Roughly one in three Americans, 96 million adults, has prediabetes – but only 2-3% are offered help to prevent progression to full-blown disease. 

The medical effects of diabetes are significant, of course – affecting eyesight, circulation and even, in severe cases, requiring amputation. But there are other implications too. With untold healthcare resources devoted to managing the myriad medical risks of the disease, adequately addressing diabetes – and, ideally, preventing it – would save American taxpayers immense sums.

Remote patient monitoring holds huge promise to help treat and improve the lives of chronic disease patients, including diabetics. And the rise of artificial intelligence and automation offer big opportunities to improve RPM technology.

Oren Nissim is CEO and cofounder of Brook Health, a developer of AI-enabled remote monitoring tools. He also is a type 2 diabetic.

We interviewed Nissim to discuss diabetes treatment challenges, how RPM can help overcome some of these challenges, how AI can boost RPM technology when dealing with chronic illnesses, how adequately addressing diabetes can save taxpayers money, and what Nissim calls "the next generation of remote care."

Q. What does the diabetes landscape in America look like today, and what are some of the major challenges?

A. Whenever you hear about diabetes today, the No. 1 topic is that GLP-1 drugs have taken off in recent years in a really big way. And that has been a transformative experience for people who are on those drugs for two reasons. First, they do help you better control your blood sugar. Second, and this probably is what gets the most attention, people who are taking a GLP-1 drug are losing a lot of weight.

Which is a good thing. The problem is these are forever drugs, meaning patients must be committed to taking them for life. I doubt anybody wants to do that, but they all end up there because people become dependent on these drugs.

But not everyone should be taking GLP-1 drugs, and they're not always covered by insurance. So, there's a growing trend of people paying for these drugs out of pocket, which is incredibly expensive and thus not very equitable.

Beyond this inequity, there remains a plethora of "food deserts" in the U.S., which only exacerbates the overall bad dietary habits in this country. Also – the inaccessibility of dietary management is another obstacle faced by far too many people. We need to make assistance from a nurse or food coach more accessible to help people get blood sugar under control. But improving access to care for someone living under a bridge or facing a diabetes-related amputation is another challenge altogether.

Most people with diabetes have type 2. For these people, managing their blood sugars – while managing everything else in their lives – can be a real challenge. Many wonder if they can do it themselves.

It's no surprise that a "wonder drug" is such an attractive option. But other than the pharmaceutical companies, who else really benefits from a drug that has to be taken for the rest of a patient's life when other options are available?

Q. How can RPM technology help overcome some of these challenges?

A. Remote patient monitoring tools can be used to help those with diabetes in a number of ways. They enable clinicians and other caregivers to keep tabs on an individual's blood-sugar levels, to nudge patients with reminders, and to help them set up wellness plans.

Also, I think the immediacy of highly personalized information is really key when you're trying to create and formulate a new habit. This kind of individualized data is not only highly informative and relevant, having access to it can be both motivating and empowering – which are essential emotional states for driving change and overcoming challenges.

Let's say you go to the supermarket and you're trying to pick out yogurt. If you have diabetes, the chances of you finding a yogurt product that is appropriate for you is incredibly slim, almost zero. And you actually have to pick up each container and read the labels to know for sure. If you've been in the dairy section of a supermarket recently, you know there is an overwhelming number of yogurt types and brands.

The food industry has made it immensely difficult to make the right choices when you are lactose intolerant. Now, imagine being able to use remote AI technology to help you understand those labels, to read them faster and give you recommendations while you're on the go, living your life and making these day-to-day choices.

This is just one example of how you can effect significant change that improves the health of individuals through remote patient monitoring technology.

Q. How can AI boost RPM technology when dealing with chronic illnesses like diabetes?

A. A lot of it is about how to make that smart agent support you daily and in the way that best enables positive change. That's when AI can really shine.

Many people are under the mistaken assumption that AI should mimic a nurse or doctor. But that's not the right lens in which to view it. Ultimately, it really is more about encouraging healthy habits and behaviors and providing healthy coaching for making those important day-to-day choices.

The reality is that control of blood sugars can be also achieved through lifestyle changes and greater awareness. This can be achieved with the right tools and support. No one should ever have to go to the extreme of having a foot amputated because their diabetes was out of control, yet 120,000 Americans with diabetes lose a leg or foot to amputation annually.

Further, AI can take into account the medical health of an individual beyond their diabetes, such as another underlying condition that must be factored into suggestions, recommendations and wellness plans. It's more of a lifestyle intervention than a medical intervention, but the end goal is the same: better patient outcomes.

Q. How is what you call "the next generation of remote care" improving outcomes for this patient population? And how can adequately addressing diabetes, especially preventing it, save American taxpayers money?

A. The vast majority of Americans with diabetes are not using AI or other advanced digital tools to help manage their conditions. But people who do use these tools have a unique agent with them at all times that understands what's going on in their day-to-day lives.

This agent is able to help them make better, smarter, easier choices on the go. That makes a dramatic difference in the lives of these people because otherwise they make dietary and lifestyle choices based on their existing habits – and their existing habits are not getting them to where they need to be.

Today, people with diabetes can see a doctor or a health coach. They'll be part of a transactional experience where they're told what to do and now they need to go home and do it. Unfortunately, that system doesn't really work because only people who are extremely motivated to make changes in their habits are successful.

The way to help more people successfully manage their disease is to switch from a transactional, encounter-based model to one where disease management is woven into the fabric of patients' lives. Most people are so used to digital technology today that they could easily integrate these tools into their daily lives.

Adequately addressing diabetes, particularly through prevention and better management, can save American taxpayers immense sums by targeting a major source of healthcare spending. With 90% of Medicare expenses related to chronic conditions like diabetes, focusing on prevention and effective management could significantly reduce overall healthcare costs.

While new drugs like GLP-1 inhibitors are effective, they're extremely expensive and create lifelong dependencies. Instead, leveraging widely available technologies such as smartphones and AI-driven apps can help people make better daily health decisions at a fraction of the cost. This approach is not only cheaper but also more scalable than traditional medical interventions or expensive drugs.

By empowering individuals to better manage their diabetes, costly complications like amputations could be avoided, further reducing healthcare expenses. Given that the U.S. currently spends more than 20% of its GDP on healthcare, preventing and better managing chronic conditions like diabetes could significantly lessen this economic burden.

Ultimately, promoting self-management and education can empower individuals to make healthier choices and understand their condition better, reducing reliance on expensive medical interventions and saving taxpayers substantial amounts in the long run.

Follow Bill's HIT coverage on LinkedIn: Bill Siwicki
Email him: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.

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