More Technology Patients Won't Use

David Kliff is the author of the "Diabetic Investor" and may be reached at dkliff@diabeticinvestor.com.

| Nov 1, 2007

This morning, a major meter manufacturer announced that its blood glucose meters will now operate on Microsoft's HealthVault. HealthVault is an online service that allows a patient to store and manage his health records without paying a fee.

These records can then be shared with the patient's physician or healthcare team.

As it stands today, nearly every glucose meter can download readings to software provided by the manufacturer. By using other programs, a patient can download not only his meter readings, but also his food intake, medications, exercise, and more. Presumably, the hope is that with all this information, the patient's healthcare team can assist the patient in better managing his diabetes.

To me, this announcement is just another example of how everyone is fascinated with technology and fails to understand the realities of life with diabetes. First and foremost, these programs make the assumption that patients are actually checking their glucose levels. That's a false assumption: Most patients rarely check their levels, and many don't check at all. Next, the programs add one more task to a patient's already demanding diabetes management. While downloading information from a meter is not a complex task, it does require effort. To my knowledge, no meter has automated this task.

Even if you have a motivated patient who is willing to regularly check his glucose levels and then download the results, that information by itself provides only a partial picture of what's going on. For the information to be truly useful, the patient must also record meal information, medications, exercise, and more. While this task is easier for an insulin pump patient, it's difficult to imagine a type 2 patient on oral medications recording all this information and then entering it all into his computer.

Suppose you have a really motivated patient who checks his levels regularly, downloads readings, keeps a diary of everything he does, and then enters all the information into the software, ready to be shared with his healthcare team - What then? Who will pay for the time it takes a physician to analyze the data and then make recommendations?

And what about patient privacy? Everyone has heard of stories of hackers breaking into systems and stealing credit card information. How does the patient know that this very personal information is not being shared?

Let's assume that a patient goes through all this work and his healthcare team provides recommendations that could lead to improved outcomes. Will the patients see any tangible benefits? Diabetes is not like a headache or a fever, where the patient feels better after treatment. Getting a patient under control takes time and effort. It is quite possible that even after all this intervention and advice, the patient may not see any tangible results for months.

Instead of adding to the patient's workload with all this fancy technology, why not provide patients with access to educational tools that they can use at their own pace? While there are several studies that demonstrate the value of educating patients, I have yet to see one proving that fancy technology leads to better outcomes. In spite of this fact, glucose monitoring companies continue to come out with these fancy systems that apply to a bare minority of patients.

The technological innovations that have actually increased sales are the ones that have made checking glucose levels easier. A perfect example of this is the Bayer meters, the Breeze and Contour, which do not require coding. This innovation had a true impact on patients and actually made their lives easier. Although that is not the sole reason Bayer is gaining market share, it is a contributing factor. Perhaps the other players in the marketplace will learn from Bayer and begin to make the patient's life easier instead of adding to their already demanding diabetes management regimens.

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Categories: Blood Glucose, Diabetes, Diabetes, Food, Insulin, Insulin Pumps, Meters, Professional Issues, Software, Type 1 Issues, Type 2 Issues


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Comments

Posted by Anonymous on 31 October 2007

Don't assume other diabetics don't check their glucose. I have many patients that check 4 or more times per day. (A few that check too often.) Some that are on pumps, and some that are very technologically literate and motivated to use this technology. By being involved, they are participating in their care, which is the ideal because they are managing their diabetes care, not me.

Posted by kmcmahon on 1 November 2007

Dear David,

I was right with you until you wrote "To my knowledge, no meter has automated this task."

Clearly, I have to step in here and remind you of the physical limitations of the meter in isolation and how it ultimately functions best as part of an automated patient education system.

Think about Apple's iPhone + iTunes for a minute and it will help you to understand how healthcordia and Diabetech are driving the convergence of diabetes technology (incl. meters) with diabetes education.

As documented in our clinical trials, the results include behavioral change followed by lowered A1c's, reduced frequency of hypoglycemia and mitigated excursions of hyperglycemia.

You apparently forgot our one-on-one discussion at ADA Scientific preceding my talk on the convergence of mobile diagnostic devices, rules engine technology and social networks including sharing clinical trial results with you. We also talked about how this convergence is introducing practice efficiencies. Also that these programs have been helping patients and their providers in the field since 2002... yet nobody knows about it???

The pivotal technological element mentioned in your article and in this comment is automation in its most extreme definition.

You were correct in pointing out how much effort is required to upload meter data to Health Vault. However, you also understated the effort required for patients and providers to use the glucose meter manufacturer's software programs, too.

Through our GlucoDYNAMIX Automated Diabetes Management System (ADMS), I'm sure you will recall from our discussion that any meter connected to our GlucoMON wireless device instantly becomes part of a real-time system which includes various forms of feedback including QuickTips dynamic education. These are delivered to the patient and their team at the teachable moment... as a text message or email, based on algorithms that consider data from the meter including in some cases that a patient may not be using their meter for blood glucose checks.

The QuickTips dynamic education feature of our GlucoDYNAMIX ADMS is in fact the embodiment of what you are asking for in your article above.

And just to be clear for the record, anyone at ADA Scientific who saw my presentation could tell you that 'fancy technology' implemented as an ADMS with a focus on behavioral change does indeed lead to better outcomes.

Posted by Anonymous on 1 November 2007

Changing behavior – the nemesis of computer technology.

David Kiff has a valid point. If technology is not consumer-driven, how good can it be? This week it was announced that Medicare is going to pay 1200 physicians, just to use electronic health records that physicians obviously do not feel are worth the investment.

If neither patients nor doctors are choosing to buy into digital, what exactly is driving healthcare technology? Darrell Pruitt

Posted by Anonymous on 1 November 2007

FYI, David is analyzing the market as he sees it for sales of these products, so forget about all the potential these devices have for patients and try looking at it from the perspective of realism. First, insurance needs to pay for these things, and so far, that isn't happening for the type 2 market, and is quite limited in coverage for the type 1 market. Until these things get paid for, the outlook in terms of company sales is what drives their revenues.

The reality may not be pretty, but its a fact at this point in time.

Posted by Anonymous on 2 November 2007

Here it is in a nut shell, this is a disease with out a cure, overtime everyone dies, as you age monituring your diabetes serves as a reminder you are sick and aging the end comes soon enough, so you live one day at a time sick or disease free we all end up in te same place

Posted by Anonymous on 2 November 2007

My mistake. The diabetes healthcare market is much more complicated than I imagined. Darrell

Posted by Anonymous on 2 November 2007

This article is flawed in a number of ways. First, the author assumes many Type 2s don't test and those who do don't know what to do with the results. Both assumptions are widely overgeneralizations. Second, while lamenting all the "effort" downloading takes the author goes on to say that getting and keeping good control takes time and effort. You can't have it both ways. Finally, while listing all the things us Type 2s have to do to stay in control, the author points out that doing so may or may not lead to tangible results. Well, one thing is for sure: without the time and effort we'll see NO results at all.

Posted by Anonymous on 2 November 2007

intersting article , I'd say that anyone who is involved enough to record , and download that information is probably well controlled anyway , and probably doesn't need that much help.

Posted by mjensentulsa on 2 November 2007

Interesting spin on the non-starter issues facing Microsoft HealthFault. As a healthcare IT analyst (and veteran 30+ years of Type 1 self-management), I came to the same conclusion from the opposite direction: Doctors won't use proprietary, portal-based systems.

My paradigm pump talks to my meter, but then I needed to buy a special USB cable to connect the meter to my PC. That links to two programs that don't talk to each other. The Windows-based program talks to my meter and lets me change settings, etc., but only the web-based program actually produces reports that are worth anything. Before my quarterly appointments, I upload the data, generate several reports (changing the timescale from the worthless 14-day default to one- and three-month intervals). My endocrinologists' office is pretty sophisticated, and they have a website that is supposed to let you communicate with them, but all my messages have been ignored thus far, so I print the reports out and carry them with me.

My doc actually spends time with his patients, so eventually I get to pull out the papers, show him some of the trends, outliers, etc. Funny thing is that only one of the "lesser" summary points prints the standard deviation of the BG readings. I almost missed it. That number, of course, basically represents the severity of "the rollercoaster" that Type 1's who attempt control are forced to ride. After that discussion, he recommended a change of my basal profile, and by BGs have leveled out somewhat.

As the author points out, HIT can generate too much information -- sometimes it's the little things that make a difference. But without ALL the data (and the automation that strung it together), that one point would never have appeared. We need to make it possible for patients without a background in healthcare IT to capture relevant data, and we need to serve it up to practitioners in ways that they find useful.

HealthFault, by the way, is about selling ads and boosting systems sales, not about treating patients.

Posted by Anonymous on 2 November 2007

To mjensentulsa, your Paradigm pump and BD link meter data can both be integrated into the same web-based program, CareLink.( as well as most other popular meters). The reports will incorporate all meter data with the pump data. CareLink Pro is Medtronic's recent release for the healthcare offices. It can link to your previously downloaded data, or download you right in the office and generate a few simple reports for doctors/educators to streamline assesment of bg control.
I take offense to the original author's comments regarding people with diabetes and their lack of self motivation. He should avoid such generalizations. He should also be aware that there are billing codes available for doctors to use when they evaluate continous glucose monitoring information, making it cost-effective to use software. Physicians know how to bill according to the time they spend with patient. If they are using a simple download format, it is actually Saving them time from flipping through a tattered logbook.

Posted by kdommer on 3 November 2007

Diabetics don't test their blood sugar??? I have been a Type 1 Diabetic for 34 years and test 5 to 6 times a day, more if there's an issue. 34 years and still no issues. :-)

Posted by Anonymous on 3 November 2007

I've been a type 1 diabetic for 28 years and I have always tested at least six times a day. I've seen the complications that come from not doing so in several relatives. I don't use meter or pump software programs very oftgen. I make my own charts on MS Excell and fax them to the endocrinologist between office visits. This works reasonably well ffor me.

Posted by volleyball on 4 November 2007

Theres a lot of good points bantered back and forth. It seems that in the type 2 group, most are older and not technology focused so while there are a growing number, the market is now small. This is a good market for a company with the pockets to wait it out. Most doctors offices do not seem to be on the technology wagon either. I would think this could be a good market to enter first. Get the docs on board, get patients on board and this will start to fly.
the iphone came late to the market, the consumer base was already familiar with the product, and saw this as the next evolution. So for diabetes technology to flourish we need to start with a more advanced meter and a medical system that can and will use the information

Posted by Dannee on 4 November 2007

From an investment point of view, the Microsoft Health Vault program may have little impact. However, I suspect the goal is to tie down future partnerships and linkages for the future, and that there will be a Google alternative ...

Posted by ricklude on 5 November 2007

I happen to use the "ricklude automatic testing & recording system".

I test my BG level and record it in a free program i've down loaded from C-Net. It's great and hard copies of every aspect of my health & care imaginable, can be made. EVERYTHING!

Why should I bother with something else?

Posted by Anonymous on 5 November 2007

One reader wrote "for technology to flourish we need to start with a more advanced meter". I think the boat is being missed by those waiting for another meter. What about SENSOR technology that is already here? I wear a Continuous Glucose Monitoring sensor and get amazing information. It gives me a motion picture of blood sugars all day long. Not just those "snapshots" given by meters!!! I wouldn't live without it and know a lot of other people in my doctors office who are starting on sensors.

Posted by Anonymous on 6 November 2007

As a 10-year diabetic using an insuling pump and a geriatric home care nurse, I see both sides of this. Non-diabetics just do not understand how much time, effort, thought, and planning go into EVERY part of a diabetic's life. Adding the time to download information is asking too much of many of us. The young patients may get more involved and stay more stable if it's geared to their high-tech lifestyle, but not the older patients.

Posted by dorisjdickson on 9 November 2007

I'm a 31 year juvenile onset. I test 15 times a day and use almost as many MDI's of 4 types of insulin.

Even though I'm a tech writer, I use a notebook for logging. I use several One Touch products, primarily the One Touch Ultra Smart. It's got good but not sufficient logging technology. I browse and use the analysis reports often.

I do not however, download the data. I'm not paying for the cable and the software.

I don't think I'm harmed by my more mechanical methods however. My A1Cs over the last 18 months have been consistently 5.1.

What do I want - accuracy!!! I could care less about all this analysis if (and I do) know I'm analyzing inaccurate data. As long as the FDA continues to allow 20% inaccuracy ... well, I'm not a happy camper. 15 tests a day (and yes it is necessary naysayers) times x retail of ~$1.50 per test (regardless of insurance that is the cost) but it's 20% inaccurate!! I've tested versus lab tests; it is THAT inaccurate.

Bottom line - I therefore, could care less about doohickies and programs if the data is wrong to begin with.

Posted by wifey on 9 November 2007

Diabetics, particularly insulin dependent types, have far too many variables to take into account to bother with that stuff. They know what brings their levels up and down.
A notebook is easier and more accessible.
What they need is technology for continual readouts. Put all the money into THAT.

Posted by Anonymous on 10 November 2007

I have diabetes in 53 years. Yes it needs a lot of testing every day. I find anylizing programs very helping and Have had two different in the last 5 to 10 years. But what I am longing for is a Continuous Glucose Monitoring sensor in order to see the tendence of bloodglucose. I think we should be helpt to get better control not told that we are not doing well enough.

Posted by jolo on 15 November 2007

I have a meter that allows me to upload my meter readings as well as my insulin taken each day.
I then fax or email those results before appointments with my doctor or nurse practitioner.

What is lost in this article is THE MOST IMPORTANT REASON THAT THE TECHNOLOGY DESCRIBED MIGHT NOT BE USED.

The main reason for those who don't test as much as might be desired is THE OUTRAGEOUS, CRIMINAL COSTS OF THE TEST STRIPS.

One can't complain or moan about testing if it is NOT understood that the FDA's cave in to Big Pharm allows for a profit of 98 cents on a dollar for test strips.

There are many insurance companies dropping test strip coverage. I read about what it costs the U.S. taxpayer for Medicaid and Medicare.
In England, the cost of the strips has created some articles in magazines talking about Diabetics getting "addicted" to testing.

Besides the difficulty, the technology is irrelevant when it becomes to expensive.

In the first post, the one that comes from what appears to be a physician, who "courageously" posted as anonymous.

It is health providers like that insensitive, totally out of touch providers that don't have a clue and are "HMOd" into giving such limited time to patients.
That line "I have many patients that check 4 times a day", is such an arrogant bunch a bunk. Does he come to the homes an check on them. NO, as he says, the patient "mananges", their own Diabetes, meaning = it is not profitable enough to provide the care needed for my Diabetic patients. Let's blame those with chronic illnesses for their illnesses, they are on their own. what a moron.

Posted by Anonymous on 25 November 2007

Good posts in general, although someone seems to have some issues with doctors.(Jolo) You are paying for a doctors time. If your insurer does not pay for his time, you get less time. Sorry. it's the way it works. Either get a new insurer or a new doctor.... who works for free. Also, you should consider a 50% pay cut without a cut in your productivity and hours with that sort of logic. The blame game is the road to failure...diabetes is your disease and success or failure in treatment ultimately depends on you. Test strips are expensive but there are options...such as lower cost testers, using AM FPG with a calculation to predict FPG curves. There are a number of these online. Most diabetics do not have to test 4 times a day...most extra testing is just not necessary...although there are some exceptions such as very active type 1's. If you are a Type 2 with a low level of physical activity, once day except when ill or fasting is usually enough. Checking to see "how high" your sugars are two to three hours after eating a big meal is just a waste. it will be high!! Then you will worry and try to limit your intake next meal.
This self pugalism among diabetics is very counter-productive and extremely expensive for insurers and patients alike.

Posted by Anonymous on 28 November 2007

Can someone explain the logic in why it is a priori harder for a type 2 diabetic to record their meal and exercise info than for a type 1? There is absolutely no logic in that statement. Interesting article though.

Posted by jolo on 29 November 2007

To the idiotic anonymous. Obviously a prostitute for the health industry, who is to blame for the lack of success with Diabetic treatment.

The single most important advance, and the only reason that managing Diabetes is a possibility is due to testing.
There is no way to figure out how certain foods, environmental stresses, exercise effects anyone without being able to test.
The fascist is correct in one aspect, treatment ultimately depends on you. That is why we need to make sure that we research, question treatments and use our energies to care about others. It is the, propagandists, the U.S. Health Industry apologists, the ADA, Big Pharm that needs to be changed. Follow the money, check the FDA, write your politicians, speak up for yourself and others. READ. Comment.
Speak up. Get involved. It is up to us.
The worst disease is apathy, laziness and selfishness that really is the main reason that the U.S. health industry is one of the world's worst.
Jon

The ripoff on test strips is outrageous.


Like anyone but employees have choices with their health insurance. That is a MAJOR, MAJOR reason why Health Insurers have no profit motive to give their customers decent service. The customers are NOT the ones who select the plan and the turnover is major.

What an i

Due some research. No one can generalize how must testing can be done, but it is due to testing that any potential of

Posted by chucky on 18 January 2008

Before meters you did your own lab work. There was paper and there were pencils. Meters and strips are wonderful and all the recent ones have connectors, software and lots of neat stuff. The only reason for a free uplink is so that somebody can sell your personal data to drug company marketing personnel. Read the fine and not so fine print before you use anything, I'll bet you give free license for the vendor to do as he/she wishes with the information you could, just as easily, take to the doctor/team yourself.

Posted by Anonymous on 21 January 2008

"these programs make the assumption that patients are actually checking their glucose levels. That's a false assumption: Most patients rarely check their levels, and many don't check at all."

What sort of diabetics are you familiar with? I test at least 6 times a day and that is on the low end of what I should be doing. I find it kind of offfensive that you would assume people are so irresponsible.

While I don't know much about the health vault system, I do use the lifescan system to look at my trends, in addition to a paper logbook. It's really useful for me to see all of the different graphs. RIght now, I bring my meter in with me to my educator when I see her, and she downloads everything so my records are kept at my doctor's office.

A one touch ultrasmart also allows you to record carbs, exercise, medications, and other information so it can be downloaded at the same time as your blood sugars.

And, for the record, you do feel way better with "treatment". After dropping my A1c by a point, I felt dramatically different.

Posted by Anonymous on 11 June 2008

I'm an LPN new to diabetes and I can't keep up with the technology! I did find one site with some information, but it was kind of hard to use. Any other help?

Posted by Anonymous on 13 September 2008

Hey, I had one patient who kept a spiral bound notebook listing each and every glucometer test he had ever made, the date and time, AND which particular finger of which particular hand he used!

And he had type 2.....so, there ARE some type 2 's who DO like to test and record ! (very thoroughly !!) :)

Posted by Anonymous on 13 January 2009

I use a Paradigm pump, test several times a day and believe that I am in control of my own destiny, health-wise. My physician will just not agree to be with me each moment of each day. I, too, would like to download results simply to allow me to better recognize trends so I can make adjustments. As each day varies in physical activity, food intake and other factors, there is no plan that is 100 percent effective, 100 percent of the time. Bluetooth connectivity would reduce the cost of the 9-pin/USB cable, but no business would give away software, or anything else for that matter, that they could profit from (would you start a business for the good of the people, and not to make money?). I am intrigued with the CGM systems, but as in any technology developed, there has to be a cash cow, as in sensors, strips, etc., and insurance companies will always be leery to cover new technologies until satisfactorily proven. My last gripe is that I have not found software, nor a way to download data, that will work with a Mac.

Posted by Anonymous on 20 April 2009

I would be more interested if all meter manufacturers enabled their software to run on computers other than windoze

Posted by Anonymous on 20 April 2009

I would be more interested if all meter manufacturers enabled their software to run on computers other than windoze

Posted by Anonymous on 11 December 2009

Too many negative vibes in this article. I have recently been diagnosed with type 2 diabetes but I have been suffering from symptoms of diabetic neuropathy for about eight years, not knowing what it was. My doctor blew it.
To my point. By monitoring and recording I learn how to control my glucose levels and eat properly. I don’t really need to show it to a doctor as much as I need to discipline myself and understand how doing the things I have been told to do helps and what works for me personally and what doesn’t. In turn I learn how to manage the diabetic neuropathy and prevent further damage that could be extreme the worst case scenario being death or maybe not. At some point death might seem better if this gets any worse.
So you can’t say the people with type 2 won’t be interested. Having lived through what I have lived through I wish I would have started this eight years ago. I would have avoided much suffering. Instead of enabling lazy fools to avoid the inevitable, managing their diabetes or pre-diabetes, try encouraging us.


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