With the recent proliferation of advanced diabetes technology, people with Type 1 diabetes now enjoy an unprecedented ability to assess and fine tune their daily management. Nevertheless, most patients still wait to talk things over with their doctors before they make even minor changes to their insulin strategies. The wealth of data that smart pumps and glucose monitors generate offers the ability for doctors to give better advice than ever, but that mountain of data can also be overwhelming.
DreaMed is an Israeli company that hopes to use artificial intelligence to save time for doctors and improve their recommendations by making diabetes management suggestions using data from their patients’ devices. It hopes that by analyzing that data with its proprietary algorithm, the business can make regular visits to the endocrinologist’s office go much more smoothly. The DreaMed slogan – “We treat the data, you treat the person” – is directed at busy endocrinologists who worry that they don’t currently have the time to give their patients the attention they need.
I spoke with Dr. Joshua Tarkoff, a pediatric endocrinologist who was among the first to begin using DreaMed. Although the COVID-19 pandemic rudely intruded on the rollout, he and his colleagues have now had enough repeat visits to have a good feeling for how patients respond to the system.
Dr. Tarkoff echoed DreaMed’s message by emphasizing to me how much the software has enabled him to “treat the patient instead of just the data.” In a regular follow-up visit, often just 15 minutes long, Dr. Tarkoff needs to spend most of that time analyzing and discussing the hard data of insulin doses and blood sugar measurements. “The amount of data can be daunting to review.” There’s barely any time to connect with the patient, or to talk about the million other variables that go into life with diabetes:
“Diabetes is hard, it’s a full-time job, 24/7. DreaMed allows me to delve deeper into diet, exercise, mental health, the other important stuff that sometimes gets lost in a regular visit. It allows for a less rushed visit.”
DreaMed works by linking up with diabetes data management software, such as Tidepool or Glooko. Data from a connected CGM or blood sugar meter and insulin pump are harvested more or less automatically: “The beauty of this is that there’s a lot of data upload that happens without the patient doing anything.”
Next DreaMed, using its algorithm, will suggest ways in which the patient’s management can be improved. It suggests changes to three major factors – basal rate, carb:insulin ratio, and correction factor – as well as other tips, such as tweaks to bolus timing. Those suggestions go straight to the endocrinologist, who has a chance to review, accept, reject or adjust them as he or she sees fit before passing them along to the patient via the DreaMed app. The endocrinologist can also update the patient’s medical records with the changes instantly.
In addition to freeing up time during patient visits, the DreaMed algorithm (named Advisor Pro) may be able to make more sophisticated judgments than can any one doctor perusing data over the course of just a few minutes. Diabetes is incredibly complex, and “a lot of different factors go into a blood sugar,” as Dr. Tarkoff noted: “Are these highs because you’re bolusing late, because the ratio is wrong, because the sensitivity isn’t strong enough, because your basal rate is too low, or a combination of all of that? The algorithm can see all those things at once.”
Naturally, the more enthusiastically a patient uploads his or her information, including carb consumption and exercise data, the better the algorithm can be. But when I wondered aloud if the technology was inappropriate for patients that tend to be less engaged, Dr. Tarkoff insisted that it is broadly applicable: “There are data minimums, but any patient that meets those minimums will get recommendations that he or she can benefit from.”
Even before the coronavirus pandemic pushed so many doctor’s visits into the virtual world, telemedicine was one of the most talked-about trends in medicine and in diabetes in specific. In January, we profiled Steady Health, a California company that functions as a remote endocrinology clinic, one of several companies hoping to harness modern communication technology to improve care for people with diabetes.
As a pediatric endocrinologist, Dr. Tarkoff sees a wide variety of patients in many different circumstances. Little children have their blood sugar and insulin managed by their parents or other caregivers, while teenagers, often on their own for the first time and dealing with the struggles of the age, are notoriously among the least compliant of Type 1 diabetes patients. But so far, “pretty much everyone is excited about it.”
So far, the system has also seemed to have improved patient engagement. “I now have patients reaching out to me between visits to see if they can do even better. Before we started using DreaMed, that almost never happened.”
Going forward, the following places will be implementing DreaMed: University of Florida, Texas Childrens Hospital, Nicklaus Childrens Hospital Miami, Schneider’s Childrens Hospital, Stanford Lucile Packard Children’s Hospital, Billings Clinic, Montana.