Boehringer Ingelheim plans to model a diabetes gamification effort on one it created in COPD.
In many ways, diabetes seems like an ideal case for the cognitive computing power of Watson.
“In diabetes especially, you’re always interested in food and activity,” Kathy McGroddy-Goetz, VP of partnerships and solutions for IBM Watson Health, told MM&M as part of the magazine’s Watson Week coverage earlier this year.
“It’s a disease where so much happens between visits to the doctors,” McGroddy-Goetz said. One of the proposed applications of a recent partnership with the American Diabetes Association is a personal diabetes “adviser,” powered by Watson, designed to fill those treatment gaps.
Another goal of the ADA–Watson alliance, which the two struck in June, is to convey information to healthcare providers in smarter ways.
“There’s an overwhelming amount of information,” laments Jane Chiang, the ADA’s SVP of innovation.
THE CUTTING EDGE
“We’re good at disseminating cutting-edge research — we have journals and meetings that do that — but it’s hard for providers to stay on top of it,” Chiang continues. “The goal of working with IBM Watson is to use its machine-learning capabilities to provide information fairly rapidly to the healthcare provider so that it can inform clinical decision-making — more effective and accurate diabetes management.”
The organization is armed with content, a vast professional and consumer network, and a brand. It just lacked a clear way to disseminate its information in a manner that resonated with its target audience.
“We needed to partner with a leader in technology to get that information out,” Chiang recalls.
The ADA is also sitting on a rich repository of data, and Watson will be trained to understand it. After ingesting the association’s 66 years’ worth of clinical and research data, Watson, which understands questions posed in natural language, will strive to create evidence-based, confidence-ranked recommendations for a range of health decisions.
“Although IBM is very traditional, it was doing innovative things — population health, personalized goals,” Chiang stresses. “It’s not just gathering information. It’s doing something with that information.”
The ADA hopes Watson can help ease the day-to-day burden of people with diabetes. “We realized that we’re not as nimble as we could be,” Chiang says. “Our leadership realized that the technology arena is something we needed to enter and make a full commitment to.”
It’s the latest example of experimentation in diabetes, where drugmakers, support organizations, and startups are experimenting with solutions that leverage technology to help manage this insidious and largely asymptomatic disease.
And the stakes have never been higher. Four hundred thousand seniors are diagnosed with type 2 diabetes every year, 27% of people 65 and older already suffer from diabetes, and an additional 50% have prediabetes, according to a trend report from the Institute of Alternative Futures.
ENABLING BETTER BEHAVIORS
Yet for all the strides made in the treatment of diabetes — recent advances include the approval of Sanofi’s daily GLP-1 Adlyxin in July and Novo Nordisk’s long-acting insulin Tresiba last September — patients are struggling to keep pace. Globally, nearly 40% of patients with type 2 diabetes are not taking their medications as prescribed, according to Diabetic Medicine. Diabetes Care, on the other hand, notes that the disease cost the U.S. health system alone $176 billion in 2012 — and, per Population Health Management, that figure is expected to rise to more than $622 billion by 2030. The Centers for Disease Control and Prevention lists diabetes as the seventh-leading cause of death in the U.S.
For HCPs, researchers, patients, and caregivers, Watson can help generate tailored treatment approaches, find hidden data patterns, and customize information that can lead to healthier behavior. In what other ways are stakeholders driving toward better diabetes outcomes?
For Graham Goodrich, VP of diabetes marketing for Boehringer Ingelheim, the first step toward driving better behaviors is through the creation of accessible educational materials.
“We have to find ways of taking complex data from our prescribing information and boil it down to something digestible and usable,” Goodrich admits. “Our scientific communications and legalese do not meet the needs of an average patient. Yes, we write to an eighth-grade level, but that doesn’t go far enough. Everyone is digesting 140-character tweets, not essays. We have to adjust our information delivery.”
Goodrich’s thoughts are echoed in Improving Type 2 Diabetes Therapy Adherence and Persistence in the U.S., a recent IMS Institute for Healthcare Informatics report in which IMS recommends tying educational materials to patients’ needs, which it characterizes as one of the “most effective interventions … in order to avoid providing information [that] is not adapted to an individual’s level of health knowledge or self-management skills.”
Goodrich clearly agrees, adding that technology “affords us the opportunity to package that educational information in a way that really resonates and promotes understanding in a way that’s empowering. The next step is once [somebody has] learned something, how do we keep it top of mind?”
One of the ways BI hopes to keep patients engaged is through “edutainment.” Goodrich says the drugmaker plans to leverage its past work with HealthPrize, a technology company that provides gamified support programs. BI launched its first gamified effort in June for another chronic disease, COPD (the company manufactures Spiriva Respimat, a prescription inhaler for COPD). Respipoints, as it’s called, is a free online program that gives users points for taking their medicine, reading educational materials, and refilling their prescriptions. They can then redeem those earned points for rewards, like gift cards.
That kind of investment could soon prove fruitful for BI. In June, an FDA advisory panel voted in favor of allowing the drugmaker to claim that its diabetes medicine Jardiance reduces the risk of heart attack and stroke. The agency is not required to follow the panel’s recommendation but often does.
Education, of course, wasn’t a one-way street before the internet era and certainly isn’t one now. That’s why the industry, alongside technology companies and their health-tech partners, has come to the realization that connecting patients to certified diabetes educators can sow trust and help reinforce healthy behaviors. And that begins with better communications.
A PERSONAL TOUCH
“When you’re talking to your endocrinologist, you have about six or seven minutes,” Goodrich says. “When your doctor asks, ‘Do you have any questions?’ the questions usually aren’t top of mind. They come during the drive home or when you’re cooking.”
That insight led BI to invest in certified diabetes educators (CDEs) — and BI is not alone. Sanofi has a similar program, COACH, which offers what Rachele Berria, head of the company’s diabetes medical unit in the U.S., describes as “tailored educational information and tools for people living with diabetes once they are prescribed one of our treatments.”
CDEs, pharma, and technology companies can strike the right balance between personal touch and more formal reinforcement of a physician’s advice. “Diabetes is very complex. People are not going to change because of technology alone,” explains David Weingard, CEO of Fit4D, a provider of web-based diabetes-coaching platforms. “People change because they’re motivated by other people. Technology is the medium that enables scale. When [patients] know their coach, they’ll text their coach.”
Goodrich agrees that the foundation of effective coaching is trust. “When people are finding relevant, valuable, and helpful information, it builds loyalty and trust,” he says. “The whole concept behind our current DTC campaign for Jardiance is that when life gets in the way, you have a backup buddy. Patients want someone to help them.”