Diabetes Connections | Type 1 Diabetes

Episode: T1D help in real-time: StrideMD offers 24/7 remote monitoring
Host: Stacey Simms
Guest: Scott Hosbin, Chief Operating Officer, StrideMD
Release Date: May 6, 2025

Episode Overview

This episode explores cutting-edge remote monitoring for people with diabetes—focusing on StrideMD, a Florida-based telehealth platform that partners with Dexcom and offers 24/7 oversight for patients. Scott Hosbin, StrideMD’s COO and a long-time diabetes tech advocate, joins host Stacey Simms to discuss how real-time intervention, practical telehealth, and adaptive support are transforming diabetes care. The conversation aims to demystify remote monitoring, clarify who it benefits, its operational nuances, and how it might evolve to address the needs of various diabetes populations.

Key Discussion Points

Introduction to StrideMD and Remote Monitoring (04:04 – 08:20)

• StrideMD’s Platform:
  • National telehealth licensed in all 50 states, focus on remote patient monitoring for diabetes (04:04).
  • Acquiring physical endocrinology centers in Florida to better bridge virtual and in-person care.
• Scott Hosbin’s Background:
  • 17 years at Dexcom; experience pioneering adoption of CGM tech despite early skepticism and insurance hurdles (04:35).
  • “[When Dexcom first started]...everyone in the space was like, ‘Don’t take the job, don’t go there...But I couldn’t stop thinking, ‘What if someone really could continuously monitor glucose levels?’” – Scott Hosbin (04:38).

The Vision and Mechanics of Remote Patient Monitoring (RPM) (08:20 – 12:19)

• Who is Remote Monitoring For?

  • RPM suitability varies: Longtime T1Ds may not want oversight, but newly diagnosed or seniors see distinct benefits (07:37).

• Difference Between Data Review and Real RPM:

  • Many clinicians believe viewing CGM reports counts as RPM, but true RPM means continuous, active 24/7 oversight (08:20).
  • StrideMD operates a live platform; critical glucose alerts trigger direct outreach or EMS welfare checks if unresponsive (09:10).
  • Real-Life Impact: "We've saved a number of lives from intervening in real time...the hospital had called us and said, ‘You likely saved this woman's life. She was unconscious with a sub-30 blood sugar and she's okay now.’" – Scott Hosbin (09:55).

• Pyramid of Care Model:

  • Health coaches (MAs or nutritionists trained in diabetes), Certified Diabetes Educators, Primary Care Physicians, and Endocrinologists—each escalating in case complexity (11:16).
  • Data triaged to concentrate resources where most needed.

Telehealth: Post-Pandemic and Beyond (12:19 – 13:48)

• Enduring Role of Telehealth:

  • COVID spurred telehealth adoption; StrideMD blends in-person clinics with remote monitoring and telehealth visits for optimal efficiency.
  • Vertical integration means patients can have triage and care without unnecessary clinic travel if not needed (12:27).

• Addressing Endocrinologist Shortages:

  • RPM and telehealth can optimize appointments: stable patients use virtual visits; higher-risk cases get prioritized in-clinic (13:48).
  • “It’s not fair, it’s not right, doesn’t make any sense...let me open up a space for the endocrinologist to take the people that are at greater need.” – Scott Hosbin (14:28).

Individual Preferences & Adaptive Monitoring (16:04 – 20:10)

• Levels of Intervention:

  • Protocols balance checking in vs. patient autonomy: adjust outreach based on individual preference and risk (16:22).
  • Notable Quote: "You learn by doing. Really. It's more on the back end...monitor, don’t bother. Try to monitor the patient and really only intercede when there's true risk." – Scott Hosbin (17:54).
  • Empathy for patient experience: acknowledging some want frequent contact, while others request minimal interference (17:24).

• Medical Non-Negotiables:

  • Certain alerts (like blood sugar <55 mg/dL) trigger immediate outreach regardless of patient preference due to life-threatening risk.
  • “I'd rather you cancel the service and know that I saved someone's life than someone was happy...but then they died.” – Scott Hosbin (19:05).

Expanding and Differentiating RPM Across Populations (22:36 – 24:49)

• Scaling Challenges:

  • Doing true RPM at scale (tens of thousands of patients) requires much more than just data dashboards; needs robust staff, workflow, and intervention protocols (21:22).

• Evolving Population Needs:

  • Most current clients are seniors, but demand is growing for pediatric, adolescent, and young adult RPM programs (23:04).
  • Different age groups need individualized protocols—current solutions mainly fit older adults; future will require pediatric- and college-specific models (24:49).

Pricing, Insurance, and Systemic Value (24:49 – 28:02)

• Cost Structure:

  • Insurance coverage is broad and growing; government and most commercial plans reimburse for RPM (24:53).
  • “If you’re doing all the things you’re supposed to, you might get about $100 a patient per month...not a lot of money...for such a low amount of money relative to the system.” – Scott Hosbin (25:40).

• Patient Out-of-Pocket:

  • Most insured patients pay little to nothing; usually a standard copay ($20 or so) (25:59).
  • Some insurance gaps remain (e.g., specific plans like Florida Blue Cross/Blue Shield), but coverage is rapidly expanding (26:13).

• Additional Value Add:

  • Beyond glucose data, health coaches help with logistical and bureaucratic challenges: authorizations, supply ordering, troubleshooting device setup (27:28).
  • "There's a hundred little traps that's keeping people from getting their diabetes supplies...they would just give up." – Scott Hosbin (28:02).

What to Look for in a Remote Monitoring Provider (28:14 – 30:13)

• Quality Indicators & Cautions:
  • Not all RPMs are the same: some only scan data infrequently or lack robust clinical staff (i.e., an “intern watching Dexcom codes overnight”).
  • Questions families should ask:
    • Is anyone monitoring data 24/7 (even with a slight lag)?
    • Do you have certified diabetes educators, health coaches, endocrinologists involved?
    • Is there clear escalation for urgent or complex cases? (28:52–30:13)

Evidence and Real-World Results (30:13 – 31:58)

• Impact Studies:
  • Published research and StrideMD’s internal findings show 30% reduction in time spent in hyper/hypoglycemia, increased time-in-range.
  • Ongoing trials: e.g., post-hospital discharge study comparing CGM + RPM vs. CGM alone for readmission rates and engagement (30:28).
  • System inertia: clinical study timelines remain slow (regulatory, IRB processes).

Notable Quotes & Memorable Moments

• On the need for real-time RPM:
  “For us, real time is very important because we've saved a number of lives from intervening in real time...you likely saved this woman's life. She was unconscious with a sub-30 blood sugar.”
  – Scott Hosbin (09:55)

• On intervention vs. autonomy:
  “Some people...think this is the greatest thing ever, I want someone to touch base with me all the time. And others I'm sure, are like, please leave me the hell alone. I am fine.”
  – Stacey Simms (17:24)

• On patient experience:
  “Monitor, don’t bother...try to monitor the patient and only intercede when there’s true risk.”
  – Scott Hosbin (17:54)

• On the end goal:
  “No one should die from a hypoglycemic event. It is one of the things that truly bothers me. With all the technology… it just shouldn't happen.”
  – Scott Hosbin (19:08)

• On system reform:
  “Meanwhile, there’s someone with an A1C at 12… being told you have eight weeks before you can see this endocrinologist. It’s not fair, it’s not right, doesn’t make any sense.”
  – Scott Hosbin (14:28)

Important Timestamps

• 04:04 – What StrideMD does and Scott’s background
• 08:20 – Defining true remote patient monitoring
• 09:55 – Life-saving interventions and real-world examples
• 11:16 – The pyramid of care and workflow
• 12:27 – Telehealth’s evolution since COVID
• 13:48 – Using RPM to address endocrinologist shortages
• 17:54 – Balancing monitoring and respecting autonomy
• 23:04 – Future vision for pediatric and young adult RPM
• 24:53 – RPM costs and insurance coverage
• 28:52 – Choosing a quality RPM provider
• 30:28 – Clinical trials and measuring impact

Summary

In this forward-looking interview, Stacey Simms and Scott Hosbin dissect what makes true remote monitoring different from mere data checks, why tailored intervention (not “bothering”) is crucial, and how StrideMD’s approach saves lives in real-time. The episode candidly addresses the trade-offs of technology and autonomy, the logistical roadblocks everyday diabetes patients face, and the promise of insurance-backed remote monitoring to transform care for everyone from older adults to young patients and their families. If you’re considering RPM—whether for yourself, your child, or a loved one—this episode is packed with practical insights, policy context, and the questions you should be asking as this field rapidly evolves.