Onduo Delivers Diabetes Clinic and Coaching to Your Smartphone
By Brian Levine and Adam Brown
Available for BCBS members in South Carolina and Arkansas, with Georgia coming soon; program includes an app, coaching, a connected meter, and unlimited supplies at no cost for type 2 diabetes
In 2016, Google’s healthcare arm (Verily) and drug manufacturer Sanofi partnered to form a new diabetes company, Onduo. After one-and-a-half years of near-silence, Onduo has now become more public about its efforts, launching a virtual diabetes clinic in select states for people with type 2 diabetes.
Adults with type 2 diabetes (18+ years) and with Blue Cross Blue Shield insurance in South Carolina, Arkansas, and Georgia may be eligible to enroll in Onduo at no cost. (If this applies to you, get enrollment details here.) Onduo has not announced when it will become available for people in different states or on other health plans.
What’s a “virtual clinic” for type 2 diabetes? Onduo’s program includes:
A Welcome Kit with a cellular-connected Telcare blood glucose meter, an A1c test kit, test strips, and lancets
Unlimited, free re-orders of strips and lancets through the Onduo app
Access to a coaching team via text message through the app
A Dexcom continuous glucose monitor (CGM) for certain people who qualify. (Onduo has not yet shared the criteria.)
This program’s offerings continue a trend of similar efforts from mySugr, Livongo, and One Drop: a connected blood glucose meter, unlimited test strips, and in-app coaching and insights. These efforts all aim to bring more continuous care and support between doctors’ appointments (especially related to food and exercise), to capture more glucose data and to help users make sense of it, and to make access to glucose monitoring supplies far easier and less expensive. If these programs can work successfully on a large scale (e.g., serving hundreds of thousands of people), we may see many more of them in the coming years.
Particularly for those who would like more time with their healthcare providers, Onduo may be a great option because of the ease of reaching out to a care team. Onduo may also be a helpful tool for those who love seeing data – the app holds glucose readings, tracks food and activity, and provides insights all in one place.
For pictures and more details on Onduo, read on, or click to jump to a section:
Less than a week after enrolling in Onduo, users receive a Welcome Kit in the mail. The free kit contains a Telcare blood glucose meter (BGM) with built-in cellular connectivity, an A1c test kit, lancets, and glucose strips. Onduo lets you use any other blood glucose meter if you prefer, but the Telcare BGM is more convenient because it automatically sends data to the Onduo app using cellular, meaning no manual entry and no dealing with Bluetooth pairing to a phone. Users can order unlimited refills of supplies (lancets and test strips) through the app.
Certain people with type 2 diabetes are also eligible to receive a Dexcom G5 CM at no cost. Onduo has not said how it decides who gets a CGM, but presumably it will be recommended for people who take insulin or sulfonylureas (e.g., glipizide, glyburide, glimepiride), have frequent high and low blood sugars, don’t check their blood glucose frequently, or are switching medications. It is not clear whether the CGM will be used long-term or just for a short period of time to help the Onduo care team get more glucose data – especially overnight and after meals.
The “Onduo for Diabetes” app uses blood sugar readings to show users glucose trends and patterns. The app lets users record meals by taking photos, input exercise manually or import it from Apple Health, and text with a coach. Unfortunately, the app can only be accessed with a code, meaning the features are not publicly available for those not in Onduo’s program.
The meal photo feature, similar to the Meal Memory app (which is sadly no longer available), helps users see the effect of a meal by pairing a picture of the food with blood glucose data. The app shows glucose level before the meal, the highest level after the meal, and the difference between the two, as well as a continuous glucose trace for CGM users. Using photos to log meals is faster and easier than manual input, and it doesn’t require searching through databases of food and selecting amounts. Photo recognition technology is not quite good enough to automatically recognize and calculate food content based on a picture, but a simple photo paired with the blood glucose information can be very helpful for users and their coaches. (diaTribe Senior Editor Adam Brown has written a lot about using glucose data to figure out how different foods affect your blood glucose, especially in his book, Bright Spots & Landmines. When he saw the meal photo feature of the Onduo app, he let out an excited “Yes!”) The app also shows daily and weekly glucose data and can sort by meal – for example, just displaying glucose data around breakfast.
Each person with diabetes in the Onduo clinic is assigned a Care Lead, who can be reached by text or phone through the Onduo app and has access to a team of lifestyle specialists and Certified Diabetes Educators. Care Leads are specialists like registered dieticians, personal trainers, fitness instructors, and beyond. Ideally, users will be paired with Care Leads who meet their greatest needs. Highly specialized members of the Onduo care team also advise when necessary. For example, a pharmacist can be brought in when adjusting a medication dose.
Individuals in the program have the option to share data from Onduo’s care team and app with their own healthcare providers.
A big unanswered question in this area is how virtual clinics like Onduo and Virta will work with the traditional healthcare system. For instance, how will healthcare providers be kept up to date about what Onduo is doing? Where is the line between providing lifestyle advice (via Onduo’s coaches) and giving medical advice?
Onduo Partners and possible features coming soon – insulin dose recommendations and diabetes education
Onduo has established multiple partnerships in a hurry – in addition to Telcare (connected BGM) and Dexcom (CGM), Onduo has teamed up with Voluntis, Glytec, Amwell, and Mytonomy. These partnerships hint at things coming to Onduo in the future:
Voluntis’s FDA-cleared Insulia app provides automated basal insulin (long-acting) dose recommendations, adjustments, and coaching messages based on entered blood glucose readings. Healthcare providers can prescribe a treatment plan and monitor progress with a dashboard.
Glytec’s FDA-cleared Glucommander sends dose adjustment recommendations for both basal (long-acting) and bolus (mealtime or rapid-acting) insulin to healthcare providers, who then approve the changes and forward them to users.
Amwell is a telehealth service, meaning people and providers can exchange health information through electronic communication. Accessible online and through an app, Amwell allows people to have full-length medical visits over video-chat.
Mytonomy delivers “micro-learning content” to users with step-by-step videos – these videos are already available to Onduo users.
Onduo has also licensed the use of American Association of Diabetes Educators (AADE) curriculum to ensure that Onduo’s program follows the standards of leading diabetes care professionals.