How Technology Is Driving Trends in Type 2 Diabetes & Obesity Reversal

AutoZone decided to shift its health coverage focus from managing to reversing type 2 diabetes, and the company is happy it did, according to a November 30 webinar “From Status Quo to real results: Why AutoZone made the switch from management to reversal for diabetes, prediabetes and weight loss,” by Virta Health.

Matt Harmon, vice president of compensation and benefits at AutoZone, said during the webinar that 40,000 of AutoZone’s 115,000 employees in the Americas are part of the Virta plan, which offers a comprehensive approach to reversing diabetes, prediabetes, and obesity. The ultimate goal is to get people off medications that include pricey and popular glucagon-like peptide-1 (GLP-1) agonists.

Before switching to Virta, the company’s number one drug spend was on diabetes drugs, according to Harmon.

“AutoZone started with the carrier solutions and weren’t seeing a lot of results with behavior change,” he said.

But over two years with Virta, company employees on the plan saw an average reduction in eA1c from 7.6 to 6.9; a 52% reduction in diabetes medications; and 50% of members completely eliminated insulin in the diabetes reversal category.

In prediabetes reversal, 55% achieved clinically significant weight loss, losing an average of 21 pounds. In obesity reversal, there was a 7.5% average weight loss; 56% of members achieved clinically significant weight loss, with an average weight loss of 18 pounds.

“We’ve seen significant financial results,” Harmon said.

AutoZone said they saved $6,000 a year per engaged member from reduced medical expenses. That’s not to mention that employees are in large part happy because they feel they have an employer who cares, according to Harmon.

How does the reversal model work?

Technology enables the Virta model of care in ways that probably wouldn’t have been possible 10 years ago, according to Kevin Kumler, president at Virta Health.  

Kumler was drawn to Virta from personal experience.

“I lost my father just three years ago to complications of type 2 diabetes. He received traditional care and management, which tends to be increasing drug regimens, which the body stops responding to, and then bad stuff happens,” Kumler said. “I followed Virta from afar and read the clinical studies and saw that they had amazing results with reversal which, in the diabetes sense, is helping people control their blood sugar while getting off of the meds they may have been taking to control their blood sugar. The happy side effect is that they typically lost a clinically significant amount of weight.”

Virta’s model of care has focused for the last eight years on diabetes type 2 reversal and transitioned in the last three years to obesity and weight loss. In recent months, Kumler said member interest in obesity and weight loss has surpassed that in diabetes.

The model revolves around personalized nutrition therapy, or helping people adopt a low carbohydrate lifestyle. The other core aspect is continuous remote care, which helps ensure positive lifestyle changes.

“It’s personalized because it needs to be something they’re willing to do forever. This is their lifestyle. It’s not a diet,” Kumler said.

Technology makes this possible

Continuous remote care is where the device diagnostics come in.

“We have basically put an endocrinologist, a PCP [primary care provider], a dietician nutritionist, and coach in [members’ pockets] on their phones,” Kumler said. “We’re able to do that because we can monitor their biometrics remotely.”

Kumler, who is a Virta patient, gets on his scale every morning and his weight immediately beams to an electronic health record, so it’s visible to his coach and doctor.

“We use a connected glucometer and ketone meter, so my coach knows what my blood glucose is and what my ketones are reading, which also tells them if I’m making progress or if I need encouragement, troubleshooting, help,” he said.

Then, there is the actual communication technology. Virta’s healthcare team might communicate with members two to four times a day. Most of that communication is with asynchronous text (human to human) with the option to talk live if needed.

AI support

While artificial intelligence (AI) supports what Virta does, the model is based on “human flesh and blood” coaching to build relationships with members, according to Kumler.

“We view AI as an amazing enabler for what we do but not a replacement for a human-to-human connection, certainly not at this point,” he said.

AI helps to nudge Virta coaches and providers to identify who might need proactive help and intervention. The algorithm, for example, sees in real-time when a member is struggling and helps to navigate how and when to reach out for the best outcomes.

“It's very important to be able to surface the right content, for the right people at the right time,” Kumler said.

Research-backed

With often escalating costs of diabetes treatment and health care claims related to diabetes and obesity and a growing body of research suggesting type 2 diabetes reversal or remission is possible, employers and health plans seem be embracing the reversal model of care.

AutoZone and other customers have validated savings through company claims, according to Kumler.

“If you can help get people off medications there are savings right there. With the other health conditions that get better when you eat in a healthier way, there are less doctor visits, less specialist visits, and less people crashing in the ER with major health issues,” Kumler said.

Virta has nearly 500 enterprise customers, the majority of which are employers, and more than 40 health plan clients, including national and regional plans like Blue Shield of California.

Virta Health has research to help back its claims, including a study published in 2019 in Frontiers of Endocrinology  suggesting that its digitally-monitored continuous care intervention showed “sustained long-term beneficial effects on multiple clinical markers of diabetes and cardiometabolic health at two years while utilizing less medication. The intervention was also effective in the resolution of diabetes and visceral obesity with no adverse effect on bone health.”

There are others

Twin Health, makers of Whole Body Digital Twin, an AI-powered technology that helps reverse and prevent chronic metabolic diseases, like type 2 diabetes, features dynamic representation of each individual’s metabolism.

Built from thousands of data points collected daily via non-invasive wearable sensors and self-reported preferences, the Whole Body Digital Twin is a predictive model that provides individualized nutrition, sleep, activity, and breathing guidance to patients and their healthcare providers, according to a company press release from 2021 about Twin Health raising $140 million in series C funding.

A new study looking at the Whole Body Digital Twin and its reported rate of remission of type 2 diabetes was presented at the 82nd Scientific Sessions of the American Diabetes Association (ADA) in New Orleans, Louisiana, in June 2022.

According to an ADA press release, “Researchers conducted a randomized controlled trial designed to determine the effect of Twin Precision Treatment technology (TPT) versus standard care (SC) on change in A1C and type 2 diabetes remission at 90-day intervals.

“Interim analysis of 262 patients (TPT n=199; SC n=63) who reached 180 days showed 94.9% (189/199) of TPT patients achieved an A1C less than 6.5% on no medications or metformin only; 83.9% (167/199) achieved diabetes remission based on ADA criteria. All nine insulin-using patients stopped insulin before 90 days. The TPT intervention in patients with type 2 diabetes allowed for significant reduction in A1C, diabetes remission (~84%), and improvement in multiple metabolic parameters at six months.” 

A ripple effect on medtech?

MD+DI has reported on medtech’s concerns about GLP-1 medications and their potential negative impact on the sale of insulin devices because people with type 2 diabetes may be able to delay insulin therapy if they take GLP-1s.

Diabetes and obesity reversal platforms, while they might positively impact diagnostic and monitoring technology sales, could also diminish demand for glucose pumps.

“In terms of the monitoring and diagnostics, I expect that to continue to grow. Those are devices that can enable this care that helps make people healthier,” Kumler said. “In terms of the devices like the insulin pumps that deliver maintenance medications, I would expect and hope that goes down. It’s an amazing tool for people who need it, but not needing the medication is even better.”