Friday, March 10, 2017

Type 2 Diabetes and Smart Phones

Over the past decade we have argued based on a multiplicity of clinical evidence that Type 2 Diabetes is dominated by weight issues. HbA1c is directly proportional to BMI. Plain and simple, almost always. Thus drop BMI, namely loose weight and HbA1c goes down.

Now along comes a new start up which apparently claims:

Blending this expertise with technology and artificial intelligence, Virta has developed a platform for continuous, remote care and personalization for each patient to use online with physicians and health coaches in effort to lower their blood sugar. In a clinical trial run conducted in partnership with Indiana University, researchers looked at 262 people with type 2 diabetes over a 10-week period to assess the impact of the Virta platform. At the end of the study, which was published in the Journal of Medical Internet Research, 56 percent of patients were able to lower their blood glucose to non-diabetic ranges (meaning A1c falls below 6.5 percent) and 87 percent were able to reduce or completely eliminate their dependence on insulin. Seventy-one percent of them also saw a weight loss of 5 percent, which is considered a clinically significant threshold.

What is strange here are two factors:

1. Getting obese folks to lose weight is difficult. My statistics is we see a 2-5% success rate. Even with gastro surgical intervention obesity all too often returns.

2. HbA1c is red blood cell dependent. Red blood cells last 60-90 days. Thus to see a result in 10 weeks or 70 days is at best pushing the envelope. One physically needs a full 90 cycle AFTER BMI reduction below 25. HbA1c must be below 5.6 to get normalized and even that is pushing the envelope.

Thus one may suspect this is an option with limited long term effects even though there is a claim on 100 million people! Most of those obese will not stop eating. Try and stop them...