Would You See a Virtual Endocrinologist?

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Visits to the endocrinologist can be frustrating.

Simply getting to the office can be very time-consuming (mine is one hour from my home, and I’m better off than many), and there’s a decided measure of absurdity to a visit that is at least partially dedicated to assuring the insurance company that yes, you do still have a lifelong disease. In many communities, endocrinologists are scarce and appointments are hard to come by, adding a frustrating level of difficulty to what should be a simple check-up. 

On the other hand, even if you get see your endocrinologist frequently, you still might lack the time to discuss your condition in much detail. I have nothing but sympathy for our overworked doctors, but it’s unavoidably true that these check-ups visits can feel hurried and even perfunctory. Diabetes is a condition that requires daily adjustments and constant vigilance, and there just isn’t enough time during a regular check-up for even the most helpful of doctors to understand her patient’s every challenge.

A San Francisco start-up named Steady Health is betting that technology can help fix this state of affairs. On January 15, the business launched what must be the world’s first full-service remote endocrinology clinic.

Steady Health

Steady Health asks you to replace your traditional endocrinologist with a virtual endocrinologist you will never meet, and with whom you will communicate via text message and video chat. Steady Health offers the same specialist care that a brick & mortar endocrinology clinic does—prescriptions, lab orders, referrals—but does it all through a smartphone app. Your new endo will arrange for routine examinations, to be performed by your primary care provider, as well as regular virtual check-ups. Between these scheduled consultations, the Steady Health team aims to provide “continuous coaching,” diabetes educators and doctors ready to harness your CGM data to provide convenient analysis and rapid feedback.

Steady Health - ReportOf course, a truly virtual endocrinologist cannot handle all of your diabetes needs. At a minimum, you still need to an old-fashioned blood draw to keep track of your A1C, and endocrinologists commonly perform several other physical examinations besides. So while smart phone technology isn’t about to eliminate doctor’s visits, Steady Health thinks these functions can be ably performed by a family doctor or primary care provider (PCP) under the direction of the remote endo. Steady Health connects with your PCP, handles the ingoing and outgoing medical information, and even puts a checklist into your hands for you to bring to the doctor’s office.

This raises a few obvious questions, so I got in touch with Henrik Berggren, Steady Health’s founder. I asked if he was concerned that PCPs would be ill-equipped to physically examine patients with diabetes; after all, they haven’t had the specialized training to recognize diabetic complications. He admitted that it was a subject that they had given a lot of thought to, but sounded confident in his conclusion: “Fundamentally we believe that with CGM connected to our clinic, we actually think that we keep a closer eye on our patients than with the traditional fingerprick and quarterly visits model.”

In a way, the Steady Health model turns that traditional care model on its head by de-emphasizing the importance of regular check-ups (by outsourcing them to a non-specialist) and paying more attention to what happens in between those check-ups.

Part of the thinking here is that PCPs are simply more accessible; their offices are likely to be closer, and they’re less overbooked. There is a known endocrinologist shortage in the US, an issue that is getting worse as diabetes diagnoses become more common and not enough new doctors enter the field. New patients now need to wait an average of 37 days for their first endocrinologist appointment, at least twice the length of almost every other medical specialty. And the shortage is felt most acutely in rural and suburban areas, where some medical centers have gone years unable to fill job openings, and waits can be as long as 3-6 months.

Continuous glucose management (CGM) technology is critical to the enterprise and a requirement for a Steady Health subscription. The data is automatically shared with Steady Health, which allows your new virtual medical team full access to your blood sugar numbers. Founder Berggren, who has Type 1 diabetes himself, is a big believer in the tech: you can read his story of how the CGM helped him achieve the best glucose control of his life.

CGM uploads provide a steady stream of actionable data to the Steady Health medical team. Got a question about a spike or hypo you just experienced? Just fire off a message, and your team already has the data at their fingertips. This isn’t totally novel; there are other businesses that offer services similar to Steady Health’s “continuous coaching,” but they all work within the context of a traditional patient-endo relationship.

Naturally, the model probably doesn’t make sense for patients that are already experiencing complications that need close expert monitoring. And a virtual endo would be wholly inappropriate for those with advanced complications, such as kidney disease. But for those that need more support for their day-to-day management – particularly those for whom visiting the endocrinologist is a hassle – it may be a compelling offering.

As the use of a CGM is required, we can expect that most of the early Steady Health customers to be people with Type 1 diabetes. But the company is ready to take on Type 2 patients as well, a market that should only grow as the technology finds more approval with insurers. Steady Health is open now in California, with plans to expand to more states over the course of 2020.

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