This month marks one year since Virta publicly launched. We’ve now shown that the Virta Treatment delivers quick and sustained type 2 diabetes reversal and significant improvements in other chronic metabolic diseases. Millions of people living with type 2 diabetes now have an effective, long-lasting and accessible alternative to the status quo of more medication, lower quality of life, and uncertainty of what the future will hold. Many have asked, how do we deliver these outstanding outcomes, and what’s behind the Virta Treatment?

First, we haven’t accomplished all of this in one year. Virta’s scientific foundation is based on decades of research and began when my co-founders, Drs. Jeff Volek and Stephen Phinney, started researching metabolic health and nutritional ketosis. Second, now our science, data science, engineering and clinical teams have taken that original work and its protocols and turned it into the Virta Treatment, a scalable and highly individualized protocol that can be delivered remotely and in most cases through a smartphone.

From the patient point of view, the Virta Treatment is very simple: it consists of careful medical supervision, medication adjustments, day-to-day support and an individualized approach to carbohydrate restriction to achieve nutritional ketosis.

However, to deliver the Virta Treatment and our results on a population level (the 99%, not just the 1%), requires a very complex protocol with nearly infinite bits of personalization. In other words, there is no set program for Virta patients. We deliver an individualized, proprietary protocol, and we achieve this personal touch by taking into account thousands of details that make each patient unique. That’s the only way to succeed at scale.

What does this mean in practice? Here are six ways in which the Virta Treatment addresses the uniqueness of each patient, each day, to achieve long-term success:

1—Pursue science, period.
Virta is rooted in scientific rigor and a dogged pursuit of understanding the drivers of insulin resistance. Our ongoing peer-reviewed clinical trial continues to add to our our founding team’s body of research, and our ability to deeply understand what may be contributing to any one patient’s metabolic health. This ensures that our decisions are always evidence-based.

2—Match the treatment to the patient’s existing lifestyle, not the other way around
We gather a large amount of contextual information upfront that can be considered at every subsequent moment of the Virta Treatment. This information is critical to each decision we make, and includes, for example:

  • Medical and surgical history, medications, and other diagnoses
  • Lifestyle, such as motivations, habits and current behaviors
  • Dietary restrictions or preferences, such as being vegetarian or gluten-free
  • Family circumstances, including food access and budget, and who makes decisions about nutrition

3—Adjust based on body’s unique response

We carefully monitor each patient’s progress over time and gather dozens of data points each day. Blood-based biomarkers, medication status, symptoms, and subjective feedback (for example, hunger level) are just some of the many examples of the data we collect daily. Based on this data we know how each patient is responding and we can adjust the Virta Treatment recommendations accordingly, near real-time.

4—Use clinical expertise and technology to extract signal from noise and deliver safe treatment
We analyze all the information coming in each day and decide whether there is a signal (vs. noise) and a reason to intervene. For example, a blood glucose reading in one context is completely normal, while in another context it requires attention. Most importantly, this combination of physician supervision and continuous monitoring of biomarkers supports our ability to deliver safe care.

5—Identify and analyze root causes for every issue encountered
If an intervention is needed, we deduce the root cause to define the optimal control. For example, we may identify that a higher than expected blood glucose reading is due to eating too much protein for dinner. Is that because of lack of understanding of the right approach? Or is it done knowingly? Or is it because there is an underlying behavior health issue? Or something else? We always try to get to the root cause.

6—Contextualize root causes to guide treatment
Before we make a recommendation to the patient, we consider context. Often, the instruction can be simple: “please reduce your long-acting insulin by X units tomorrow morning.” In other situations, two separate issues may share the same root cause but require vastly different controls based on patient context. Take the prior example of eating too much protein for dinner. In some cases we recommend focusing on portions to eat slightly less protein overall. In others we may recommend adding more fat to a meal to reach satiety sooner.

To generalize, we collect dozens of data points from each patient each day, and then decide the appropriate individualized control to keep each patient on track towards long-term metabolic health and type 2 diabetes reversal. We repeat this process thousands of times for each patient.

When all these variables and potential controls are combined, we’ll end up with millions of different permutations. What seems simple on the surface becomes a highly complex protocol that is necessary to ensure efficacy and safety, both short-term and long-term at the population level.

That is the Virta Treatment, which allows us to deliver outstanding outcomes that last.

We’ve now optimized our protocol with thousands of individuals and use data from every new patient to further improve Virta Treatment. In other words, the more patients we treat, the better results we can deliver to the next patient. It is this iterative model that allows us to deliver consistent results under constantly changing circumstances.

We’ve got a long way to go, but we’re excited about what we’ve accomplished, and we hope you are, too.

Dr. Sarah Hallberg on the one-year results of Virta’s clinical trial

19 Comments

  1. I am just curious why you have completely neglected the glucagon metabolic pathway, and only focus on insulin??

    Reply

    1. Virta Health

      Could you give us a little more clarity on this question? We’re not sure what you’re asking!

      Reply

  2. I am going to 67 in May. I hate the medication I am on. I travel a lot and I am type 2. Is there any hope for a guy like me. I would love to be involved with your group. How do I start.

    Reply

    1. Virta Health

      There’s definitely hope for you! You can fill out our application here to schedule a free consultation: https://www.virtahealth.com/apply

      Reply

  3. Kevin M. Miles March 27, 2018 at 8:28 am

    Sam,
    Congrats on making so much progress in such a short time . In the spirit of friendship and winning let me offer my unsolicited thoughts on what I have reviewed of your offering .

    Site looks like it was designed by scientists(which is good of the customer is a scientist) .

    The technical jargon leaves me feeling like I still have to solve the problem because your offering doesn’t do it for me and if I knew as much as your site things I do then maybe I can solve this myself keep doing what I’m doing .

    You need to show the product in use by someone famous that average consumers can relate to .

    Assume : Smart phone chimes with text instruction , “put down the ice cream “ , take another insulin pill/shot/, if you walk two more miles today you will be on target to reduce your insulin by x percent or to zero etc. Like having Pavlov in your phone to condition you somehow to make adjustments that can be measured and documented and obviously analyses using machine learning and AI.

    What would really be exciting is if it can tell a patient what’s working that helps( diet, exercise, impact or supplements , especially exotic supplements like C60 and Cannibis Oil. Can your tool safely and accurately show a person how to get off of insulin using a menu of options which are measured by the app with graphics that make understanding intuitive and simple ?

    Good luck on your exciting venture.

    Obviously you’ve selected one vertical market but the concept applies to many others .

    It’s disappointing that like so many other companies in the valley , you have selected a team lacking “diversity” . It doesn’t look America but it does look like the Valley! Lol.

    This is short sighted because your customer base for the first product, at least, is much more diverse than your team, and being close to customers is the way to exceed their expectations .

    I saw you have the one African American doctor but what you need is a relationship with someone like Morehouse School of Medicine and Howard University School of Medicine at the very least .

    Let me know if you’re interested in discussing how we might tweak your diversity approach so that you will not make the mistake of allowing some competing concept to best you when it counts .

    Good luck. Looks like a blockbuster if you get the distribution side covered before time/technology/new discoveries erodes any advantage you have today .

    That’s why it’s imperative you make sure your not just talking to scientists but to real like customer and the poor of people likely to produce your future customers .

    KMM

    Reply

    1. Kevin – thank you for your thoughtful feedback. There are several insights that are high on my and our list to focus on, one of which is diversity.
      Very much appreciated!
      /sami

      Reply

    2. KMM…OMG they have something that can help all people of all colors and you imply that if they aren’t diverse “enough” ( whose metric? Morehouse & Howard sounds like you don’t want real diversity, just black relationships) with their employees and relationships Virta could fail or die to lack of diversity??? How pompous!! Sounds like a shake down taken from the playbook by “Rev” Jesse Jackson.

      Reply

  4. What’s interesting is how the scientific perspective, and in-depth articles attract me to this site. And bring on Oprah or Marie Osmond as a spokesperson? Gag!

    It just goes to show how everyone is different. The Silicon Valley vibe feels very good to me, and I’m nowhere near the Valley. I’m rust-belt raised.

    Reply

  5. Please I don’t know if I can afford but my meds make me gain weight with exercise I can’t poke my fingers or my belly arms n legs no more my fibromyalgia can’t handle it and I don’t want to end up like my mom please help I keep my a1 down but when I can’t handle what the meds do I quit and it’s not good

    Reply

    1. Virta Health

      We’re sorry to hear you’re having such a difficult experience. We are currently covered by select insurance plans, but we’re working hard to make Virta available via insurance to as many people as possible. Most of our existing patients come in through their employer-sponsored health plans, and for these patients, Virta is free and a fully-covered benefit. We also offer an out of pocket option which costs about $370 per month and a patient assistance program to help cover the costs for those who qualify. You can fill out this form to apply for the patient assistance program and learn more about the treatment: https://www.virtahealth.com/apply

      Reply

      1. Is there any way to tell if my insurance covers Virta?

        Reply

        1. Virta Health

          If you apply, we can help determine if insurance will cover all or any portion of the cost. Alternatively, you can also check directly with your insurer to see if they cover Virta or can expand their coverage to include Virta.

          Reply

  6. Hi
    I am 49 years old and type 2 diabetes for 5 years. Taking medication twice a day. I am tired of this health condition and can you help me??
    Susan

    Reply

    1. Virta Health

      We’re sorry to hear you’re having such a difficult experience. You can fill out this form to apply for Virta and learn more about the treatment: https://www.virtahealth.com/apply

      Reply

  7. Kenneth MacKillop July 4, 2018 at 8:06 pm

    T2DM is usually “progressive”, involving continuing loss of beta cells and function. Diagnosis occurs at ~20% of normal beta-cell function, when insulin granulation is lost — this threshold is the same for other forms of diabetes.
    Humans only have the capacity to replace beta cells at a very slow rate.
    Virta is claiming “reversal”. I believe this claim, but the most common measure of beta-cell recovery would be an OGTT. Better would be oral “disposition index” — measurement of beta-cell function using glucose/insulin clamping.
    Are you making such measurements on your cohorts? I have seen no mention of it, but I think this would be hugely important to really understanding the “reversal” process, which requires restoration of lost insulin-secretion capacity. Complete recovery would be indicated by a normal OGTT, probably requiring a decade or more on the ketogenic diet.
    It would be valuable to quantify the RATE of recovery in a study such as Virta’s, even if only on a fraction of the overall cohort participants.
    I am a diabetic, and would volunteer myself, but have found that I am HNF1-alpha (a monogenic type).

    Reply

    1. Virta Health

      Thanks for your feedback! We define reversal as maintaining an HbA1c below 6.5%, with the elimination of all diabetic medications removed (except for metformin).

      We have more of our data and links to our published research here: https://www.virtahealth.com/research

      Reply

  8. Kenneth MacKillop July 4, 2018 at 8:36 pm

    I think the Virta team should be aware (and may already be) that T2DM is unique in its preservation of normal amino-acid stimulated insulin secretion (AASIS) at time of diagnosis and well afterward, despite severe GSIS deficiency. This is unlike T1DM and the HNF monogenic types wherein both GSIS and AASIS are deficient.
    This is why normal BG can be achieved in early T2DM using diet alone. Dietary protein alone absolutely requires use of insulin or secretagogue in other forms of diabetes for a normal postprandial response (which is flat), due to insulin-secretion deficiency and consequent portal-glucagon and HGO excess (i.e. hyperglycemia).
    Hence, I suggest this as another area of study for Virta and/or partners. It has been paid little attention since the 1970s.
    It might be useful to acquire some monogenic diabetics such as myself for study comparison to T2Ds. I estimate I have ~40% beta-cell function — there is no risk of ketoacidosis in cases like mine, and so short-term experiments (e.g. eliminating insulin or secretagogue) can be performed without safety hazards, for the most part.

    Reply

  9. I’m interested in your model of care. However, I’m curious as to why you define reversal of diabetes as a reduced a1c WITH taking Metformin. Why with Metformin? I’d like to get off all my meds including Metformin.

    Reply

    1. Virta Health

      Hi Patti! We define diabetes reversal as maintaining an HbA1c below 6.5%, with the elimination of all diabetic medications (except for metformin). We don’t mean that you must be on Metformin on Virta, just that we don’t use that as criteria for reversal.

      We do reduce or eliminate Metformin in many of our patients. We just don’t include it as part of our reversal criteria because some patients choose to stay on this medication for reasons other than blood sugar control.

      Reply

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