David Klonoff: 0:03

Welcome to Diabetes Technology Report. I'm Dr. David Klonoff. I'm an endocrinologist at Mills Peninsula Medical Center in San Mateo, California. We have a very talented guest today, and he will be introduced by my co-host, Dr. David Kerr.

David Kerr: 0:32

Thanks, David, and hello to everyone. I'm David Kerr. As usual, I'm speaking to you from sunny California, from Santa Barbara specifically. Today we have Amiyad Fredman from Sweet Spot, and he's based in St. Louis. Amiad, welcome to the podcast. Lovely to see you. Thanks for having me here to both Davids. Excellent. So we always begin this because I'm interested in the person behind the company. So how come you have ended up devoting your existence to dialogue at the moment? What was the spur for that?

Amiad Fredman: 1:11

Yeah, you know, it's funny because when you look back at your path, any path really, it has a tendency to kind of appear uh linear in hindsight. But of course, when you're in the midst of it making each decision, sometimes it seems a little bit more jumbled in the moment. And so looking back, there is this nice linear story. Uh so my background is in medicine. I am a trained physician. I graduated from uh School of Medicine and GW in Washington, D.C. with my MD. And then took a turning point in my career. After obtaining my MD, I decided to take a little bit of a leap of faith and jump into the digital health world. I had some experience in medical school working with different product teams in the digital health space. And I really just loved my time working with developers, designers, and saw the impact that someone who is medically trained, someone who is medically minded, can have not only in the classic positions in a health company that you might think of for a physician, chief medical officer, medical director, clinical studies, things like that, but more on the ground level, right? More working in the trenches with designers, with developers, with the product teams. So that's how I got my start in digital health. How I came into diabetes was actually just a function of my exploration in the space of digital health. So, you know, diabetes is such an interesting and unique area and specialty of medicine because I think so often those who end up in the specialty have a direct connection. They know someone with diabetes, they have a personal connection to the disease. In my case, it was really the technology that actually pulled me in and grabbed me. So Sweet Spot, as I'm sure we'll discuss more, is all about making use of the power of CGMs and insulin pumps, making sure we are fully utilizing that technology. And so that's really what got me into the diabetes space.

David Kerr: 3:26

Well, it's great to have really smart, young, driven people in diabetes. So what is the problem that Sweet Spot is trying to solve in a nutshell?

Amiad Fredman: 3:37

Sweet Spot is solving the problem of data accessibility for CGMs and insulin pumps and data impact. We know that these devices are incredibly powerful, obviously moving from a one-point metric of a hemoglobin A1C or a blood glucose measurement from a finger stick to now information every five minutes. But how is that continuous data visualized and digested by the healthcare system and by the physician to make treatment changes? A lot of times that data is just kind of acted on reactively, right? Every three, four, six months when the patient comes in for their visit with their endocrinologist. And that's good. You have obviously more insight, and maybe a patient is more motivated and is able to look at the numbers on their own. But that continuous and cloud-enabled ability that comes with the devices is somewhat lost in the healthcare system. And so Sweet Spot was created to ensure that we take advantage of the remote monitoring capabilities that CGMs and insulin pumps bring with them today, and to ensure that doctors can be proactive in taking care of their patients who are on these devices and have the support to do so rather than reactive.

David Klonoff: 5:15

Amy, and how can a patient achieve the sweet spot experience? Where do they go? What type of a doctor would they see?

Amiad Fredman: 5:23

So sweet spot partners typically with endocrinologists. We partner with private practice endocrinologists all over the country. We're working with more health systems now as well. And so we actually start with the provider. Primary care absolutely is on the table as well. You know, more uh people living with diabetes are being managed by their primary care providers every day. And so wherever the patient goes to receive their diabetes care, that's where Sweet Spot is starting at. And it is with the providers who are looking for help, essentially, in being able to manage and monitor their patients on a CGM and doing so remotely.

David Klonoff: 6:04

Well, you mentioned that you're very interested in CGM data. What exactly do you provide that maybe someone without Sweet Spot would not be providing?

Amiad Fredman: 6:14

So when Sweet Spot started, we really thought of ourselves as a software company. We started with the technology. We built a system for doctors and care teams to use that, you know, was invisible to the patient. It was to get at that data accessibility and make sure that doctors can see who they need to reach out to, who needs that care in between their visits. But we quickly learned that even if you had the greatest, you know, innovation and technology, and we think certainly Sweet Spot is that, it's not really worth all that much if the provider or the clinic does not set up with the resources to use it. And we know that time is a limited resource in healthcare. And so what I would say am most proud of with Sweet Spot is our clinical team. So we have an entire clinical service that we provide with Sweet Spot. And we like to say we only bring on really the best of the best. And I think we we truly do, an incredible team of diabetes educators that every day are keeping an eye out on all patients who are part of the Sweet Spot program and reaching out to them at least once a month or more if needed, if their data tells us to. If their data is saying, hey, this patient can't wait until the next time they come in the office. They we need to reach out now. We need to adjust their insulin now. And so that is the sweet spot experience. It feels a lot like, and maybe you like this term, maybe you don't, but it feels a lot like what's known as concierge medicine. It is going kind of that proactive above and beyond mile, and you know, I almost like a guardian angel sometimes. I use. And patients say that. They say, wow, I've never had my doctor reach out to me before. And and those are the types of comments that really motivate us and keep us going.

David Kerr: 8:17

I mean, just to clarify though, do you have, if you're a person with diabetes, do you have to be on a pump and you have to be on the CGM to qualify for sweet spot? Or are you because of the explosion in the interest of CGM, even outside of insulin, let alone pumps, what about those folks? Well, would they benefit from this kind of interaction?

Amiad Fredman: 8:43

Right. So Sweet Spot in in its current state today, the CGM is the starting point. Being on a CGM is what tells Sweet Spot that they are that this is a person who is eligible for this program. Now, to your point, more people are coming on CGMs than ever before. And this new standards of care and diabetes was recently released, and it is encouraging and continues to encourage the CGM adoption, getting CGMs not just for your type one patients, but for your individuals with type two. We're seeing more pre-diabetes now having CGMs as well. So these individuals are all, you know, eligible for the Sweet Spot program. And, you know, in the future, could Sweet Spot, you know, take another step and look at the diabetes as a whole? And, you know, we're actually looking into chronic care management right now. And so, yes, that is certainly something that is on the table, but we really want to be at that forefront of innovation. And at the end of the day, we passionately believe in these devices and see firsthand the impact they can have in someone's life who lives with diabetes. And so that's where we truly believe is where we want to be spending our time.

David Kerr: 10:00

And and also practically, what about other data, other inputs? Do people have to keep food diarrhees? Do they have to photograph their food? Do they have to wear an Apple Watch? What other stuff do people have to provide a sweet spot in in order for your team to understand the glucose profiles?

Amiad Fredman: 10:20

It was really important to us from the very beginning to not require any behavior change from the patient. So there is no new device that they need to wear. There is no new app that they need to download. Whatever they're doing today is fine. As long as they're sharing their data with their provider, you know, their DEXCOM data with their provider, that is where Sweet Spot is coming in. Now, if you have a patient who is particularly motivated and within their DEXCOM Clarity app is keeping that food log, that of course is only going to help their diabetes educator with that context and going to provide more insight. But very intentionally, we didn't want the individual or the patient to have to do more than they're already doing because already living with diabetes is much more than someone who doesn't, right? They're already making much more decisions on a daily basis than someone who isn't living with the disease.

David Klonoff: 11:20

Aaron Powell, there's a new method for analyzing how well a person is doing based on their CGM data called the glycemia risk index. Are you using that at Sweet Spot? And if so, what do you do with that information?

Amiad Fredman: 11:36

Yes. So the glycemia risk index or GRI has been a really important and valuable metric for us at Sweet Spot. In taking in all this patient data, it's very easy to get overwhelmed to have that data overload. GRI is exactly what we were looking for as a single metric and a metric of triage that you can use that is a compound metric for all of the time in range data, time below, time above, time in range. And it shows you one number that you can then really sort on, essentially, your patient population to get a sense of, all right, who's who's the patient I need to focus on today? Who are the five? Even more than that, because glycemia risk index is typically conveyed in this graph or almost like heat map type of display, it's a wonderful visual indicator to the user, who is the clinician, to be able to just quickly see without needing to do any math in their head, okay, what's going on with this patient? How does that compare to this patient? This patient's having some more issues with hyperglycemia, this patient's having more issues with hypoglycemia, and the relative risk that those levels of hyper hypoglycemia are contributing to their overall glycemic health. So it's a very powerful, almost visual triage tool that we've been able to tap into. And it's also a very nice, colorful tool that adds a nice burst of color to our sweet spot platforms that's very eye-catching, which, from a design standpoint, actually is significant. So we use GRI every single day as a method of triage, and we also use GRI as our main metric to capture clinical outcomes. Because again, it is one metric that we can say for our patients who started in this area of uh glycemic, glycemic risk according to their GRI, they, you know, on average improve to this, you know, glycemic uh risk index or zone of GRI. And so from a patient, if an individual basis, for each patient, we're able to see how their GRI changes over time. But then also from a population standpoint, we're able to see how the sweet spot intervention contributes to GRI changes over time from a population standpoint.

David Klonoff: 14:05

Amiens, we're hearing a lot now about artificial intelligence being used to analyze uh data streams and reach conclusions that would be too complicated for a human, even with a computer. What do you think is the future of AI for diabetes?

Amiad Fredman: 14:22

Well, I think there are a lot of implications for AI in the world, in healthcare, in diabetes. I almost divide it into two aspects that are particularly exciting for me. The first one is what you mentioned, Dr. Klonoff, which is actually, you know, AI is something that has been this in the sphere of things for the past decade or so, which is AI and data, right? How can we take raw glucose values? Of course, we're getting this data every five minutes, every one minute. And based on that, fine trends and warning signs that maybe would be difficult, if not impossible, to spot from the naked eye. So again, it comes from that proactive standpoint. That's very exciting and comes back to data, data, data. Data is key. And then there is more of the broad applications of AI, which comes into the workload and workflow aspect of AI and healthcare. And that is something that I'm particularly excited about. You know, one of the reasons I got into digital health is because I, as someone who is a self-proclaimed nerd, right? And someone who's always been passionate about technology, it drove me absolutely crazy in medical school how technology was often associated with an eye roll, right? It made doctors' lives harder. The EMR, you know, how many more clicks do I need to go in? From the patient experience, we all know what it's like seeing a doctor and they're spending more time, uh, sometimes looking in the computer than speaking with the patient. These are things that have been negative implications of technology's use case in healthcare. I think there's a potential for AI to reverse some of that and to uplift the burden, the administrative part of healthcare and being a physician and bring the provider back to the face-to-face, eye-to-eye with the patient as well. So both of those things are things that I'm incredibly excited about and that we're actively looking into. It's a sweet spot.

David Kerr: 16:26

I mean, I've got a couple of practical questions again. So, from a physician point of view, and actually I love the idea that primary care is going to get more involved in CGM and automated insulin delivery systems and so on and so forth. So, how is what's the business model here? And at this moment in time, how popular is Sweet Spot?

Amiad Fredman: 16:48

That's a good question. It's a good question. Well, I'll take the the latter part of your question first. In terms of popularity, it's been really humbling to see Sweet Spot picking up steam and becoming more of a well-known name. Um, you know, we go to various conferences in diabetes, the um uh technology conferences, the uh uh ADCS, uh ADA, of course. And we've been going to these now for the past couple of years. And it's always exciting to see the feedback and the reaction. But every single year we're seeing more individuals coming to us saying, Oh, my friend told me about Sweet Spot. They said this is something I had to come see. And so that is neat seeing that name, you know, starting to become a little bit more well-known, certainly as a startup founder. That's that's very that's very humbling. And then, David, your first part of your question, remind me. The business model, I mean the business model. Right.

David Kerr: 17:45

How do you who pays for this? So what do they pay and that type of stuff?

Amiad Fredman: 17:49

Yeah. So that was also something that very early on in the early days of Sweet Spot was really important to us that this had to make sense, not just from a clinical standpoint, not just from a workflow standpoint, but from a financial standpoint, from the perspective of the provider as well. And so Sweet Spot's pricing model and business model essentially says to the provider, you don't pay anything for Sweet Spot. Sweet Spot is bringing in revenue for the practice based on this new type of care deliverance that is being given, this care in-between visits, remote patient monitoring, chronic care management, whatever the various CPT codes that are able to be utilized. That is a new revenue stream that Sweet Spot is enabling for the provider and the practice. And actually, it is only based on the work that is completed that Sweet Spot generates any revenue for itself as the company. And so that was something that was really important to us to be able to really be hand in hand in terms of success with the practice and the provider and say, we don't make a dime unless we're working for you. And our success is inherently tied to the providers and the practice's success.

David Klonoff: 19:08

And what's it like practicing medicine in St. Louis, Missouri?

Amiad Fredman: 19:12

Well, my version of uh, I guess my method of medicine practice looks a lot different than the regular physician in St. Louis, Missouri. So I am full-time engaged in Sweet Spot. So people ask my specialty, I like to say startups, remote monitoring. And so at this point in time, I've I've actually taken my full dedication and focus onto managing the company and the product and the clinical team. But that's that's, you know, I think important. Uh, you know, easy to kind of make the joke about that there in terms of the specialty. But I think in today's age, what does digital health mean? And I think we will see more and more physicians finding careers for themselves in non-traditional ways. I mean, there's a real need for that. And I certainly uh, you know, uh see that every day.

David Klonoff: 20:08

Amien, I would like to thank you for participating in our podcast today on behalf of me and Dr. David Kerr. You're one of our first speakers on Diabetes Technology Starts podcast, which is for startups and uh your company is a startup. Uh, we wish you success. And uh the Diabetes Technology Starts podcast is available at the Diabetes Technology Society website and at Spotify and at other sources of podcasts. I look forward to seeing you again, and for now, to the audience, goodbye. We'll see you later. Goodbye.