Diabetes In Real Life

Diabetes In Real Life

Source: Healio interview
Disclosures: Klos reports being employed by Onduo a Verily company. Weiner reports serving as a clinical adviser to Livongo Health.
October 13, 2021
4 min read
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Tips for using diabetes apps in practice

Source: Healio interview
Disclosures: Klos reports being employed by Onduo a Verily company. Weiner reports serving as a clinical adviser to Livongo Health.
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Susan Weiner
Beth Klos

Susan Weiner, MS, RDN, CDN, CDCES, FADCES, talks with Beth Klos, RDN, LDN, CDCES, about the benefits of using apps for helping people with diabetes address challenges in self-management.

Weiner: How can certified diabetes care and education specialists incorporate apps and their data into counseling?

Health care professionals should educate themselves about relevant apps and help users see data as neutral information that can be used to manage their diabetes.

Klos: The technology available to measure glucose and record behaviors that influence glucose levels are powerful tools we can use to inform diabetes self-management education. They can give us a unique window into behavior and challenges, allowing a higher degree of customization of care.

It is telling that professional organizations support people with diabetes using current technology because of the advantage it can give them managing a chronic condition. Illustrating that point is that the American Diabetes Association advises people with diabetes to explore the range of current devices that are “easier to use and less invasive.” We currently have a wide variety of tools, including apps, connected meters, continuous glucose monitors, smart insulin pens and closed-loop systems. Enabling people with diabetes to interpret their data and implement change is a natural part of the expansion of the use of diabetes technology. The Association of Diabetes Care and Education Specialists (ADCES) supports this work and supports diabetes care and education specialists in using technology to help people with diabetes optimize their outcomes.

Once a diabetes care and education specialist commits to incorporating technology into their practice, they could start by exploring any resources or integrations available in the organization where they work and reviewing their organization’s guidelines on using technology. If they are practicing independently, familiarizing themselves with the apps they are seeing in practice is a starting point.

An effective way to develop a working knowledge of apps is to review their websites or download them for firsthand experience with their features. Some apps may generate reports, or the data can be reviewed when meeting with the person with diabetes. If the data are housed in a portal, creating a clinic account may be the first step in accessing the data.

When reviewing CGM, one useful resource is the Ambulatory Glucose Profile (AGP) report, which has had years to mature. It is currently in version 4 and generated from at least 7 days of CGM data. Analytics on that amount of glucose data create many possibilities to collaborate with the user.

Weiner: What skills are easily transferable to working with tracking data from technology?

Klos: Our existing skill set in collaborating with and guiding people with diabetes in managing their condition makes using technology and data a natural fit. Like having more pieces of a puzzle, more data helps us assess patterns more accurately. That clearer picture leads to more targeted assessments and customized starting points for conversations with people with diabetes. Their insights may reveal areas where they need more education to move forward or their challenges managing diabetes despite having a strong knowledge base.

The same essential person-centered skills that we use in other settings, such as the transtheoretical model of behavior change, patient empowerment, motivational interviewing skills, and so on, come into play to effectively support people with diabetes.

Skills in working with multi-cultural populations also transfer to different platforms. Some apps, connected meters and other products have multilingual options for the app or device. There are also products that allow the user to share glucose data with their support system, and while these are not exclusively for children, they have become indispensable for parents of children with type 1 diabetes.

Weiner: As a clinician, how do you manage the large amount of data that apps generate?

Klos: Self-education and experience are important allies. Diabetes care and education specialists new to apps and portals could start by noticing high level similarities in capabilities. These often align with the factors in the ADCES 7 Self-Care Behaviors. Then they can get to know the specific technology most commonly used by the people they see. The unique display features, settings that can be adjusted, and defaults, such as the default goals for glucose data, are some starting points. Any reports generated or weekly/monthly overviews may be the first data to review, to keep a broad perspective and focus on what is really important. When analyzing AGP report data, AGPreport.org's CGM Clinical Guide clearly articulates priorities. ADCES’s Danatech and various resources from the Academy of Nutrition and Dietetics also provide useful reviews of the tech available.

Weiner: How do you work with individuals who are frustrated by slow progress when they see their glucose data?

Klos: When someone opens up about their feelings on diabetes, it presents an opportunity to empathize and then introduce the idea of learning to be neutral about their own data — viewing it as information that can help problem solve. Research has shown that guilt and shame around diabetes are common, and the prevalence and impact of those feelings should inform these discussions. When people with diabetes express frustration, it is important to first acknowledge it and express empathy. Then, it can be helpful to identify and mention the efforts that the person with diabetes is making to help them move forward.

Logging data and using technology take effort, as do other activities they may be involved in, like going to physician appointments and picking up prescriptions. Even if they haven’t reached the glucose numbers they would like yet, diabetes care and education specialists and other clinicians can affirm their efforts, especially when they are starting new behaviors that feel unfamiliar.

For more information:

Beth Klos, RDN, LDN, CDCES, is a Clinical Care Specialist II at Onduo a Verily company (formerly Google Life Sciences). She can be reached at bethklos7@gmail.com.

Susan Weiner, MS, RDN, CDN, CDCES, FADCES, is co-author of The Complete Diabetes Organizer and Diabetes: 365 Tips for Living Well. She is the owner of Susan Weiner Nutrition PLLC and is the Endocrine Today Diabetes in Real Life column editor. She can be reached at susan@susanweinernutrition.com; Twitter: @susangweiner.