Say hello to the mobile app universe of diabetes coaching, where all you have to do is look to your smartphone to get the kind of diabetes advice and counseling that once was limited to expensive and time-consuming in-clinic visits.
Hello, 21st century moment where there's an app for everything and digital health is reaching a fever pitch.
Diabetes coaching on its own isn't new. But we're now seeing a growing number of medtech companies working to build personal, one-on-one coaching service directly into their platforms.
We covered this trend in the past with all the emerging tablet and smart devices. And now the concept seems to be exploding, especially following the recent American Association of Diabetes Educators (AADE) annual meeting in early August, with a number of new announcements on this front.
Here's what we're seeing:
Diabetes Educators Going Mobile
At the AADE meeting held in San Diego, our own AmyT was on the scene and witnessed increasing energy from the educators about using mobile health tools and social media with their patients; there was no longer a sense of convincing CDEs (certified diabetes educators) to embrace these tools, but rather a cry for help from them to get the necessary access and reimbursement in place.
At the conference, New York-based diabetes coaching company Fit4D announced its ambition to employ the largest team of CDEs in the country by August 2017 (!)
While the Fit4D platform doesn't actually include a mobile app, but it's a tech-based platform that uses a range of resources including text messaging, emails, and coaching by CDEs either in-person or online, as users prefer. Coaching topics include basics of diabetes education; tips and tactics to optimize therapy; advice on nutrition, fitness and overcoming psychosocial barriers; the importance of preventive care and more.
Fit4D has found its success partnering with a number of major employers to offer its program to a wide swath of people touched by diabetes.
"It’s a burgeoning industry, for sure," said AADE's new chief technology and innovation officer Crystal Broj. "We know that diabetes educators want to interact with their patients in the ways they are comfortable with and used to. While we’ve seen many diabetes educators and education programs explore a variety of technologies, including apps, the lack of widespread reimbursement for virtual diabetes education has been a challenge."
From an AADE perspective, Broj says the organization's goal is to be a lead resource for developers as they marry healthcare protocols with tech tools that provide ways for educators and patients to make informed data-driven decisions. Meanwhile, many CDEs may begin to find their best career paths within these medtech companies.
Case in point were two of the high-profile announcements made at the AADE conference...
For those not familar with mySugr, this startup founded overseas has been around for three years now and we've been big fans since day one. It's a fun diabetes logging and motivational app that features a colorful little "diabetes monster" that users can personalize and name. He pops up continuously to help users stay enthused about the daily routine tasks of diabetes management.
The co-founders have both been living with T1D since they were kids -- VP of product management Fredrik Debong of Vienna, Austria, who was diagnosed about three decades ago at the age of 4 (same year as me in 1984!); and CEO Frank Westermann of Germany, who was diagnosed as a teenager about 18 years ago.
Over the past several months, mySugr has been expanding here in the US with a new San Diego office and adding more support for us PWDs who live Stateside. It's also been great to see longtime type 1 and diabetes blogger Scott Johnson join the communications team at mySugr, and working with him in that role.
Now, with mySugr Coaching, they're also working with well-respected CDE Gary Scheiner, a longtime type 1 himself, who is acting as head coach with the whole program running through his Integrated Diabetes Services practice in Pennsylvania. Gary’s been working with mySugr for about a year, evaluating and exploring how this mySugr Coaching service should be launched.
“We see this as good, high-quality, trusted advice to bridge the gap between clinic appointments,” Johnson tells us. “We’re not looking to replace anything happening with your own clinical care team, but appointments can be so spread out that you're left with so much time where you don’t have the guidance you need. This can help there.”
How it works?
This coaching feature is built into the mySugr logbook on the mobile app.
When you first use the app, it’ll walk you through a personal assessment so the CDE has an idea of what your therapy plan looks like and what goals you have for D-management.
From there, it will use a message-based system within the app to exchange information with Gary and his team. That's all HIPAA-compliant and includes medical history records, to help determine the path forward for each user.
This is largely aimed at type 1 PWDs, as it targets intensive insulin management in these early stages, which is “Gary’s sweet spot” relating to his practice and expertise. Eventually, they see it moving beyond that T1D crowd.
For now, it’s only iOS-compatible but mySugr is working on an Android-enabled app for this coaching aspect. Eventually, Johnson tells us they believe it could evolve into video conferencing (like Gary is already using in his practice). mySugr also envisions opening it up to more CDEs throughout the country.
Down the road, the vision would be to get employers and insurers to reimburse for this mySugr Coaching. But for now, it’s cash-based for users.
Subscription costs: the mySugr Pro package that includes mySugr Coaching is regularly $39.99/month, or $399.99 a year. But mySugr is currently offering a launch promotion for half-price, at just $19.99, or $199.99/year. You can also still purchase mySugr Pro without coaching features for only $2.99 a month (or $27.99/per year).
I am actually part of a mySugr Coach group beta test at the moment, and am excited to write a review soon -- so stay tuned for my personal take on this one!
One Drop Experts
Also timed in conjunction with AADE meeting was One Drop's announcement of its new Premium service that they hope to launch by late October. This includes One Drop Experts, a coaching program offering 24/7 access to CDEs who are at the ready to guide users and answer their questions.
You may remember that last year, we introduced One Drop as the ambitious startup with hopes of remaking the glucose meter and D-management into a unified, "badass" type of experience that's both simple and affordable.
The new Premium package is a monthly subscription service that costs $30-40 per month (or $360-480 per year) sans insurance. Aside from the coaching, it will include their very sleek new compact wireless glucose meter with built-in lancet device and carrying case, dubbed One Drop Chrome.
One Drop founder Jeff Dachis, a T1D himself and digital marketing expert, says they expect FDA approval of the new Chrome meter and coaching app service by the end of September, at the latest. The meter is Bluetooth-enabled and will talk directly to an iOS or Android mobile app, and one of the big benefits for users is access to unlimited testing supplies and test strips delivered directly to your door.
No kidding. That’s the foundation of the One Drop premium product, alongside the existing One Drop mobile app that tracks all your relevant information in one place -- blood glucose, medication, food, and activity – and offers personal insights from that data.
The coaching aspect One Drop Experts is designed for all people with diabetes, we're told, whether they’re living with T1D, T2, LADA, gestational or even pre-diabetes. This coaching service meets the most current standards from the ADA and AADE7 based on their digital therapeutics programs.
The key developer of this coaching app is Mark Heyman, a type 1 CDE and psychologist who specializes in behavioral health. He said One Drop Experts will grow to include educators all across the country, and the plan is to enable PWDs to find someone who is as local as they want, but at least in the same time zone. They plan to bring on educators and clinicians with a range of expertise, from behavioral health to dieticians and so on.
How it works?
There are two components to this coaching service within the app:
- One Drop | Experts On-Track: a 12-lesson, structured program that covers all aspects of diabetes (medication, food, activity, stress) and focuses on basic education, skill building and supportive accountability.
- One Drop | Experts On-Call: gives users access to an expert anytime, with no structured program, including sending helpful information about diabetes management every couple of weeks to keep users engaged.
It’s all designed to be “near real-time,” meaning that users will get a response from one of the experts within 12 hours at the very most -- a pretty impressive responsive window! Of course, One Drop emphasizes that this is not meant to replace doctors or clinical advice; it's aimed at behavioral change, not medical advice or emergency situations that tie into insulin dosing.
“You get to see your coach on the app and view their bio," Dachis says. “Also, this isn’t a one-person show -- we’ll have educators with different disciplines from all over the country. That way, people can see each expert and find someone who might work well for them, maybe if that expert has a love for Paleo or behavioral psychology that might be particularly helpful.”
Heyman tells us that his team maintains a dashboard that allows them to view responses from consumers as they arrive, so it’s a first-in, first-out response system.
One Drop Experts has been in beta testing with a small group of users for about six months. That's grown into a two-arm clinical study being conducted in San Mateo, CA, that will wrap up by year’s end, and published in early 2017.
In the future, the One Drop team plans to develop more specialized coaching – developing specific programs for PWDs who are navigating pregnancy, kids going off to college, the elderly or newly-diagnosed kids and adults. And no surprise: OneDrop is hiring CDEs across the country.
On top of One Drop Premium, the company also has a professional version aimed at insurers (payers) and care provider networks that give them access to this tool for broad, population-based patient care. That version is offered to patients directly by the insurer or healthcare provider at no cost, in contrast to the consumer product with a monthly out of pocket price tag.
“Our near-term vision is self-care, empowering people to stay healthy,” Dachis says. “All of this is derived from your own data, everything we do is rooted in that. This is a unified service, and it’s not one thing that makes it amazing. It’s all of the things that we think help people be more empowered to manage their diabetes better.”
With the launch of this coaching feature expected in later October, we're also looking forward to doing a trial-run of this product and sharing our review here at the 'Mine.
Livongo and Beyond
Of course, the company that kind of "wrote the book" on integrating coaching with mobile diabetes devices is California-based Livongo.
They feature coaching as part of their base package, with a colorful touch-screen meter equipped for cellular communication, an engaging app, and subscription fee as their foundation that also includes delivery of supplies to your door.
How it works?
The Livongo meter actually incorporates a pedometer and is in constant two-way communication with a "smart cloud" setup. It not only stores data but sends feedback and suggestions on what to do next, and it can even alert a care coach to call a user immediately in case help is needed (!) That care coach is either one of a team of CDEs employed by Livongo, or can be any physician or CDE of the user's choosing.
The monthly cost to patients for any amount of necessary test strips plus the coaching service is no more than $75 out-of-pocket, and less for those whose employers or health plans cover Livongo. That's a max of $900 for a full year of testing supplies; a platform to easily share data with your doctor, family, etc. at the touch of a button; and a coaching service complete with real-time response that can alert emergency contacts in case a user doesn't respond to a phone call after a low reading.
Livongo even has the scientific data to back up the value of devices paired with coaching, proving how beneficial this type of service can be -- and justifying those like mySugr and One Drop who are now stepping into this coaching universe.
As more of these options materialize and additional clinical data is released showing the impact on health outcomes, we're excited to see how traditional diabetes care will be transformed into something mobile, dynamic, more nurturing, and (gasp!) maybe even a little bit fun.