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Michael
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May 15 • 13 tweets • 4 min read
1/ NOT THE THREAD DIGITAL HEALTH WANTS TO READ, BUT THE THREAD IT NEEDS TO READ. Walk with me…🧵
2/ Many people know about the darling of digital health — Livongo. Arguably the highest profile digital health company ever due to an $18.5 billion dollar merger with Teladoc back in 2020. medcitynews.com/2020/10/telado…
3/ Livongo is/was known for its digital diabetes program. Unfortunately, the market never demanded that Livongo prove their program works. By the time Teladoc published an RCT, it turned out that the program was NO BETTER THAN USUAL CARE. ncbi.nlm.nih.gov/pmc/articles/P…
4/ Maybe that’s why Teladoc is dropping in value? 🤷🏼‍♂️ healthcaredive.com/news/teladoc-r…
5/ Or what about Omada? They are another digital chronic disease unicorn. Did you know they recently published the largest digital diabetes prevention study…of all time! Honestly, kudos to them for doing it. globenewswire.com/news-release/2…
6/ Here is the registered study protocol for PREDICTS clinicaltrials.gov/ct2/show/NCT03…
7/ Study was a 12-month randomized control trial of a digital diabetes prevention program.

D-DPP: 52 weekly sessions, lifestyle coaching, virtual peer support, and behavior tracking tools. N=299

Control: single-session small-group diabetes-prevention education class; N=300
8/ Despite the high level of support in the d-DPP arm, the participants only achieved a trivial improvement in glycemia (-0.08% A1c compared to control) and modest improvement in weight (-5.5% d-DPP vs -2.1% congrol) at 12 months.

sciencedirect.com/science/articl…
9/ So why all the fuss? Because being no better than usual care is not a scientific achievement or progress, and I’ll let you decide if that is worth $18 billion. Also, stop digitizing the diabetes prevention program!!! It’s over 20 years old!! The science has progressed!
10/
FOR EXAMPLE ⤵️

Pharmacy-led ketogenic diets have far better data for glycemic control. nature.com/articles/s4146…

Virta has demonstrated a more effective digital diabetes/predm program. frontiersin.org/articles/10.33…
11/ Heck, I could put people on a single drug, close my eyes, and outperform all the programs above. #tirzepatide diabetes.org/newsroom/press…
12/ While I appreciate the efforts to finally start validating some digital health programs that have been around for a while, the validation should have happened sooner. Also, the results should be more impressive to warrant their current valuations (IMO).
13/ The point is that we should not lower the scientific standard for digital health companies. It’s time for digital health to put its money where its mouth is. Because lives are at stake, and no one gets a pass. [end]

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More from @MichaelAlbertMD

Michael
May 14
Why is losing weight hard? Evolutionary adaptations to prevent starvation and death constrain weight loss. Conversely, hypothalamic inflammation can promote wt gain affecting the fxn of the homeostatic feedback system that constrains wt.
-Dr. Katherine Saunders #YWM2022Virtual
Weight Loss Goal? Not a number but a health improvement. With modern treatments, I would argue we should aim for 10% TBWL. #YWM2022Virtual
An example of a patient's AOM weight loss journey. Weight loss journeys should be realized over years as virtually no one gains all their weight in 3-6 months. Setting expectations early on is essential!! #YWM2022Virtual
Read 5 tweets
Michael
May 14
"If someone has myopia, you wouldn't tell them to try harder to see. You would not shame them for needing glasses." -Lee Kaplan

Yet, in obesity, we shame people for seeking evidence-based treatments and implore them "to eat less and move more" harder. #YWM2022Virtual
The legacy bias in bariatric surgery qualification #YWM2022Virtual
Weight stigma worsens the AEs of obesity. onlinelibrary.wiley.com/doi/full/10.10…
Read 5 tweets
Michael
Mar 22
1/ STEP 4 Trial of Semaglutide for obesity treatment is a beautiful illustration of the physiology of body weight regulation. Let's explore it in this 🧵 Image
2/ First off, all study participants "received open-label once-weekly subcutaneous semaglutide, 0.25 mg, increased every 4 weeks to the maintenance dose of 2.4 mg once weekly by week 16, and continued to week 20."
3/ In addition, all participants received a lifestyle intervention from week 0 to week 68, which included:
👉counseling
👉Calorie-reduced diet
👉150 mins of PA / wk
👉tracking

In behavioral weight management, this is referred to as standard behavioral therapy (SBT). Image
Read 11 tweets
Michael
Mar 20
1/ Understanding Obesity Pathophysiology Through Outcomes:

IMO, the limitations of these surrogate measures (fMRI & PET), make outcome studies a more reliable insight for understanding obesity mechanisms.

A [thread] on outcomes for clinical interventions for obesity. 🧵
2/ Do Diets Matter? Yes and No. They matter because you have to eat, and you want to do so in a way that promotes health. But, are they reliable txs for obesity? No. Meta-analysis of long-term RCTs (avg wt loss 0-4 kg). Most intensive diet interventions result in 3-5% wt loss. Image
3/ But...but...what about low carb? Mind you, I am talking about population averages. There will always be a level of precision that will be difficult to capture in studies. Most intervention studies have outcomes representing a waterfall plot where results are variable. Image
Read 24 tweets
Michael
Mar 15
1/ Is Obesity A CHOICE?

The thread 🧵. For starters, please answer the following question ⬇️
2/ So Why We Are Gaining Weight? Unquestionably, we are eating more, and this increased consumption at a population level is the leading candidate.
3/ How much more? Around 20% more Calories are ingested per day. With a large % coming from ultra-processed food sources.
aicr.org/resources/blog…
Read 23 tweets
Michael
Nov 4, 2021
1/ It is no surprise that Semaglutide is the bell of the pharmacotherapy ball. Let's review some key takeaways from the STEP trials to understand why SEMA 2.4 mg is so exciting.
*credit to Dr. Wadden. #OW2021

STEP 3
2/ Intervention: Intensive Behavioral Therapy + Low Calorie Diet +/- SEMA 2.4 mg #OW2021
3/
Control arm: IBT + LCD lost ~6% BW.
vs.
Experimental arm: IBT/LCD/SEMA 2.4 lost 16% BW. #OW2021
Read 6 tweets

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