If you didn't believe before that the wearable activity tracker company Fitbit was really invested in diabetes, believe it now. Over the past few years, the San Francisco company has doubled down on its healthcare focus including several diabetes-specific initiatives:

At our recent DiabetesMine Innovation event, Fitbit's Medical Director John Moore said the company's mission is to empower and inspire people to live healthier lives by creating "an experience" that blends together all the data from diabetes and Fitbit devices.

Not surprisingly, most of the company's efforts are aimed at the bigger market of people with type 2 diabetes, and part of that is a focus on minimizing medications and even helping T2s to stop taking insulin if that's a doctor-agreed move. But the reason this is exciting for all PWDs (people with diabetes) is that Fitbit is forging a path to give health insurance companies strong incentives to provide patients with the latest technology (CGM and data sharing) and tie success with those tools to cost savings. Thumbs up on that!

This is all part of Fitbit's strategy to evolve from being just tracking steps to helping people live healthier overall, as laid out by their CEO earlier this year. Diabetes is a core focus, and the company also "sees potential in other chronic disease categories including heart health, sleep disorders and mental health," a spokeswoman tells us.


How Fitbit Helps

A couple of examples of how folks are using Fitbit to better manage their blood sugars and health:

Type 1 in Pittsburgh: 27-year-old Zack Hawthorne, who was diagnosed at age 13, is one who manages his type 1 diabetes with the help of his Fitbit. Zack relies on Fitbit’s food logging feature to manage his daily calorie and carb intake as a critical part of managing his condition, as well as using it to keep tabs on his heart rate during cycling races. We're told that when he experiments with intermittent fasting, he relies on the Fitbit app’s food logging feature, heart rate tracking and monitoring glucose data through his connected CGM throughout the day.

Heart Blockage Alert: 34-year-old Michael Glen in Salt Lake City, UT, purchased a Fitbit Ionic after vowing to turn his health around as someone with type 2 diabetes. Weight loss was one of his goals, starting out at 326 pounds. Over time he was able to steadily lose weight and even run his first 5K. We're told that Michael didn’t realize how much he relied on his smartwatch until he went camping earlier in the year and noticed his heart rate monitor read 40 BPM -- an extreme low reading that came with shoulder pain and shortness of breath. He drove an hour to the ER and was immediately flown to the nearest major hospital for surgery, where doctors found 100% blockage in his right coronary artery and another artery blocked 80%. With only a 50/50 chance of surviving, Michael credits Fitbit for helping him stay alive today.

Clearly, Fitbit has a role to play beyond its origins as a consumer fitness gadget, which prompted the recent launch of their newest healthcare initiative. 


New Fitbit Care Program

Launched in September 2018 through the Fitbit Health Solutions division, the brand new Fitbit Care initiative aims to connect the data being generated on Fitbit devices with the work of healthcare professionals and health coaches to offer personalized care plans and continuous support for patients.

Through the new Fitbit Plus app, users stay in close communication with their health coach and medical care team, and can also schedule phone and in-person meetings. The idea is that together, they can tackle anything from weight management to smoking cessation, managing a chronic condition like diabetes or hypertension, or even more complicated conditions like congestive heart failure.

The new app also integrates data from other Fitbit tech as well as other health and diabetes devices and apps -- including glucose data, blood pressure, and medication adherence.

The September announcement also came with news of an initial deal with insurance giant Humana, in which that carrier's employer group has access to this "preferred coaching solution." Fitbit says more than 5 million Humana members will have the potential to access Fitbit health coaching or wellness solutions through a variety of channels, including the Go365 health incentives program and the Humana Employee Assistance Program (EAP).

This adds to the roster of health insurers that Fitbit is targetting, starting with UnitedHealthcare announced in January.


UnitedHealthcare and Other Insurers Getting Digital

Fitbit and Dexcom together have teamed up with UnitedHealthcare on a pilot program geared toward Medicare Advantage plan participants (those getting extra insurance aside from their regular Medicare coverage). By design, seniors taking part in this pilot program have T2D and don't use insulin.

How it works is that participants get a Dexcom CGM and a Fitbit motion tracker -- either the Fitbit Charge 2 or new Fitbit Ionic Watch -- that integrate to share data. They also receive personalized diabetes coaching provided through UHC, to get more insights about that diabetes and health data along with info about medications being used, food and exercise patterns, sleep and heart rate.

“Continuous glucose monitoring can be a game-changer for people enrolled in our Medicare Advantage plans, as the data can be translated into personalized information that can be acted upon in real-time,” said UHC's Brian Thompson, Medicare and retirement unit CEO, in a statement.

Importantly, the partners will be working to tie this to insurance claims data. Dexcom's VP of Corporate Development Matt Dolan tells us they'll track how the Dexcom-Fitbit use influences health and then hopefully use the positive outcomes data -- like less medication needed or better "adherence" -- to influence insurance claims and costs.

For UHC, this is part of a broad effort to use digital health technology to change the way they operate, in terms of analyzing claims and focusing on improved member health. In January 2017, UHC created a program called UnitedHealthcare Motion in which it offers members a Fitbit Charge 2 wearable through an employer-sponsored initiative.

Participants will get up to $1,500 in annual insurance savings for achieving daily walking goals; to date, those participating have collectively walked more than 230 billion steps and earned more than $38 million. While Dolan says this is part of the UHC pilot program currently involving only Medicare Advantage folk, if successful, it's likely we'll see a broader push for this type of CGM-fueled incentive push by other insurers over time.

In fact, other payers are already creating similar alliances with medtech players, such as the Blue Cross/Blue Shield plans including Anthem that have partnered with Google-Sanofi-backed venture Onduo to monitor PWDs' glucose levels, using a yet-to-be-unveiled wearable device. A pilot is beginning this year, according to public statements from the Blue Cross/Blue Shield Association.


Fitbit Ionic + Diabetes Data?

Of course, many of us are anxiously awaiting the Fitbit Ionic model that will actually display Dexcom CGM data after that announcement in September 2017. After Fitbit bought Pebble and announced it would be discontinuing that watch in favor of its own design, the #WeAreNotWaiting community has been anticipating the Ionic with bated breath.

We still haven't heard a timeline for that, aside from "as early as possible in 2018," and with the year almost over, there are still no publicly-available photos of the Ionic showing CGM data (we asked both Fitbit and Dexcom).

We're also not sure how that will factor in with Fitbit's partnership with One Drop that began in November, allowing for Fitbit activity data to be weaved into the One Drop mobile app and reports -- which also mentioned a specific offer for users of Fitbit devices, including the Ionic watch. Clearly, all of this data integration is leading us to a new place with health insurance claims and approvals!


New Minimally Invasive CGM

Another big interesting step on the part of Fitbit in mHealth is their recent investment of $6 million (!) into Sano Intelligence (not to be confused with Sano Tech), which is developing what it describes as a "minimally invasive" CGM device aimed at people without diabetes.

That's right, Sano does not plan to seek FDA approval, but rather plans to launch this as an over-the-counter general health product for people with working pancreases to monitor the variation in their blood sugar levels.

This Silicon Valley health startup has apparently been around since 2011, and has made periodic appearances at medtech conferences, but remains mostly unknown. Their product is a biometric sensor built into a low-profile skin patch that monitors glucose through interstitial fluid, but via "minimally invasive microstructures that are placed on the body."

Coverage on  Gizmodo last year noted that the sensor "looks like a nicotine patch with a circular piece of metal in the center, containing the Bluetooth receiver and battery. It kind of looks and feels like sandpaper or Velcro when you put it on the skin.”

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Source: Gizmodo (January 2017)

Hmm, we'll see... but Fitbit for one is clearly sold on this potential non-invasive CGM given it's multi-million dollar investment.


As noted, what's really powerful here is Fitbit's efforts to connect use of the latest digital health tools to insurance coverage and financial incentives. Apple, Google and Samsung are all part of this puzzle too, of course, and more consumer-facing companies are talking with payers and even regulators about future investments in the medtech arena.

For us PWDs, this is all good news -- to help underscore our health needs and eventually ease our pocketbooks.