This content originally appeared on Beyond Type 1. Republished with permission.
By Jordan Dakin
Beyond Type 1: Can you talk about the founding of DreaMed?
Eran: DreaMed started as part of one of the biggest institutes for people with type 1 diabetes in Israel. The director of this institute is Professor Moshe Philip (co-chairman of ATTD). His vision was to bring in technological people to try to develop solutions to help the needs of people with diabetes. One of our first projects was to create an algorithm for automated insulin delivery… We were the first in the world to do automated insulin delivery clinical trials outside of a hospital and we published these results in the New England Journal of Medicine. This was the first manuscript about people looping and then we were the first to send people home with automated insulin delivery in 2012.
We created a relationship with Medtronic Diabetes, which allowed us to communicate with their insulin pump and a continuous glucose monitor. After we finished a lot of sessions of clinical trials, we decided we wanted to regulate our technology software as a standalone medical device. That’s why we established DreaMed in 2014. Since then, we’ve made a licensing deal with Medtronic. They were the first investor in the company and our technology will be part of their next-generation advanced hybrid closed loop system: the 780G. But working on the closed loop project, we always knew that not all the people with diabetes would have access to closed loop, but we very much believe that the majority will have access to continuous glucose monitoring (CGM) technology.
The thing that we were focused on is how we can use our expertise to create something that will be able to help the providers and the patient better dose insulin based on data that comes from CGM and from insulin delivery devices. For that purpose, we started to develop a technology that we call today the DreaMed Advisor. DreaMed Advisor is a decision support system that captures all data and recommends very precise, personalized insulin delivery for that specific patient. Not in a real-time manner, but in the manner of a treatment plan.
BT1: Can people on MDI utilize DreaMed advisor?
E: It’s not regulated for MDI patients at the moment. Our MDI version is on clinical trials, and I really hope that during this calendar year, we’ll be able to share the status of these programs and how fast we think it will be available on the market.
Do you think part of the reason people are sometimes slow to adopt technology is because there are some who question using it for matters like medical decisions?
I think what we’re experiencing right now are more logistical issues – how the data flows from the devices to the platform, the fact that clinics are using multiple platforms to download the data from the patient devices, and the fact that most of what we see today is not digitalized. Clinics are still printing reports – about 20 to 30 pages every visit. They don’t have the manpower because they are so overloaded with work: all the documentation, mailing the claims, dealing with that download of the data when the patient arrives at the clinic, etc.
But what I see when I visit clinics and when I talk to people and I hear lectures is that 2020 might be a moment where some of the barriers can be solved. Not all of them, but some of them can be overcome to allow us to implement such a program.
One of the things that is very interesting to me is the role of the people with diabetes in this. Everybody knows that people with diabetes pay a lot of money for healthcare costs, right? The majority of that is from the insulin costs, but even to see a doctor, there is a certain co-pay and co-insurance that patients are paying each visit. The question is how much patients will be open to removing the barriers, and saying, “I prefer to pay out of pocket for a service that will allow me to get the titration of my data with technology, together with a healthcare provider that is considered a top doc because they have clinical studies behind them. For that, I’d be willing to pay out of pocket and eventually, I will save costs because I will pay less, and I will get better outcomes, and I will spare my other costs of going to the ER in hypoglycemia and DKA because of that.” I think that patients are playing an important role in this equation.
I’m sure a big goal for DreaMed is to lessen the burden on physicians in terms of needing to see patients so frequently.
In no way are we trying to make providers obsolete. We think that they are an essential part of patient care because at the end of the day, caring for a patient with type 1 diabetes or any type of diabetes is not just about numbers, it’s not just about the type of insulin. There are a lot of things behind it and we need our providers in the game.
Dr. Greg Forlenza from the Barbara Davis Center very nicely told me, “With your technology, I’ll finally be able to go back and practice the art of medicine and not be a technician.” I think that this is the service that we would like to bring to providers because if we’re able to let them go back to dealing and practicing the medicine, and we can take away some of the barriers, all the technicality and calculations, and we’re going to provide better, more frequent care for their patients. I think that everybody will be happy about that. One of the goals that we have for this year is to try to build the right model in order to make that happen.
We’ve heard that certain endos are starting to charge a co-pay for visits where they review CGM technology, which hasn’t previously been the case. So costs in terms of things like that seem to only be going up for these patients.
I understand what you’re saying, I think that we need to look at that. We have two sides to this. Number one: there’s the side of the provider that spends a lot of hours caring for their patients and the majority of these hours are non-billable time. In the end, we want to find a way for the providers to collect some of this money because we don’t want our doctors to lose money. We want them to sustain their business so they will be able to provide us better care.
But the magic here is creating that without significantly increasing the costs on the patient side. Because if it will increase the cost from the patient’s side, the patient will say, “I don’t want to download my data, don’t charge me for that” and that means we lose because then they’re not going to get that same tight control. These are some of the questions that we are trying to find answers to. How can we be innovative not just on the technology side but also on the commercial side to find a model that will be good for providers but also good for patients?
If someone is interested in utilizing DreaMed’s technology, where do they go from there? Do they just contact their physician and ask if they can use DreaMed?
Right now, that’s the right process. They need to go to the doctor and tell them, “I’ve heard about this cool technology, here’s the information,” and put some polite pressure on the doctor to explore the technology and see if they can implement it. If the clinic is using Glooko, we are integrated, so they can continue to use their Glooko account and we will be able to get into agreement with the clinic and open Advisor on top of Glooko.
If the clinic is using Tidepool, or if the patient has an account, we are also integrating data from Tidepool, so we will be able to just provide a clinic our standalone platform and then connect the clinic’s Tidepool account. From there, every time that a patient downloads his data through Tidepool, we would be able to pull that data and analyze it, then provide recommendations for the provider.
What do you envision as the next step? What’s ahead for DreaMed?
I think that next step from our end is to develop more technologies so we will be able to expand our intended users. We’re working to reach patients on multiple daily injections – that’s our first goal. Then we’ll go to those on insulin with Type 2, either multiple daily injections or basal only. That’s from the development side. For 2020, our main goal is to try to find the right commercial model and how we can have as many patients as possible enjoy this technology as fast as possible.
Can you talk a bit more about the importance of patients having access to any and all options?
I think that patients should have the right to get access to the top tier docs anywhere, anytime that they want to. But that doesn’t mean that they will be able to make all of their treatment decisions alone. I think that there is a great deal of importance in having healthcare providers as part of patient care. But I do think that it’s wrong for patients to have to wait for six months to see a doctor in order to change something in their treatment.
We need to find ways to make top tier treatment accessible to everyone… This is what we believe in. It’s in our mission to provide the best solutions for people with diabetes with our technology.
Do you have a personal connection to type 1 diabetes?
Nope. I don’t have a personal connection. I’ve been working in this business for 14 years. Seven years of my career was spent in the hospital. I was the technical guy in the clinic sitting in the corridors, talking to patients. We did closed loop studies and in those closed loop studies, we did 24-hour studies, stayed overnight, and took care of patients. So I have a very strong connection to people with diabetes.
The fact that we have the ability to provide something to improve their care is a privilege. It’s not something that everybody gets the chance to do in their lifetime. That’s why I’ve been a part of this for so long, this same type of work, because I don’t have a personal connection, but I have an emotional connection to people with diabetes.