Nearly one in three Americans – 96 million adults – have prediabetes, but only 2-3% receive help to prevent it from progressing to full-blown disease.
The medical consequences of diabetes are, of course, significant – affecting vision, the circulatory system, and in severe cases, requiring amputation – but there are other consequences as well. Because so many healthcare resources are spent managing the myriad medical risks of diabetes, properly addressing and ideally preventing it could save American taxpayers enormous amounts of money.
Remote patient monitoring holds great potential for improving the treatment and lives of people with chronic diseases, including those with diabetes, and the rise of artificial intelligence and automation offers huge opportunities to improve RPM technology.
Oren Nissim, CEO and co-founder of Brook Health, a company developing AI-enabled remote monitoring tools, is himself a type 2 diabetes patient.
We spoke with Nissim to discuss the challenges of diabetes care, how RPM can help overcome some of these challenges, how AI can enhance RPM technology when addressing chronic diseases, why addressing diabetes properly can save taxpayers money, and what Nissim calls “the next generation of telehealth.”
Q. What is the current state of diabetes in America and what are the main challenges?
A. When you hear about diabetes today, the No. 1 story is that GLP-1 drugs have become extremely popular in recent years, and it has been a transformative experience for people taking these drugs for two reasons. First, these drugs help people better control their blood sugar levels. Second, and perhaps most notable, people taking GLP-1 drugs have lost significant amounts of weight.
That's a good thing. The problem is that these drugs have to be taken for life, which means patients have to be prepared to take them for the rest of their lives. Nobody wants to do that, but eventually it happens because people become dependent on these drugs.
However, not everyone should take GLP-1 drugs, and they are not always covered by insurance, so more and more people are paying out of pocket for these drugs, which is very expensive and unfair.
On top of this inequality, the United States still has a large number of “food deserts,” exacerbating the country's overall poor eating habits. And difficulty managing one's diet is another obstacle faced by so many. We need better access to nurses and dietary coaches to help control blood sugar levels. But improving access to care for those who live under bridges or face amputations due to diabetes is another challenge entirely.
Most people with diabetes have type 2. For these people, managing their blood sugar levels while also managing everything else in their life can be a real challenge, and many wonder if they can do it on their own.
It is not surprising that a “magic bullet” would be an attractive option, but who, other than pharmaceutical companies, really benefits from a drug that a patient must take for the rest of their life when other options are available?
Q. How can RPM technology help overcome these challenges?
A. Remote patient monitoring tools can be used to help people with diabetes in a variety of ways. Clinicians and other caregivers can monitor patients' blood glucose levels, prompt them with reminders, and help them create health plans.
I also think that the immediacy of highly personalized information is really important when you're trying to create and establish new habits. Not only is this kind of individualized data incredibly useful and relevant, but accessing it also makes you feel motivated and confident — both essential emotional states for driving change and overcoming challenges.
Let's say you're at the supermarket trying to choose a yogurt. If you have diabetes, the chances of finding a yogurt product that's right for you are slim, almost zero, and you have to actually pick up the container and read the label to know for sure. If you've been to the dairy section of a supermarket recently, you've probably noticed the overwhelming number of types and brands of yogurt.
The food industry has made it extremely difficult for people with lactose intolerance to make the right choices. Now imagine if remote AI technology could be used to understand labels, read them faster and provide recommendations while you're out and about making everyday choices in your daily life.
This is just one example of how remote patient monitoring technology can make a big difference in improving personal health.
Q. How can AI enhance RPM technology when it comes to addressing chronic diseases such as diabetes?
A. It's all about how smart agents can support users on a day-to-day basis and best effect positive change. That's where AI really shines.
Many people mistakenly believe that AI should mimic nurses and doctors. But that's not the right lens to view AI through. Ultimately, AI should encourage healthy habits and behaviors and provide healthy guidance for making important daily choices.
In reality, blood sugar control can also be achieved through lifestyle changes and increased awareness, with the right tools and support. While no one should have to make the extreme choice of amputating a foot because their diabetes has gotten out of control, 120,000 Americans with diabetes have a leg or foot amputated each year.
Additionally, AI can take into account an individual's health conditions beyond diabetes, such as other underlying conditions that need to be factored into suggestions, recommendations, and health plans. This is a lifestyle intervention rather than a medical intervention, but the end goal is the same: improving patient outcomes.
Q. How is what you call “next-generation telehealth” improving outcomes for this patient population, and how can it save American taxpayers money by better managing diabetes and especially preventing it?
A. The majority of Americans with diabetes don't use AI or other advanced digital tools to manage their condition, but those who do have their own unique agent with them at all times, someone who understands what's going on in their day-to-day lives.
This agent helps them make better, smarter, and easier choices on the go, which makes a dramatic difference in these people's lives because otherwise they're making dietary and lifestyle choices based on their existing habits, and their existing habits aren't going to get them where they need to be.
Today, people with diabetes can see a doctor or health coach who tells them what to do and then they go home and do it. Unfortunately, this system doesn't really work, because only those who are extremely motivated to change their habits are successful.
The key to helping more people successfully manage their disease is to switch from a transactional, face-to-face model to one where disease management is woven into the patient's life. Most people today are comfortable with digital technology, making it easy to integrate these tools into their daily lives.
Addressing diabetes properly, particularly through prevention and better management, can save American taxpayers enormous amounts of money by targeting a major source of healthcare expenditures. Because 90% of Medicare costs are related to chronic diseases such as diabetes, a focus on prevention and effective management can significantly reduce overall healthcare costs.
New drugs like GLP-1 inhibitors are effective but are prohibitively expensive and cause lifelong dependency. Instead, widely available technology like smartphones and AI-driven apps can empower people to make better decisions about their daily health at a fraction of the cost. This approach is not only cheaper than traditional medical interventions and expensive drugs, but also more scalable.
By helping individuals better manage their diabetes, they can avoid costly complications such as amputations and further reduce healthcare costs. Considering that the United States currently spends over 20% of its GDP on healthcare, preventing and better managing chronic diseases such as diabetes can significantly reduce this economic burden.
Ultimately, promoting self-management and education will empower individuals to make healthier choices and better understand their condition, reducing reliance on costly medical interventions and saving taxpayers significant financial burdens in the long run.
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