Digital diabetes management tools fail to provide meaningful clinical benefits and increase health spending, a new report from the Peterson Health Technology Institute (PHTI) shows.
This is PHTI’s inaugural report after launching in July as an independent evaluator of digital health solutions. The analysis evaluated eight digital tools that support people with type 2 diabetes: DarioHealth, Glooko, Omada, Perry Health, Teladoc’s Livongo, Verily’s Onduo, Vida, and Virta. These solutions use three approaches:
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- Remote patient monitoring (Glooko)
- Behavior and lifestyle modification (DarioHealth, Omada, Perry Health, Livongo, Onduo and Vida)
- Nutritional ketosis (Virta)
PHTI looked into both the clinical effectiveness and the economic impact of the companies. The researchers reviewed more than 1,100 articles, including 120 from the evaluated companies. The analysis found that remote patient monitoring and behavior and lifestyle modification solutions only achieved a small reduction (but not “clinically meaningful”) in hemoglobin A1c compared to those who received usual care. The tools also did not improve other health factors, like weight loss, body mass index, blood pressure and cholesterol.
“One of the things that was most striking about this evaluation is how consistent the results are,” said Caroline Pearson, executive director of PHTI, in an interview. “As a researcher, you often see really messy data. All this data lined up in a pretty tight range of impact that do show that digital solutions deliver small benefits relative to usual care, but those benefits are neither large enough nor durable enough to really change people’s health prognosis or their clinical care.”
In addition, these solutions led to a net increase in spending. For patients using remote patient monitoring solutions, annual spending is projected to rise by $723 to $2,002, depending on coverage type. For those using behavior and lifestyle modification tools, annual spending is projected to increase by $484 to $574.
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However, Virta’s solution, leveraging nutritional ketosis, had more promising results. It was able to create a clinically meaningful reduction in hemoglobin A1c and achieve remission in some patients. It had an initial net increase in spending but could lead to long-term savings.
Pearson said PHTI aims to show better evidence on the digital health industry and make sure those that have good evidence can achieve market adoption.
“Right now, what you see is actually there’s not a tight link between evidence of performance and market adoption,” she said. “That means that great technologies with good evidence can’t get adoption, and then you have broad adoption of technologies that just aren’t delivering their value. Our hope is that by continuing to be clear about what’s working, we can drive better innovation and better investment.”
Omada, one of the evaluated companies, pushed back on PHTI’s report, noting that it only considers the two metrics of cost and HbA1c reduction.
“The reality is that Diabetes Self-Management Education & Support (DSMES) is a complex treatment approach and A1c reduction might not be the goal for everyone in these virtual care programs,” said Dr. Carolyn Jasik, chief medical officer at Omada Health, in an email. “As an accredited provider of DSMES, we’d like to see further analyses conducted that take into account other measures like weight, lifestyle modifications, patient education, program engagement, healthcare maintenance, etc., to better capture the true value of virtual care programs for diabetes, pre-diabetes, weight management, and hypertension.”
She added that Omada recently published a peer-reviewed study that found that those with type 2 diabetes and an elevated A1c saw an average 1.8-point reduction in A1c and weight loss of 7.3 pounds after one year.
Richard Frank, chief medical officer of Vida, said that “the PHTI report gets some things right — diabetes is a huge problem in this country, and we spend way too much dealing with the downstream effects of the disease. As the report states, until we find an outright cure, the most effective treatment is ‘substantial, and durable progress toward glycemic control.’ Vida’s diabetes programs are clinically proven to do just that, as reflected in our body of peer-reviewed publications (available on our website), and the satisfaction of the tens of thousands of members who have found success with our diabetes program.”
PHTI laid out several recommendations for purchasers, innovators and providers. For purchasers, it recommended requiring data analysis and transparency and aligning payment with clinical outcomes. Providers, meanwhile, should understand the effectiveness of the solutions before they recommend them to patients. Innovators should make sure to create adequate evidence to support the adoption of their solution.
In the future, PHTI will analyze solutions for virtual physical therapy, blood pressure monitoring and mental health.
Photo: gustavofrazao, Getty Images