Do digital health platforms work for diabetes management?

Diabetes is one of the most common chronic conditions in the nation, with more than 38.4 million Americans living with the disease – including almost 9 million who aren’t aware of it. A further 97.6 million adults, or close to a third of the population, are living with prediabetes that may progress over time.  

The human toll of diabetes and its complications is staggering, and the economic costs are similarly distressing. In 2022, the total financial outlay related to the condition reached $412.9 billion, including $306.6 billion in direct medical costs and $106.3 billion in indirect costs.  

It’s no wonder, then, that diabetes management has been a major focus for healthcare innovators, including a long list of digital health companies that have poured billions of dollars into apps, devices, and platforms to assist people with the daily challenges of living with the condition. 

But have they been successful? A new report from the Peterson Health Technology Institute (PHTI) argues that they haven’t really hit the mark.  

The paper found that while digital health platforms produce some small reductions in blood glucose that exceed the rates of traditional clinical care, these benefits are likely to reduce over time – and the costs added to the healthcare system outpace the limited savings achieved through these methods. 

Furthermore, the evidence reviewed by the team does not show significant gains in health equity and access, which has been a key selling point for moving healthcare services online. 

The report casts doubts on the positioning of the explosive diabetes digital health market, which is already worth more than $18 billion and is expected to reach nearly $50 billion by the end of the decade. 

Examining the evidence of digital health’s effectiveness

PHTI surveyed clinical evidence for the three major categories of digital diabetes management tools: remote patient monitoring (RPM) platforms, behavior and lifestyle modification programs, and nutritional ketosis solutions. 

They focused primarily on the first two, which comprise the majority of solutions available on the market, but did point out that digital health tools geared toward helping individuals achieve and maintain nutritional ketosis as a pathway to diabetes remission may have a greater chance of producing meaningful clinical results than other types of platforms. 

For the broader market, however, the evidence does not point to a high degree of effectiveness. When compared to traditional clinical care, RPM and behavior modification tools only delivered a 0.23–0.60% point reduction in HbA1c while increasing total health spending over a 1-3 year timeframe. 

Digital health tools aren’t reversing the spending trend either, the report asserts.  

“If 25% of eligible users participated, remote patient monitoring solutions would increase Year 1 spending by $21.3 million per million commercially insured lives; behavior and lifestyle modification would increase spending by $5.1 million per million enrollees in Year 1,” the document states. 

The results around health equity and access were similarly lackluster, with studies under review failing to show “compelling evidence that these solutions are preferentially addressing health disparities,” the authors wrote.  

“Further, only 29% of studies reporting on HbA1c included participants with levels above 9%, suggesting that solutions are being tested in less complex patient populations, rather than among individuals who are at highest risk for diabetes-related complications. Therefore, published results should be reviewed carefully before generalizing across populations,” the team said. 

A swift rebuttal from digital health advocates

The Digital Therapeutics Alliance (DTA) was quick to respond to the report, issuing a statement that commended PHTI for its efforts but disagreed with its conclusions.  

“DTA acknowledges the importance of evaluating evidence and health economics, as these principles are integral to our core values. Unfortunately, the framing of this report detracts from the evidence based approach that they are attempting to promote,” the organization said. “While we support their overarching methodology, it’s essential to address specific oversights in the approach to evaluate the products and suggest areas for improvement in future reports.” 

DTA pointed out three major concerns about the PHTI report, including the limited sample size of companies that may not accurately represent the full range of solutions available on the market, an over-reliance on predictive models for gauging cost-effectiveness instead of using real-world evidence, and the lack of endocrinologists as advisors to provide expert clinical perspectives. 

“PHTI has the opportunity to support the future of healthcare by developing an advanced approach evaluation to match advancements in treatments and the new expectations of today,” DTA said. “The expectations include positive, real-world health and economic outcomes, addressing the whole person, and accessibility to diverse patients.”  

“We recommend PHTI include experts that are specific to the condition they are studying, invite more stakeholders to provide input into their analysis via public forums…expand the cohort before making generalizations, and be more transparent on inclusion and exclusion of evaluation criteria. DTA looks forward to supporting PHTI in its future efforts to evolve the evaluation of modern medicine.” 

What’s next for digital diabetes management? 

 The report may or may not influence digital health investors who are slowly but surely returning to the funding arena. The massive scale of the diabetes epidemic will continue to demand attention from innovators, and the idea of using digital channels to connect with consumers isn’t going away any time soon. 

The key to achieving more notable clinical and financial results will be developing platforms, devices, and other tools that truly resonate with consumers at key points in their diabetes management journey while being accessible, easy-to-use, and simple to integrate into the clinical environment. 

Finding the right balance may continue to be a challenge for digital health companies – as well as the providers and payers who collaborate with developers – but the continued maturation of the market will no doubt produce more clarity around measurable and meaningful results for people living with diabetes. 

Jennifer Bresnick is a journalist and freelance content creator with a decade of experience in the health IT industry.  Her work has focused on leveraging innovative technology tools to create value, improve health equity, and achieve the promises of the learning health system.  She can be reached at jennifer@inklesscreative.com.