.
With an efficacy of 58 percent, if the DDP were a drug, it would be a “magic pill.” But it is a new organizational model, and models spread much slower than drugs. The Centers for Disease Control and Prevention (CDC) funded research to modify the DPP intervention program into a group model and gave funding to the Y, which was formally known as the YMCA, to implement the program at 10 sites. It is a group-based program that encourages healthy nutrition, structured physical activity, and behavior modifications, such as stress management and motivation. This program is delivered through a 16-session core program over 20 weeks and monthly maintenance sessions for reinforcement.
UnitedHealth Group decided to collaborate with the Y and the CDC to scale the DPP model nationally for a greater population impact. This collaboration eventually led to the formation of a national network of community-based lifestyle coaches who deliver the DPP to people diagnosed with prediabetes. Due to the potential of these initiatives, there is now federal interest to scale up these prevention initiatives. A CDC program determines eligibility of model sites and the Patient Protection and Affordability Care Act (PPACA) has a provision that gives grants to providers of intervention programs.
Prediabetes screening is available and it is a prerequisite to enroll people in lifestyle intervention programs. There are opportunities to leverage digital technologies to commercialize the DPP and deliver it in a personalized form to an even greater number of people who are at risk for developing type 2 diabetes.
“Imagine a day when you can walk into a pharmacy, place your arm into an armrest-like device and get screened for prediabetes. If you have prediabetes, there should be a second step,” said Sean Duffy, co-founder and CEO of Omada Health, a company headquartered in San Francisco, California.
It is likely that a very easy and quick way to screen for prediabetes will soon be available in the United States. SCOUT DS is a portable tabletop device that assesses the risk for prediabetes and type 2 diabetes in individuals 18 years or older. SCOUT DS is the first noninvasive optical skin test for diabetes screening that does not require blood or fasting. The patient simply “rests” his forearm on it and waits less than four minutes to find out whether he has prediabetes. The results help determine whether further diagnostic testing is necessary. Its maker, VeraLight, a privately-held medical device company, headquartered in Albuquerque, New Mexico, was founded in 2004 to develop SCOUT DS.
Omada Health is working on the second step. The DPP has demonstrated that lifestyle interventions have a lot of potential to improve lives and reduce healthcare costs. Innovators like Duffy are thinking about how to make such programs available to more people with prediabetes. Omada Health is dedicated to reversing the course of type 2 diabetes instead of managing it. Their approach is to deliver group-based programs for chronic disease prevention through social-web technologies.
“The standard of treatment for prediabetes is generally a pamphlet from your doctor that tells you to exercise, eat right, and lose weight. We know that doesn’t work. Changing someone’s behavior is tremendously difficult. Prediabetes is a wake-up call. Most people want to do something about it but they don’t know what they should do,” said Duffy, who is currently on leave from Harvard’s MD-MBA program.
Before establishing Omada Health, its founders tested out their group approach with a small group in California’s Bay Area to see how it resonates with people. The response was positive and this convinced the founders to start a company around their idea. They applied to Rock Health, a digital health startup incubator in San Francisco, California, and became one of the companies in Rock Health’s first batch. While at Rock Health, Omada Health launched a second prototype to test the effectiveness of a shortened 2-months DPP that was structured around facilitators, and its potential to scale up. The results of this clinical trial were positive. Omada Health graduated from Rock Health at the end of 2011, bringing in a seed fund, and started working on a production prototype in January 2012.
“From the beginning of Omada Health, we’ve felt that a lot of the technologies that exist ignore the reality that it’s really tricky to figure out what’s going on in a person’s life. For this reason, we have facilitators who can get to know everyone in a group of ten and understand their concerns. It’s scalable but it’s not a magic switch. It’s a difficult people challenge,” Duffy said.
To tackle this problem, Omada Health partnered with BodyTrace, a company that was founded in 2007. BodyTrace is located in New York, New York, and is on the mission “[…] to create the most effective fitness and weight loss community on the web by combining the latest technology with the power of social networks.” The BodyTrace eScale is a bathroom scale that wirelessly uploads weight and body mass index (BMI) to the BodyTrace website. Studies show that tracking weight assists weight loss and also aids weight maintenance. BodyTrace does more than just tracking weight. It also gives feedback based on what you enter for fat, calorie, carbohydrate, and protein consumption.
Omada Health algorithmically matches people into groups of 8 to 12 with one facilitator or lifestyle coach who is “incredibly kind, empathetic, charismatic, strong communicator and has a passion for this.” Each participant receives a kit in the mail that includes a BodyTrace eScale. The facilitator manages the group through a dashboard with metrics for each member over a 16-week program. Depending on the group, the goal might be to achieve a 7 percent weight loss at the end of the curriculum. The facilitator monitors the weight loss progress thanks to the BodyTrace eScale and sends out a module of the curriculum to the group on a weekly basis and encourages and cheers members in this “small patient community” for their weight loss progress.
Within the traditional healthcare system, medical professionals do not have the time and resources to manage patients’ nutrition and fitness while also giving them support at this level. Omada Health has come up with a solution that integrates Web and social technologies with a patient community that is moderated by a trained lifestyle intervention facilitator, or lifestyle coach. This product can be scaled so that more people have access to the information, patient community and support that they need.
Digital Health Innovators and Entrepreneurship
The Potential of Digital Health to Scale Up
Until recently there was little assistance for someone who was diagnosed with prediabetes. The New England Journal of Medicine published results from the Diabetes Prevention Program (DPP) study in 2002, a 3-year study of more than 3,000 people diagnosed with prediabetes. The study showed that it is possible to reduce the progression of prediabetes to type 2 diabetes by 58 percent through lifestyle intervention that targets physical activity and weight loss. Treatment with the drug metformin reduced the risk by 31 percent overall. Research shows that lifestyle interventions are more cost-effective than medications.
Yet, many years since the DDP study was published, few people diagnosed with prediabetes are benefiting from its findings. Lifestyle intervention programs are only beginning to get traction within the wider healthcare community. Cost is the main reason for slow adoption and implementation. The direct medical costs of the metformin group were $2,542 and $2,780 in the lifestyle group per participant due to one-on-one counseling with clinical personnel and nutritionists.
With an efficacy of 58 percent, if the DDP were a drug, it would be a “magic pill.” But it is a new organizational model, and models spread much slower than drugs. The Centers for Disease Control and Prevention (CDC) funded research to modify the DPP intervention program into a group model and gave funding to the Y, which was formally known as the YMCA, to implement the program at 10 sites. It is a group-based program that encourages healthy nutrition, structured physical activity, and behavior modifications, such as stress management and motivation. This program is delivered through a 16-session core program over 20 weeks and monthly maintenance sessions for reinforcement.
UnitedHealth Group decided to collaborate with the Y and the CDC to scale the DPP model nationally for a greater population impact. This collaboration eventually led to the formation of a national network of community-based lifestyle coaches who deliver the DPP to people diagnosed with prediabetes. Due to the potential of these initiatives, there is now federal interest to scale up these prevention initiatives. A CDC program determines eligibility of model sites and the Patient Protection and Affordability Care Act (PPACA) has a provision that gives grants to providers of intervention programs.
Prediabetes screening is available and it is a prerequisite to enroll people in lifestyle intervention programs. There are opportunities to leverage digital technologies to commercialize the DPP and deliver it in a personalized form to an even greater number of people who are at risk for developing type 2 diabetes.
“Imagine a day when you can walk into a pharmacy, place your arm into an armrest-like device and get screened for prediabetes. If you have prediabetes, there should be a second step,” said Sean Duffy, co-founder and CEO of Omada Health, a company headquartered in San Francisco, California.
It is likely that a very easy and quick way to screen for prediabetes will soon be available in the United States. SCOUT DS is a portable tabletop device that assesses the risk for prediabetes and type 2 diabetes in individuals 18 years or older. SCOUT DS is the first noninvasive optical skin test for diabetes screening that does not require blood or fasting. The patient simply “rests” his forearm on it and waits less than four minutes to find out whether he has prediabetes. The results help determine whether further diagnostic testing is necessary. Its maker, VeraLight, a privately-held medical device company, headquartered in Albuquerque, New Mexico, was founded in 2004 to develop SCOUT DS.
Omada Health is working on the second step. The DPP has demonstrated that lifestyle interventions have a lot of potential to improve lives and reduce healthcare costs. Innovators like Duffy are thinking about how to make such programs available to more people with prediabetes. Omada Health is dedicated to reversing the course of type 2 diabetes instead of managing it. Their approach is to deliver group-based programs for chronic disease prevention through social-web technologies.
“The standard of treatment for prediabetes is generally a pamphlet from your doctor that tells you to exercise, eat right, and lose weight. We know that doesn’t work. Changing someone’s behavior is tremendously difficult. Prediabetes is a wake-up call. Most people want to do something about it but they don’t know what they should do,” said Duffy, who is currently on leave from Harvard’s MD-MBA program.
Before establishing Omada Health, its founders tested out their group approach with a small group in California’s Bay Area to see how it resonates with people. The response was positive and this convinced the founders to start a company around their idea. They applied to Rock Health, a digital health startup incubator in San Francisco, California, and became one of the companies in Rock Health’s first batch. While at Rock Health, Omada Health launched a second prototype to test the effectiveness of a shortened 2-months DPP that was structured around facilitators, and its potential to scale up. The results of this clinical trial were positive. Omada Health graduated from Rock Health at the end of 2011, bringing in a seed fund, and started working on a production prototype in January 2012.
“From the beginning of Omada Health, we’ve felt that a lot of the technologies that exist ignore the reality that it’s really tricky to figure out what’s going on in a person’s life. For this reason, we have facilitators who can get to know everyone in a group of ten and understand their concerns. It’s scalable but it’s not a magic switch. It’s a difficult people challenge,” Duffy said.
To tackle this problem, Omada Health partnered with BodyTrace, a company that was founded in 2007. BodyTrace is located in New York, New York, and is on the mission “[…] to create the most effective fitness and weight loss community on the web by combining the latest technology with the power of social networks.” The BodyTrace eScale is a bathroom scale that wirelessly uploads weight and body mass index (BMI) to the BodyTrace website. Studies show that tracking weight assists weight loss and also aids weight maintenance. BodyTrace does more than just tracking weight. It also gives feedback based on what you enter for fat, calorie, carbohydrate, and protein consumption.
Omada Health algorithmically matches people into groups of 8 to 12 with one facilitator or lifestyle coach who is “incredibly kind, empathetic, charismatic, strong communicator and has a passion for this.” Each participant receives a kit in the mail that includes a BodyTrace eScale. The facilitator manages the group through a dashboard with metrics for each member over a 16-week program. Depending on the group, the goal might be to achieve a 7 percent weight loss at the end of the curriculum. The facilitator monitors the weight loss progress thanks to the BodyTrace eScale and sends out a module of the curriculum to the group on a weekly basis and encourages and cheers members in this “small patient community” for their weight loss progress.
Within the traditional healthcare system, medical professionals do not have the time and resources to manage patients’ nutrition and fitness while also giving them support at this level. Omada Health has come up with a solution that integrates Web and social technologies with a patient community that is moderated by a trained lifestyle intervention facilitator, or lifestyle coach. This product can be scaled so that more people have access to the information, patient community and support that they need.