January 1, 2016

Getting the Most Out of Our Meters and CGMs

Integrated diabetes management [IDM] requires programs that must be willing to listen to patients, but learn from them as well.

Some would argue that this is why integrated diabetes management is needed, as it not only collects and transmits data, but it provides for an easy interaction between the patient and their healthcare team. It is the healthcare team that is doing all the date analytics and all that the patients need to do is collect the data. This focus on data can actually make a patient tune out even when they are getting good advice. This should not happen under any circumstance.

The Livongo and TelCare meters are two of many that transmit data to the cloud and also sends messages to the patient on their meter. Now in theory these messages are meant to help the patient better manage their diabetes. Yet these constant messages can also be annoying. What both systems lack is a sense of balance and perspective. Solid diabetes management is a marathon and not a sprint. And as any marathon runner can attest, races are filled with multiple variables. For some, the goal is to finish with a certain time. For other runners, the goal is merely to cross the finish line. The same is true for managing diabetes. For some, the goal is to keep their glucose levels in a tight range, while for others it’s just achieving an HbA1c of 7 or below. What’s lacking in most of the IDM programs we have seen is understanding these different patient perspectives and understanding that diabetes management is not one size fits all.

The survey did not cover this, but one reason patients don't download or review this data regularly is that for the majority of patients, managing their diabetes is just one more thing they must do each day. That, as we have said countless times, the vast majority of patients want to live their lives with diabetes, not for their diabetes.

Most patients want diabetes management to fit into their life, not run their lives. If IDM is ever to take hold, the approach must be more nuanced, more patient.
The fact is most of these programs, instead of learning from the patient, make assumptions about the patient. Perhaps the biggest assumption they make is that these patients actually care what their A1c is, that they want to do all the work to achieve good outcomes. While we wish this was true, sadly for the vast majority of patients, this just isn’t true, not even close.

IDM will only be impactful if it works with the patient as a partner, not as a dictator. It should understand the demands of diabetes management and it must learn from the patient before offering advice. For IDM to be truly impactful, it must not be a one size fits all approach. This will just cause patients to tune out. Yes, there is hope for IDM, but this hope only goes as far as IDM programs being willing to not just listen to the patient, but learn from them as well.

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