Decoding Diabetes With Dr. Bob: Diabetes in the Digital Era

The traditional U.S. healthcare system has never been particularly good at caring for people between visits – and that’s where diabetes lives. Most management happens outside of the clinic, when people with diabetes are making day-to-day choices around meals, exercising, taking their medications, and monitoring their glucose.

Our system wasn't built for the requirements of diabetes management, and honestly, considering the clunky patient portals most healthcare providers currently work with, traditional clinical care is not where it needs to be yet. Connected diabetes care (virtual diabetes management programs and platforms that engage people with diabetes) picks up where traditional care leaves off by providing person-centered care through consistent support, real-time adjustments, and timely engagement.

I’ve long been passionate about this space. My time with companies like Onduo – an early joint venture between Google, Sanofi, and Dexcom – gave me a front-row seat to the potential and the limits of these care models. I’ve guided several other connected diabetes care startups since, and the experience has been intriguing. For all our technological prowess, we are still in the early innings of figuring out how to integrate digital tools in ways that scale and last.

Digital health era: What’s changed?

The COVID-19 pandemic was the tipping point for digital health. For a brief period, we saw near-universal adoption of virtual care in endocrinology and primary care. But post-pandemic, most providers reverted to pre-COVID habits. Why? 

Partly because reimbursement reverted, and the tech wasn’t always seamless. But it was mostly because workflows didn’t adapt fast enough for the majority of providers, never becoming intuitive compared to in-person visits. In my personal experience, I was surprised that many of my patients at the Joslin Diabetes Center preferred to deal with Boston traffic and parking hassles to be seen in person, despite having telehealth visits as an option. 

Still, that pandemic accelerated investment in digital health. In recent years, we’ve seen the advent of artificial intelligence (AI) in healthcare. While most AI applications to date have focused on admin or operations (think prior authorizations, documentation, and scheduling), we’re beginning to see promising clinical use cases. One of the clearest is AI-assisted retinal imaging, offering scalable screening for diabetic retinopathy.

Eventually, AI could help the field triage patients with particular personalization, predict who’s likely to benefit from certain interventions, and even customize data based on behavioral patterns. Imagine an app that not only tracks your glucose but knows when and how you’re most likely to respond to a suggestion and adjusts accordingly. 

Making sense of the “Wild West” of connected diabetes care

One of the two papers Close Concerns founder Kelly Close, Dr. Brian Levine, and I co-authored years ago, offered a taxonomy for connected diabetes care – a way to bring structure to what often feels like the Wild West of virtual diabetes care offerings. Five years later, it still holds up surprisingly well.

The taxonomy sorts connected diabetes care programs into four categories from top to bottom: 

1. Virtual diabetes visits
2. Non-physician virtual diabetes clinics
3. AI coaches
4. Quantified self-solutions 

The type of program a patient uses depends on clinical need and patient preference. From a population health perspective, higher-risk patients would be offered programs in categories higher up on the pyramid, and vice versa, thus aligning the cost of care with potential savings. 

What we are seeing now is that, as companies grow, they may start in one tier but then develop the full suite of solutions addressing other tiers. For example, Lark Health was an AI-driven coaching platform for many years. Due to the rise in popularity of GLP-1 receptor agonists like Ozempic, the company has now added a virtual clinic providing obesity care and GLP-1 prescribing where appropriate. 

Are digital health tools effective?

It depends on who you ask, from data-driven perspectives or personal experience.

Part of the challenge is that traditional clinical trials aren’t well-suited to fast-evolving tech. By the time the study wraps up, the platform may have already upgraded. That’s why real-world evidence is so important here. It’s not just more practical – it’s often more relevant.

That said, one of the biggest hurdles is outcome standardization. In the early days of patient-centered medical homes, we faced a similar problem. Everyone was piloting something different, with different metrics, and it slowed adoption. It wasn’t until the Commonwealth Fund brought stakeholders together to agree on a shared evaluation framework that things took off. 

We developed some common evaluation tools that significantly accelerated the spread of these medical homes and ultimately led to their incorporation in the Centers for Medicare and Medicaid Services Innovation Center payment models. We need something similar to happen here with connected diabetes care.

Where are we headed?

Connected diabetes care programs are becoming more consolidated and integrated with all the other offerings out there, within and outside of diabetes. Programs are also stepping in to prescribe medications to people with diabetes. 

Consolidation of programs and offerings is already happening, both within diabetes and across other conditions. For example, Omada Health has expanded to offer care for mental health and musculoskeletal conditions. The advantage of consolidating programs is that it increases their appeal to employers and payers, who often prefer single platforms that can do more.

Prescription offerings are another growing trend. We’ve seen programs like 9amHealth and Form Health move into GLP-1 prescribing, bringing medication management under the same roof as behavior change. This could help overcome therapeutic inertia (the well-documented delays in advancing to an optimal medical regimen), especially in under-resourced settings.

Integration, not parallel systems. This is the real vision for connected diabetes care. Its goal should not be to compete with traditional care – it should augment it. Some of the most exciting work now is happening in segmented populations; for example, tailoring tools for teens with type 1 diabetes, older adults with cognitive challenges, or those with diabetes depression. One-size-fits-all is out. Precision engagement is in.

Final thoughts

Connected diabetes care isn’t a silver bullet, but it could be a powerful tool – and for many, it already is. If we can align the stakeholders, define meaningful outcomes, and put the patient experience at the center, we can keep building something that truly changes lives.

The information and insights in this column are adapted from an original Closer Look column, published by Close Concerns. Written by Dr. Bob and Elaine Young, this column was originally designed for clinicians, researchers, and professionals working in diabetes and obesity care and has been adapted for diaTribe audiences.

Read more installments of Decoding Diabetes With Dr. Bob here:

• Meet Dr. Bob
• Diabetes and Mental Health
• The GLP-1 Revolution
• Automated Insulin Delivery