As an investor, I use three heuristics to evaluate healthcare startups.

Will the product or service…

1. Improve dramatically a patient’s experience of care?
2. Materially reduce the per patient cost of healthcare?
3. Deliver meaningful health improvements for patients?

This is no secret — the triple aim has been around for a while. At Venrock, we often see companies that meet one or two of these aims, but rarely do we see all three meaningfully achieved at the same time.

Virta Health is one of those rare companies, and it has been an incredible privilege helping their team grow and work towards a world where type 2 diabetes (T2D) reversal is a treatment accessible to everyone living with this chronic disease that may not have to be chronic anymore. With their two-year results peer-reviewed and published in Frontiers in Endocrinology, Virta is showing that even patients who have lived with T2D for years can improve their health beyond their wildest imagination and safely get off of expensive medications.

Improving the Experience of Care

One of the biggest challenges in treating T2D is that the traditional model of healthcare is at odds with the reality of living with a chronic disease. It is by definition a condition that patients live with day to day, but patients only see their physician once or twice a year.

Virta is so effective because their clinicians engage with patients every day. This gives them massively more data to inform clinical decisions and many feedback loops to help patients and clinicians figure out what works. Also, Virta’s clinical team is super specialized, unlike most endocrinologists who treat many different diseases, and solely focused on providing medical care for T2D based off of the daily data coming from patients.  

As a result, being a Virta patient is a drastically different experience. Not only does the treatment result in significantly better outcomes, but the care also teaches patients about their physiology and how to proactively manage their metabolism. This gives patients unparalleled peace of mind and confidence.

Reducing Health Care Costs for Type 2 Diabetes

T2D is expensive. The long-term complications of heart attacks, kidney failure, and vascular disease are budget busting for patients and health insurers.  

Beyond these increased health risks, certain classes of diabetes-specific medications are startlingly high cost as well. The cost of insulin has recently been in the news for its skyrocketing price over the last 15 years. Insulin is not only expensive, but it also engenders risks for hypoglycemia and weight gain. This is a point that is often overlooked by providers who are conditioned to cajole patients at every visit to carefully titrate insulin: prescription medications often have side effects that alleviate a set of symptoms at the expense of others.  

For example, SGLT2 Inhibitors, a newer class of oral medications for T2D, have a bunch of side effects like kidney failure, hypotension, increased cholesterol levels, and increased risk of developing bladder cancer. It would be far better and more cost effective if we manage T2D without relying on these medications. With Virta, patients lower their glycated hemoglobin (HbA1c) and eliminate medications at the same time.

Amazingly, Virta trial patients were able to discontinue 67 percent of their starting diabetes-specific prescriptions at two years. In addition, 91 percent of patients who began on insulin were able to reduce or eliminate their dosage, and the average daily dosage of insulin for this group of patients went from 81.9 to 15.5 units per day. The average annual medication costs for this group of patients on insulin dropped by more than 50 percent between baseline and two years.

Meaningful, Long-Term Health Improvements for Patients

When Virta’s 10 week results published in JMIR Diabetes, I wrote about the rapid improvements demonstrated by patients who opted into the treatment. Ninety percent of patients who began the trial taking insulin were able to reduce or eliminate their dosage and 48 percent of patients met the definition for diabetes reversal.

While early conversations with trial patients made us confident that they would be able to stick with the treatment, it still needed to be proven that Virta could succeed at demonstrating long-term therapeutic benefit.

With one-year results published in Diabetes Therapy and now two-year results in Frontiers in Endocrinology, Virta proves that their initial results are lasting. The vast majority of patients stick with it, and Virta is consistently able to deliver long-term, clinically significant improvements in health outcomes related to T2D, avert complications, and save thousands of dollars per patient.

Specifically, of patients who completed two years 55 percent were able to reduce their HbA1c below 6.5 percent (the threshold for T2D diagnosis) without diabetes-specific medications, and 34 percent within that subset of patients were able to achieve partial or complete diabetes remission.

With standard T2D care, the rate of partial remission is approximately 2.4 percent, and it is known that patients who have had T2D longer are less likely to achieve remission. Virta crushes this metric even with a harder to treat population. At the start of the trial, Virta patients had lived 8.4 years on average with a T2D diagnosis. Given this context, the fact that such a substantial percentage of patients were able to put their disease in remission is remarkable.

In addition to T2D, Virta patients demonstrated significant improvement in markers of related to other chronic diseases, including cardiovascular disease risk factors as well as markers of non-alcoholic fatty liver disease. Virta’s treatment is improving metabolic health and the benefits of it are being felt by multiple systems in the body.

Looking Ahead

What Virta has been able to achieve for patients, payers, and providers is extraordinary. Virta is giving hope and better health to thousands of patients with T2D. The Virta treatment is scalable, safe, effective and totally personalized for all types of patients and lifestyles. Having doctors, diabetes educators, social workers, dieticians and coaches work with patients daily works much better than the once or twice a year status quo. Our team could not be more excited to work with Virta, and we look forward to continuing to help them improve the lives of patients for years to come.

To read more about Virta’s recent two-year results, see remarks from Sami Inkininen, Co-Founder and CEO of Virta, here.