Telemedicine Is Essential to This Diabetes Treatment

The Centers for Disease Control and Prevention in the United States reported in 2017 that 30.3 million Americans had diabetes. In this episode of Mastering Innovation on SiriusXM Channel 132, Business Radio Powered by The Wharton School, Anand Parikh, general counsel and the head of business development at Virta Health, talks about his company’s technology-driven solutions for this public health problem.

Amid the growth of telemedicine, Parikh says, Virta Health offers people with diabetes steady monitoring, real-time assessment, and intervention guidance. He says, by incentivizing patients with the positive, rather than the negative, Virta Health sees higher patient compliance rates when it comes to changing behavior. Payment for services depends on the customers’ overall results rather than individual services, which may be a model for increasing accountability in the health care sector.

An excerpt of the interview is transcribed below. Listen to more episodes here.


Anand Parikh (general counsel, head of business development, Virta Health)

Anand Parikh: When you have folks who are diabetic, they’re taking antidiabetic medications to lower their blood sugar. If you’re not triaging those medications very carefully on a near real-time basis, then there is risk for a hypoglycemic event. And that’s why we have a physician involved and why anyone attempting to manage their diabetes through the use of carbohydrate restriction should have a physician involved in their care.

Harbir Singh: So is it really other people were not able to execute on this real-time sort of assessment and intervention?

Parikh: There are a couple of different things that are at play in why we’ve been able to be the first folks to do this. One is the science. Some of our scientific co-founders have been working on the science for 30 or 40 years. The science has progressed to the point where we know how to administer this protocol safely and sustainably. The second thing is the world has really gotten to the point where there is a unified vision on telemedicine in the last few years.

In order to do this, you have to do it through the use of technology because your average diabetic only goes to their endocrinologist once every three months, if they’re lucky. We adjust medications on a real-time, hour-to-hour basis. You need to be able to practice medicine virtually in order to deliver that degree of care. We have a lot of artificial intelligence powering the recommendations that our physicians are given, especially as it relates to medication management and patient management generally. Those advances have only really occurred in the last few years, which enabled this holistic, full-stack approach to healthcare.

Singh: When people sign up with you, would they need to then tell their personal physician that they are on this other protocol and going to now work with them, or is it supplemental?

Parikh: A lot of our patients will tell their physician, but we act as a cardiometabolic specialist and do not take over primary care for the other aspects of an individual’s care. Sometimes, our program works so quickly that we are even able to get people healthy in between primary care physician visits. You might visit your physician in January as a diabetic on antidiabetic meds. By the time June comes around, we may have you off all of your insulin or other meds and have your blood sugar in the healthy range. It happens really quickly.

Singh: So, why are people so unsuccessful? I can understand this is real time with a lot of monitoring, including the dosage itself, and very personalized. That may be part of the answer to my question — that many people who have been on the periphery and who are prediabetic are very aware of what to do or what they should be doing. If you can get such quick results, then what have they been missing? To put it another way, how can this approach diffuse faster through the population?

“We adjust medications on a real-time, hour-to-hour basis. You need to be able to practice medicine virtually in order to deliver that degree of care.” – Anand Parikh

Parikh: One in 100 people can get the written advice: “Hey, this is what’s going to be best for your individual metabolism,” and they can take that advice. They can effectuate it, and then, they can do it by themselves. But, for a lot of us — I count myself in this group — we need help and guidance. I need the ability to see what’s going on in front of me.

Singh: I see. It’s just too technical in some sense. We have a call. Let’s go to the phone lines. Ram, go ahead, please.

Ram: Hello, this is Ram. I work in a medical office, and we have been running obesity clinics for some time now. I have a couple of questions. You might have answered it already, but the first question is: What kind of digital, online measurements are you doing to see how the patient is doing? Let’s say with A1C. Number two: A lot of this stuff is personal. You can tell them to do the Keto diet, but you don’t know what they will actually do. A lot of this stuff is motivation related. How do you handle that aspect?

Parikh: Those are great questions Ram. In terms of what we are monitoring, we’re monitoring a whole suite of biomarkers — everything from blood glucose to blood ketones to weight to sleep to other subjective markers like mood, energy, hunger, cravings, and all of these things. We’re taking in a variety of different pieces of data. To your second question about how to motivate individuals, one of the amazing things is what we are able to tell diabetics. A diabetic goes into a medical clinic, and they’re diagnosed with diabetes. They’re told that this is a lifelong condition: “You will have this forever, and you will be taking medications forever until you die.” What we’re able to do is to provide an entirely different paradigm change to that. I have seen people, with my own eyes, cry when they’re taken off insulin because they thought this was a life sentence. Being able to change that paradigm is incredibly motivating and incredibly powerful for a lot of people.

Singh: Fascinating. I agree completely with what you’re saying that in part, there’s a whole issue about compliance. Some of my physician friends say that’s a big issue. Many people, they feel like they don’t want to do it. This is not something that you can sense. Compliance is really important. Part of what I hear you saying is that the motivational piece comes from the ongoing monitoring. It’s kind of a positive atmosphere, probably. The ongoing monitoring forces people to stay involved.

Parikh: There are so many benefits. When you’re asking someone to really engage in diabetes management and you’re saying to them, “You know what? Keep taking your insulin, and over time, you’ll gain more weight, and you’ll take more insulin. But hey, you’re doing well.” That’s not a very compelling picture, and it’s just not a very compelling life for anyone.

The ability to take people off meds and the ability to lower people’s blood glucose at the same time, giving them back that freedom to live without needles and without insulin, is a much more positive picture. We, as humans, are inherently and intrinsically motivated by the positive and the possibility of a positive rather than the avoidance of a negative.

About Our Guest

Anand Parikh is the head of business development and general counsel at Virta Health, which provides the first clinically proven treatment to safely and sustainably reverse type 2 diabetes without medications or surgery. Prior to Virta, Parikh was at Morrison & Foerster LLP where he worked on corporate matters for clients including Softbank, Intel, and Apple while maintaining an active practice representing venture-backed companies. He also worked in the California State Senate as a Senate Fellow and clerked for Chief Judge Gerald Rosen of the U.S. District Court for the Eastern District of Michigan. Parikh received his undergraduate degree in Political Science and Biology from the University of Michigan and a JD from New York University School of Law.

Mastering Innovation is live on Thursdays at 4:00 p.m. ET. Listen to more episodes here.