Home-Brewed Insulin and DIY Bionic Pancreases

For patients suffering from diabetes, managing the disease is a complicated undertaking. Keeping an ever watchful eye on blood glucose levels, carefully considering how every meal or physical activity will impact blood sugar, and knowing how much insulin to take, and when to take it, can be an overwhelming burden. Although insulin treatments and technologies like Continuous Glucose Monitoring systems are available to ease that burden, diabetes treatment has failed to innovate quickly enough to take full advantage of technologies that could transform care. The result is a broken system that fails to meet many patients’ needs for affordable insulin or for more sophisticated approaches to diabetes management.

Now, some technologically savvy patients are taking matters into their own hands. In a fascinating piece published in the New York Times this week, writer Peter Andrey Smith paints a picture of a DIY revolution in diabetes care, as diabetes patients overcome hurdles to getting the treatment they need with their own homespun solutions.  

Smith looks at how user-driven innovation is changing the market in diabetes care from the bottom up, and how it might encourage healthcare technologies, drug manufactures, and regulators to quickly catch up. Parents of children with Type 1 diabetes are using homemade computer programs to remotely monitor their children’s glucose levels; some creative patients are hacking their way towards a bionic pancreas; while patient-led groups of biotech hackers are developing generic forms of insulin by reverse engineering expired insulin patents as part of the Open Insulin Project in an effort to bring down the astronomical insulin prices in the U.S.

On that topic, A recent New York Times opinion piece points out that insulin prices in the U.S. are six times higher than in most of Europe. With only 3 manufacturers dominating the insulin market, and no competition from generic manufacturers, prices have risen at alarming rates in the past five years. For example, the price of Humulin R U-500 has skyrocketed by 325 percent between 2010 and 2015.

Those rising costs coupled with the rapidly growing diabetes population creates a market scenario in serious need of transformation. The Centers for Disease Control and Prevention estimates that 29 million adults are living with diabetes in the U.S. That number is expected to more than double, along with costs related to diabetes treatment, over the next 25 years, according to a report by the American Diabetes Association.

While there are plenty of companies working to address these issues with new technologies and new treatments, too often diabetes patients are presented with one-size-fits-all solutions. The DIY revolution in diabetes care is a clear indication that the industry’s current approach isn’t sufficiently personalized or patient-centered.

Diabetes management and treatment can vary greatly from person to person, and it’s clear some patients are being left behind. Here at Aspire, our Daibetter, formerly Tempo Health, LLC, team is focused on personalization as we develop technologies that can adapt to each individual. Not only does our Soft CGM system have the potential to dramatically broaden access to continuous glucose monitoring with a more affordable, less intrusive solution; the adaptive algorithms our Soft CGM uses will tailor the algorithm to each individual to deliver more accurate, personalized glucose predictions.

Moreover, if the efforts of the Open Insulin project or other patient-led innovations truly lead to more options in the marketplace, and generic drug manufacturers step up to mass produce cheaper insulin treatments, the result will be more variation in insulin treatment plans, and more variation in the duration of short-acting insulin. That means personalization in diabetes management solutions will be more important than ever.

Change is coming to diabetes care. And more likely than not, the DIY movement to innovate diabetes treatment and management are just the birth pangs of a much bigger transformation to come.

The Power of Patient Feedback

In healthcare, the growing importance of patient engagement is gaining a lot of attention from journalists, healthcare providers, and other analysts in the industry. More and more experts are recognizing that when there’s more communication between the doctor and the patient, and the patient becomes actively engaged in their own healthcare, the results are better health outcomes and lower costs.

According to an article in the healthcare policy journal Health Affairs, studies have shown repeatedly that engaged, “activated” patients are more likely to engage in preventive behavior like having regular check-ups, screenings, and immunizations. They’re also more likely to adhere to treatment and avoid health-damaging behavior. That in effect lowers costs. Patients who score higher on engagement had lower rates of costly care like hospitalizations and emergency department visits, as well as lower costs overall.

The question for many providers is: how do we get patients engaged in their own care? First of all, the immense power of patient feedback shouldn’t be underestimated. At Aspire venture MedStatix, we believe a simple request for feedback can be the crucial first step to helping patients understand their critical role in a health plan, and it can give providers the knowledge they need to improve their relationship with the patient.

While customer service has long been a tenet in most industries, it’s often been an overlooked, if not ignored, facet of the healthcare experience. With the Affordable Care Act and the rise of crowd-sourced information on the Internet, patients have more and more say in their healthcare choices, and that means more consumer power. To keep pace with the rapidly changing healthcare marketplace, providers need to pay more attention to the patient experience, not only for their own financial survival, but also for the welfare of their patients and the health of the industry as a whole. And when building trust and empathy between the doctor and patient, there may be no tool more effective than a genuine request for feedback.

To manage the patient experience, providers need tools that can quickly gain reliable feedback from patients. As the truism goes, you can’t manage what you can’t measure. With the MedStatix platform, doctors get actionable feedback in real-time, with an average response rate of more than 40 percent, that drives insights to power real change in provider communication, practice operations, and the overall customer service in healthcare.  

Not only does the platform allow doctors and patients to see overall patient satisfaction scores, it also delivers useful metrics directly related to how successfully a practice engages their patients. A communication index measures how well doctors are communicating with patients. Patients can also rate how well doctors involved the patient in healthcare decisions, how well doctors listened to the patient, and how well doctors explained illnesses, options, and procedures.

By measuring patients’ perceptions in these areas, providers are sure to find ways to improve their scores with operational changes or simple policy tweaks. For example, one practice who uses the MedStatix platform wanted to improve their communication scores, as well as scores on whether patients felt they had enough time with a doctor. To do so, they simply added the policy for their physicians to always ask the patient whether all of their questions were answered at the end of the visit. In a classic halo-effect scenario, doing so not only addressed the doctor communication index, it also improved patients’ perception that they had enough time with the doctor.   

Improving the patient experience can have big benefits for providers—boosting patient loyalty and recommendabilty. In an age of ultra-savvy consumers, where an honest online review can have far more power than any marketing campaign, positive feedback is a valuable resource. But perhaps most importantly, a positive patient experience is also correlated with better patient engagement, and hence, better health outcomes.

According to the same Health Affairs article, several studies have shown that patients with high engagement scores report more positive care experiences, better exchanges with physicians, and more out-of-office contact with physicians. Although we can’t be sure which direction causality is going in that relationship, the correlation between the two should certainly get providers thinking about the potential benefits of improving patient/doctor relationships. And that should get us all thinking about just how powerful patient feedback can be.

Put it to the Test

No startup is immune to getting carried away with excitement about their ideas, but when it comes to developing those ideas into a real world product, all too often startups forget to ground themselves by testing their assumptions first.

In an interesting article from Y Combinator’s blog The Macro, author Yevgeniy Brikman argues that for startups to be more successful, they must engage in a process of repeated trial and error that makes incremental, but tested, progress towards the end goal: releasing a successful product for market.

Too often, Brikman says, startups spend months, or even years developing a Minimal Viable Product without finding out first whether anyone would actually be interested in the product.

According to a study of 101 failed startups conducted by CB Insights, an NYC data research company, the number one reason startups failed was that there was “no market need”, which accounted for 42 percent of failed companies. The number two reason, at 29 percent, was that the company “ran out of cash”. 

The solution? Put your product in front of real users as quickly as possible, no matter how incomplete, Brikman says. Most likely, you’ll have to go back to the drawing board over and over again, but the trial and error process is the surest way to get to where you want to go, without wasting vast amounts of time developing something that nobody wants.

A Minimal Viable Product, Brikman says, is not actually about the product, it’s about the process.

“An MVP is a process that you repeat over and over again: Identify your riskiest assumption, find the smallest possible experiment to test that assumption, and use the results of the experiment to course correct,” Brikman writes.

At Aspire Ventures, we’re taking a similar approach as we develop software solutions to help diabetes patients manage their disease. With periodic “sprints” followed by real-world feedback, we’re making sure real consumers are keeping us on course.

Last month, we completed a “design sprint” where we developed a concept, designed a product, built a conceptual prototype, and got customer feedback in a 5-day period.

That resulted in plans for a new mobile application, Soft CGM, that uses personalized algorithms to allow diabetes patients to continuously monitor their glucose levels without actually using a continuous glucose monitor. Instead, patients can get accurate glucose predictions based on other, less intrusive inputs like health trackers, finger sticks, and manual data inputs. We already laid the technological groundwork for Soft CGM in the previous year when we applied our machine learning platform A2i to diabetes management. During that period, we found that we could accurately predict glucose levels with non-CGM data, but moving forward with product development relied on a few assumptions that first needed to be put to the test.

The most important assumption is that users will actually be willing to enter the necessary data into a Soft CGM system such as finger stick data, carbohydrate intakes, and health tracker data. And for the app to work correctly, users would also need to input data during a “training period” to allow the system to calibrate to the individual user.

At the end of our first design sprint we received positive feedback from a group of diabetes patients that such a product would be very useful, and that they would indeed go through the training period and input the necessary data if the system provided accurate predictions. While that was indication that we should move forward with the project, we can’t claim it as a total victory, because humans are by and large terrible predictors of their own behavior.

Which brings us to the next step. To thoroughly test our assumption, we’re now in the midst of a two-week development sprint to build a useable prototype. That prototype will be tested internally by Aspire team members who have type 1 diabetes to see if users can actually follow through and enter the data for the benefits of Soft CGM. If internal testing goes as hoped, we’ll begin refining our product for clinical trials.

As we move toward the end goal of a Soft CGM market release, we’re keeping our focus on the process that Brikman so skillfully explains: identify the riskiest assumptions, and find the smallest experiment to test those assumptions. Likewise, we’re keeping focus on the consumers and diabetes patients who will ultimately benefit from that process.


Super Bowl Highlights New Media Trends, and Missed Opportunities for Advertisers

While brands spent vast sums of money kicking off advertising blitzes at the Super Bowl this year with $5 million TV ads and digital campaigns, new trends in media consumption reveal they may have missed some marketing opportunities.

According to this article in Venture Beat, half of those watching sports content do so on a mobile device, PC, gaming console, or smart TV. Indeed, it’s a new era for TV viewership as online video replaces traditional channels. So what does that mean for advertisers?

Although the big budget TV ads can steal the media spotlight, many brands overlooked a digital marketing avenue that has a higher return on investment: email. And with more people on their devices than ever—not only checking their email between plays but also supplementing their viewing experience with other online content—the opportunities to reach consumers with email advertising during big TV events are greater than ever.

Knowing how to reach customers and generate sales with email takes particular savvy. Not only do you need to know who to reach, when to reach them, and how; you also need to have an efficient way of doing so. Personalized approaches that tailor ads to individuals in particular contexts are gaining a lot of traction with a lot of brands, but there’s clearly a lot of room for growth. When it comes to intelligent solutions for hyper-targeted emails, Aspire venture Wylei is on top of their game.

Wylei’s predictive emails give companies an easy way to send individualized, context-specific emails that harness user data to self-assemble when the user opens the email. That can be an extremely useful marketing tool for any brand looking for an easy way to personally reach customers when they’re most likely to engage, like during a super bowl, an Academy Awards ceremony, or political debate.

Leading up to Super Bowl 50 last week, Wylei ran an email campaign for Marriot International that incorporated this touching super bowl-related video:

Within two weeks the video has 1.5 million views and counting.

Using sophisticated tools like the Wylei platform to create smarter email strategies is the easiest way to get the biggest bang for your buck. But don’t take our word for it, read the article here.