Digital Diabetes Management Solutions

Type 2 diabetes impacts almost one in seven people in the United States and is the most expensive chronic condition, leading to significant clinical complications. Given the critical role of patient self-management in diabetes, there has been significant investment in creating digital diabetes management solutions with patients as the primary users.

The core objective of these solutions is to support improved glycemic control through tracking of blood glucose, paired with additional education and support. These solutions use three broad approaches:

• Remote patient monitoring—Enable physicians to support remote patient monitoring of blood glucose levels with a goal of improved glycemic control.
• Behavior and lifestyle modification—Engage patients with a mix of behavioral, clinical, and lifestyle modification programs in addition to glycemic feedback with a goal of glycemic control and other health improvements.
• Nutritional ketosis—Induce a state of ketosis in patients through intensive dietary guidance and monitoring of glycemic and ketone levels with the goal of diabetes remission.

Read the Executive Summary

Report contributors and reviewers provided important expertise and insight throughout our process. Those who directly contributed to the report have no relevant conflicts of interest to disclose.​

Digital diabetes management solutions in the remote patient monitoring and behavior and lifestyle modification categories do not deliver meaningful clinical benefits, and they increase healthcare spending relative to usual care. The evidence showed that improvements in glycemic control for patients using digital diabetes management solutions were minimal and short-term. 

After accounting for the average price of these products, these solutions increase net healthcare spending for purchasers because the small, estimated savings are less than the cost of the solution. Exceptions may include 1) people with higher starting HbA1c who are newly starting insulin, and 2) people seeking diabetes remission through nutritional ketosis.

These findings are based on the criteria set forth in the ICER-PHTI Assessment Framework and the currently available evidence. PHTI conducted a secondary research review that relied on published literature and information. PHTI did not conduct original testing of the tools. Please see the full Digital Diabetes Management Solutions report for the complete assessment, methods, and recommendations.

Purchasers

• Require data analysis and transparency
• Align payment for solutions with their clinical performance, including financial performance guarantees in contracts
• Focus the deployment of solutions to patients with the highest HbA1c levels

 Innovators

• Clinical evidence generation is critical to support adoption
• Sustainability of clinical benefits is central to a solution’s impact
• Provider acceptance and engagement matters
• Contract for results

Providers

• Performance may vary by sub-population
• Diabetic remission is a worthy goal that may be supported with effective digital solutions
• Be aware that many digital health solutions are cost-additive