Transforming Diabetes Management 2

This post was originally published in LinkedIn.

In this article I will share openly my experience with SugoSure, a comprehensive diabetes management system which I designed and developed with input from a Medical Advisory Board comprising 3 of Singapore’s leading endocrinology specialists.

SugoSure is a system intended to transform diabetes management. It addresses many current care delivery problems to inform and motivate patients, improve access to quality care and (ultimately) reduce the total cost of diabetes care.

ConnectedHealth launched SugoSure in Singapore in 2022 but the product has had limited adoption to date.  Why and what are the lessons we can learn from this?

Designing a Diabetes Management System

I started to evaluate existing health tech approaches to diabetes care in 2018.  At the time, various apps allowed patients to log their blood sugar readings and some other metrics but gave little support or motivation – they were simply electronic notebooks.

Many of these apps had clearly been developed with little clinical input and they rarely allowed access to data by a patient’s doctor or care team, so didn’t support remote monitoring.  Patient users had limited in-person support so were often unsure exactly how to use them and didn’t receive much useful guidance.

We designed SugoSure to address all these weaknesses while also closing the gaps in diabetes care delivery mentioned in my previous article.

I still believe in the principles of SugoSure’s design, which it shares in common with certain diabetes platforms which have since had some market and clinical success in the US, notably OnDuo. Conceptually, I feel SugoSure should be in good company.

Barriers to Change in Singapore

We chose Singapore to be SugoSure’s launch market for largely practical reasons since ConnectedHealth is based here. Although small, Singapore is wealthy and tech-savvy and the country even declared a War on Diabetes in 2016.  Surely a reasonable initial market for SugoSure, before expanding to larger markets overseas?

With hindsight I’m not sure that was a good business decision.  It’s been hard for us to build much of an installed base here for a number of reasons – which perhaps serve as learning points for other countries and health systems who are trying to transform diabetes care.

Engaging Doctors

Despite the impeccable credentials of SugoSure’s team and Medical Advisory Board, we have been unable to gain much support from doctors, whose adoption and endorsement are of course critical.

We hoped doctors would see the value of SugoSure and recommend it to their patients.  This was based on our earlier market research which provided very positive feedback on its design and functionality from a range of public and private sector medics.

But upon product roll-out we faced a barrage of reasons why doctors didn’t want to change the status quo:

‘I don’t have time to use products like this.  In fact I don’t even have 30 minutes to view an online demo to understand how it works’

‘I don’t have the right patient profiles for SugoSure’

‘I am concerned about medico-legal issues relating to a tool like SugoSure’

‘I am overwhelmed by requests to use technology in my practice that are complex and hard to use’

Regulators and Payers Should be Important

Doctors don’t operate in vacuums – they are required to do certain things or encouraged to adopt certain technologies or paid in ways which influence their practice patterns by regulators (government) and healthcare payers (government or insurance companies).

So SugoSure’s strategy includes explaining to these bodies how SugoSure can help them meet their objectives.

In Singapore, SugoSure always generated interest and conceptual support for its approach. But this did not translate into tangible support to encourage adoption by bodies such as the Ministry of Healthcare Transformation and Agency for Integrated Care.  Talk but no action will not lead to transformation.

Business plans discussed with private healthcare providers failed to produce the near-term earnings uplift needed for SugoSure to be embraced.  And insurance companies also seemed to be more short-term revenue focused than strategic (which seemed strange for an industry which should have the longest time horizons of all).

What about Patients?

The other target group for SugoSure is, of course, patients.  Despite limited success with doctors, regulators and payers we fearlessly developed direct-to-patient digital marketing campaigns.

These were built around a series of steps which would triage out patients whose status made them unsuitable for SugoSure and allow us to nurture those who had room to improve their diabetes control.  We led candidates through clinically-based user trials to map out lifestyle plans and identify clinical issues for our nurses and affiliated doctors to focus on.

Our patient campaigns were quite successful (thanks for Google and Meta’s incredibly sophisticated social media marketing tools). We have thousands of patients in our CRM list whose interest was piqued by SugoSure. (Patient data is of course strictly held under Personal Data Protection Act rules).

But without encouragement from their doctor, how many of these translated into revenue-generating subscriptions? Not enough.

‘This looks helpful but I don’t have enough time to monitor my diabetes – it’s not causing me any problems right now’

‘I’d rather just take more pills and be able to eat whatever I like’

‘You have to pay for SugoSure?  It should be free’

‘How come my doctor didn’t recommend this to me?’

For patients who tried SugoSure, getting them to use it in the right way took a lot of time from our health coaches – who found themselves providing a much-needed role educating patients who should have received such education years ago.

So What’s Next?

As you read this perhaps you are thinking ‘this sounds like a gripe essay by someone who doesn’t know how to design and launch a product’.

If that’s what you really believe about SugoSure then I’m sorry to hear that.  But I don’t think this is the case. For sure we could have done certain things better. But on balance I think we have done a reasonable job at trying to trying to transform care with a commercial innovation.

SugoSure’s goals are hugely ambitious and complex to realise. The Singapore market has its peculiarities and has not, so far, been supportive.  Perhaps this will change.  Or perhaps the various stakeholders here have lessons to learn (I will try to extract relevant learnings in my next article).

Or perhaps there are better ways for society to sow the seeds for healthcare transformation.  I’m now looking at different markets outside Singapore in my quest.

‍