Wow! Advanced Technologies and Treatments for Diabetes 2018 (ATTD) Update

I just returned from the ATTD Conference held in Vienna and my main reaction was WOW! The future for people with diabetes is so very bright. So bright that I was inspired to start blogging again and to work harder on my own entrepreneur projects.

A central theme to the conference was that we, the healthcare industry, are not doing a good job for people with diabetes….glucoses after meals and overall blood glucoses are just too high. And, the numbers of new people with type 1 diabetes are increasing across the world. We must do better.

Compared to last year which was almost exclusively artificial pancreas data discussion, there was much more focus on the benefits of cgm in clinical practice: monitoring time in range, using cgm with or without pumps (the DIaMonD study was discussed multiple times), and assessing post prandial highs that improve with faster insulins (fiasp, afrezza). I would have loved to have also seen Steve Ponder’s sugar surfing included in the discussions but I guess Europe hasn’t met the surfers yet? Integrating cgm data with the 'internet of things' such as fitness trackers, refrigerators, mattresses with AI could perhaps one day anticipate trends and assist artificial pancreas algorithms.

I was interested to learn more about experiences with Abbott freestyle libre (flash) sensor, pros and cons, and to learn about a new implantable cgm sensor by Roche called Eversense which is currently approved for 6 months usage for each sensor in Europe. Cons though in my opinion are that the device has to be charged each day, is a bit bulky, and must be done as a procedure at the endocrinology office.

I was also impressed with #DIYPS #openaps being discussed ‘openly’ and enthusiastically with JDRF's statement of collaboration and Roche’s announcement of support for the movement. I would have liked to have seen more patients on the stage, however, discussing their stories and experiences (pros, cons) rather than just from a physician point of view. Nonetheless, nightscout supporters and patient advocates were everywhere in the audience making sure that the industry pushes harder to get products out faster in the name of the #wearenotwaiting movement.

Of course artificial pancreas was a big part of the conference. When the audience was polled using the conference's interactive app, artificial pancreas is thought to be the technology that will most improve patients' lives in the next 5 years. It was exciting to see that future Tandem and Omnipod artificial pancreas data suggests time in range was 88%! I am very much looking forward to the commercialization of their systems with the dexcom g6 sensor (hopefully next year?). The bionic pancreas with both glucagon and insulin, the iLet, is also working toward commercialization and would not require the meal announcements required by the other systems and algorithms. When BigFoot gets closer to commercialization I am guessing they too will be at a future ATTD conference for announcements. However, I was particularly impressed with the amount psychosocial data that is being evaluated with current artificial pancreas projects…they are looking to define more specifically how these systems help (or hurt) people with diabetes to achieve their life goals. In other words, it was said that good health is not a specific hgba1c or time in range but rather ‘having the health to live the life one wants to live.’

Digital innovations were also present at the conference. One of my favorites is the MedAngel temperature sensor. The device is placed in the bag that you carry your insulin in. It alerts you through a mobile app if the temperature is not safe for the insulin thereby keeping it most effective.

A French video game by Solar Games peaked my interest as it is basically a sims experience in which a practice develops its own content for diabetes education that they would like their patients to learn. However, I feel that the concept of diabetes virtual coaching currently provided by the wonderful app MySugr as well as by Canary Health are more likely to make the largest impact. Of course we need outcomes data to really know. Nevertheless, support for self management with a chronic disease like diabetes as well as motivators for health behavior change is an area that needs more attention because...no technology or treatment works if a patient doesn't use it.

Access to technologies was also discussed with Dr. Irl Hirsh’s call to action being that physicians should actively immerse themselves in economics nomenclature and population health cost-savings analysis so as to better advocate for our patients with payers. Perhaps we should all have a Masters of Public Health, I know it has certainly helped me.

Count me in for more tech entrepreneurship in the near future because the future is so so bright! :)


Disclosure: I am a paid speaker for Dexcom helping to educate primary care providers about the benefits of cgm for their patients.

Pediatrics Rocks!

Kids are just so wonderfully authentic and fun...which is why pediatrics just rocks!

When educating a family about a new endocrine diagnosis, I always make sure to try to explain it to the child too. When I finish, I make sure that the child understands what I have said by asking him/her if they have any questions.

A recent patient that I had, a quiet, thoughtful 6 year old boy throughout appointment, was memorable. Even though he was quiet for most of the appointment, I could tell from his intense eye gaze that he was following the conversation. 

Soon, the time came for me to ask: 

‘Do you have any questions?’

He thoughtfully then asked: 'Did you have tacos for breakfast?’

I love pediatrics!! :)

Why?

The road to improving healthcare over the past several years has most certainly had a focus on implementing ‘upgrade’ technologies such as EMRs and tablets, but also creating new technologies like 3D printers and Watson-like doctors. 

However, in my opinion as both a practicing doctor and technology entrepreneur, the focus is all wrong. EMRs, 3D printers, and Watson-like brains are not fixing the real problems that plague the broken healthcare system that I am experiencing everyday. Perhaps that is because the current technology ‘innovators’ do not experience the healthcare system everyday as patients and doctors do. And, the current ecosystem for healthcare technology startups does not support doctors and patients as founders. If necessity is the mother of all great inventions, there will be no ‘real’ problem-solving in healthcare by new technologies until doctors and patients are REALLY involved.

Why not have a bigger focus on getting doctors and patients REALLY involved? Asking beyond 'Why...does the image of a successful startup founder always have to be 20-something nerdy hipster with a beard and a hoody?’ the following why questions must be addressed:

• Why…are there not very many patient or doctor initiated startups being funded by VCs?
• Why...does a healthcare startup doctor have to quit being a doctor that they worked so hard to become and love?
• Why…do healthcare accelerators occur only in a few select cities?
• Why...would a doctor with both school loans and 'skin in the game' debt as well as bills and a family move to a city's accelerator for 3 months without any salary or paid shelter?
• Why…would a patient who is receiving life-saving care leave their treatment team to be a part of an accelerator in another city?

Trackers and Childhood Obesity

Over the past week, it has been thrilling to read about the increasing presence of health trackers at the Consumer Electronic Show this year. By some reports, health-related consumer devices occupied close to 10% of the exhibit floor space! A good summary of several of the leading trackers is here:

In my pediatric endocrinology practice (Central Ohio Pediatric Endocrinology and Diabetes Services in Columbus Ohio), we have been using trackers to fight childhood obesity over the past year with increasing success. One such example that comes to mind is an adorable 6 year old boy who had increasing weight over the preceding 2 years peeking at 90 pounds when he first came to see me. However, upon following a strict modified-Atkins diet along with using the Jawbone UP tracker, he (and his whole family) have now started losing weight as is noted in his growth chart below:

He starts by uploading his tracker to his phone.

The app keeps track of his steps measured on the device. We have set a goal of 10,000 steps per day to help with weight loss which he has been achieving regularly. At his appointments, I am easily able to monitor his progress.

I am excited to see how much fun he is having using the tracker which fits very easily into this tech-savvy family. The future is now in healthcare and technology...and it's looking healthier for children!

American Diabetes Association Meeting 2013

On a weekend with a full moon summer solstice,

And a national title win for the Blackhawks lighting up the skyline, magic is everywhere in Chicago and dreams seem possible. In the midst of this, the ADA annual meeting is occurring.

Research and posters are abundant, and possibilities for better treatments and technologies like the artificial pancreas seem certain. But what about a cure? The answer: more research needs to be done.

NIH budget is smaller for diabetes than for HIV or cancer.

This is despite the large numbers of people that have diabetes, and that are projected to obtain diabetes in the near future.

Manny Hernandez of Diabetes Hands Foundation discussed this fact at the non-profit’s first ADA fundraiser event.  He said, ‘Not that HIV or cancer aren’t important, but diabetes is too’. For diabetes dreams to come true, physicians, nurses, pharmacists, caregivers, and advocates all need to make more noise and to raise more money.

As I slipped away for a brief lunch in this dreamy town of Chicago at the amazing Paris Club to indulge my own dreams of a return to Paris, I reflected on a primary message that I see developing about what needs to be done to make the dream for a diabetes cure come true: more noise and more money.

Summary: Today tremendous economic, social and political pressures dictate the physician’s ability to deliver proper health care. Just like early HIV advocates and cancer advocates, diabetes advocates must unify their voices to make a choir of noise that gets economic, social, and political attention, and eventually more scientific funding. Diabetes dreams can then come true. 

EndoGoal Diabetes App Wins!

EndoGoal Diabetes App recently won entry to the semifinals in New York City at the Healthcare Innovation World Cup Event sponsored by Boehringer Ingelheim and HITLab.

At the semifinal event we won $2500 from Boehringer Ingelheim!

We will be using the funds to start building the rewards platform that will accompany the app that has been available for download since September 2012 (ios/android).

EndoGoal App and its rewards platform will provide real money rewards for glucose checks by a person with diabetes. The money comes from friend and family sponsors who matter most to each person with diabetes. On the platform, friends and family can make donations as they see fit to help support their loved one with diabetes.

Points earned by checking glucoses and entering them onto the EndoGoal App journal each day can be 'cashed in' on the rewards platform each week for a prepaid visa card! We will begin building the platform now with the talented Columbus-based nonprofit technology team, GroundWork group. Although we still need to raise more funds to complete the work, stay tuned for future announcements! You can check out the winning EndoGoal demo and business model presentation here:

South By Southwest 2013: An EndoGoddess Perspective

I am a patient, doctor, and a technology consumer early adopter (aka geek).

As a technology consumer early adopter, my life is comfortable and modern: I communicate with friends across the world in an instant, I deposit checks using my smartphone and I find anything I want to buy and then purchase it too. As a doctor, whether I like it or not, I must use archaic technology such as fax machines to confirm letters of medical necessity, prescriptions with pharmacies, and communication with school nurses. As a patient, I must actively advocate and fight for what I need with multiple long phone calls: making a claim with my health insurance, keeping up with my mail order medication refills, making an appointment, finding out my lab results.

Currently, I occupy all worlds at separate times. However, at South By Southwest, it was possible to imagine living in all worlds at the same time…and to randomly audition for a movie role too (yes, on a lunch break, I did just that). Here are a few of my favorite examples from this year’s meeting that really sparked my imagination as a doctor, patient, and technology consumer:

Despite an electric atmosphere of optimism, South By started out with a message of caution from All Gore. He discussed both the opportunities and the responsibilities specific to new technologies that are making their way into the future from South By. Specifically, he pointed out some of the ‘stalker-like technology’ social applications as well as ground-breaking genetic science technologies that must be created and used with caution: identity theft, security concerns, ethical concerns.

Aetna had a big presence at South By this year reflecting their dedication to making the newest and the best technology products. CarePass Sync is a new platform they have launched this month which helps move health-related data between apps that Aetna has curated. Once an Aetna patient has downloaded a CarePass Sync enabled app, they can choose to enable sync, and agree to give the app permission to accessed certain components of their CarePass Sync “personal health cloud”, as Aetna calls it. Each patient's personal data then automatically populates the apps that each user wants to download.

Portable 3D printers roamed around the conference center advertising easy, modern, personalized creations and communication. Tons of implications for healthcare but in this day and age it would just be nice to replace the fax machine for communication.

Neurowear was one of my favorites in the exhibit hall. Brain wave analysis through headphones were translated to a representative song choice: mine was a space invader song after viewing the Minecraft and gaming expo; but the guy standing in line to try Neurowear right before me had Madonna's 'Like a Virgin' on his mind...nonetheless, a fun way to interpret and personalize health quantifications.

Anyone wearing google glasses were instant celebrities such as this guy who posed for my picture. Google glasses are a high profile example of wearable tech which had a big presence. Translations to healthcare and virtual gaming are currently only fantasy but likely to be reality in 1-2 years.

Artificial Intelligence, or AI, uses data to personalize and modernize tasks. One of my favorite examples was TempoAI which analyzes your email, phone conversations, and calendar behaviors to push the link or phone number you need right before your conference call meeting. Certainly, the data provided from wearable sensors like google glass could have large implications for healthcare. However, progress is stalled in the field of AI and healthcare until liability is better understood. Thus, AI will only be applied to calendars and personal assistants at the moment.

A low tech, high touch favorite moment of mine was meeting grumpy cat at the Mashable station. Sometimes a cute frown and a low tech star at a high tech meeting are just the right ironies.

As a participant since the beginning of the health track at South By in 2011, it is thrilling to see how health tech has grown. The excitement in the air was electric this year! We are certainly witnessing the start of a new era and future as patients, doctors, and technology consumers which looks to be not only comfortable and modern but fun and personalized too!