Digital Diabetes Management Tools Fail to Deliver Meaningful Health Benefits While Increasing Spending

Investors have embraced digital diabetes management tools, but their value has not been established.

Type 2 diabetes affects over 38 million adults in the U.S., making it the eighth leading cause of death and costing >$400B annually - the most expensive chronic condition to treat. Since 2010, $58 billion have been invested into digital tools for diabetes management, which should lead to better glycemic control, thus translating into improvements in associated conditions and lower healthcare spending. However, purchasers of healthcare are uncertain whether these digital diabetes technologies are worth the significant investment.

Independent, evidence-based assessments help payers and providers understand the value of these technologies to guide decision-making.

The current federal regulatory framework does not consider the value of digital health solutions. The Peterson Health Technology Institute (PHTI) fills a void in the evaluation of digital health solutions through rigorous, independent, evidence-based research to answer three fundamental questions about digital diabetes management tools:

1)      How well do they work?

2)      For whom do they work?

3)      And are they worth it?

Companies were invited to submit clinical, economic, and commercial information, while patients were engaged directly for feedback on their priorities, user experience, and outcomes. PHTI worked with independent evaluation partners, clinical advisors, patients with Type 2 diabetes, and other stakeholders throughout the assessment process.

As a partner to PHTI, Curta assessed the clinical and economic impact of these technologies using the published ICER-PHTI Assessment Framework for Digital Health Technologies, including the systematic literature review and budget impact assessment.

PHTI’s evaluation found that digital diabetes management tools fail to deliver meaningful health benefits while increasing spending. 

Popular digital tools for managing Type 2 diabetes provide only small, temporary reductions in hemoglobin A1c levels that are insufficient to improve long-term health outcomes or reduce healthcare costs. However, the nutritional ketosis intervention from Virta showed promise for achieving diabetes remission, and may help higher-risk patients establish good self-management habits when starting insulin therapy.

For patients using tools in the remote patient monitoring category, annual spending is projected to increase by $2,002 for commercial insurance patients, by $1,011 for Medicare patients, and by $723 for Medicaid patients, as a result of higher provider payments.

For patients using tools in the behavior and lifestyle modification category, annual spending is estimated to increase by $484 for commercial insurance patients, by $513 for Medicare patients, and by $574 for Medicaid patients.

For all payers, the increased spending associated with virtual diabetes solutions has a significant impact on total spending given how many people could be eligible to use the solutions, including 4.3% of those with commercial insurance, 17% of those with Medicare, and 4.8% of those with Medicaid.

Overall, the tools increase net healthcare spending across insurance types despite limited clinical benefits.

The next generation of diabetes management tools should aim for clinically meaningful glycemic control.

For payers, PHTI recommends requiring data transparency, aligning payments to successful results, and focusing performance guarantees on high-risk patients. For innovators, PHTI advises generating robust clinical and economic evidence, ensuring sustainability of effects, engaging providers, and being willing to put fees at risk based on delivering proven value. For providers, PHTI notes that while diabetic remission is a worthy goal, many solutions are cost-additive and performance may vary, so they should carefully evaluate appropriate patients who may benefit, such as those newly initiating insulin with very high A1c levels.

Next Steps…

PHTI’s next assessments include virtual physical therapy, blood pressure monitoring, and mental health tools.