Digital Health Age:

Building the tools to stop diabetes before it starts


Epidemic is a dramatic word, but in the case of diabetes it’s entirely justified. With 4 million sufferers in the UK, diabetes is already one of the UK’s most deadly non-communicable disease, exacting enormous human cost and consuming nearly 10 per cent of the NHS budget.

With the afflicted population projected to reach 5 million by 2025, diabetes could effectively cripple the healthcare system, while costing the national economy billions of pounds in lost productivity – yet it’s also the most preventable of all public health crises.

In the UK and worldwide, almost 90% of all diabetes is Type II adult-onset: a product of poor diet and exercise rather than genetic inevitability.

In theory this makes stemming the epidemic a straightforward task of getting pre-diabetic patients to make better lifestyle decisions, but in practice this is exactly what makes it so hard to address.

Getting patients to take a month-long round of medication is often easier than having them cut down on refined sugar and processed snacks for the rest of their lives. Established medical services have been slow to address the crucial need for pre-diabetic intervention though.

Information on nutrition and exercise is widely available, of course and most GPs are diligent about letting at-risk patients know they need to get their diets in order. But warnings only go so far.

To head off the coming crisis we need well-developed systems and services that prioritise healthier habit formation and make it a consistent part of any pre-diabetic patient’s routine. We also need to design the way we persuade, to ensure it’s targeted, timely and actionable.

In practice this means taking advantage of the tools we already know to be effective at changing behaviour: counselors, coaches and personal technology.

In the United States, where diabetes poses an even greater threat, Omada Health is a rapidly expanding service that partners with employers and health insurance companies to provide health-coaching to patients who struggle to change their diet or activity levels.

After identifying patients at risk of Type II diabetes and other chronic ailments, Omada digitally connects them with counselors and peer groups, to offer not just information and encouragement, but consistent feedback and progress-tracking.

The results have been overwhelmingly positive and ultimately save Omada’s clients millions in treatment costs while improving patient outcomes across the board.

Digital tools for health management are advancing too, but still relatively immature. While hundreds of smartphone apps exist to help users track their calories and tick off activity goals their impact on diabetes is still minimal. This is largely because they too focus on providing general guidelines rather than in-the-moment feedback.

A smartphone app concept called Nudge, recently created Smart Design, offers a glimpse at what better integration in this space might look like.

By essentially wrapping a nutrition consultant inside a shopping assistant, Nudge lets family members synchronise their shopping lists, then offers real time advice to the one doing the shopping, suggesting healthier alternatives at the moment he or she reaches for the supermarket shelf.

In each of these cases, the breakthrough isn’t one of technology so much as intent. We’ve had access to smartphones, fitness trackers and the internet for a decade now but what we’ve lacked is the idea that dietary and exercise habits deserve just as much attention as the symptoms of disease.

In our current, symptom-driven approach to medicine in the UK, US and many other countries, asking doctors and health organisations to apply this level of diligence to heading off the disease before it starts is asking a lot. Fortunately, the tools are improving rapidly.

No coaching service or smartphone app can end the diabetes epidemic on its own and addressing its root causes will require involvement from both the private and public sector.

Our hope is that services like Omada and Nudge can raise awareness and serve as a model for like-minded organisations, spurring them to create their own solutions to help patients fend off diabetes before it strikes.

In the long run, this would not only ease the suffering of individuals and families but also lift some of the load from our already overburdened healthcare systems.

This article first appeared in Digital Health Age

Feb 2016