Digital Diabetes Tools: Diabetes Prevention, Care & Support

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Alicia Warnock, MD, Chief Operating Officer Stability Health

Digital Diabetes Tools: Diabetes Prevention, Care & Support

Introduction

Why Make Diabetes Digital?

Digital Diabetes Tools

How Digital Diabetes Tools Can Help Patients

How Digital Diabetes Tools Help Providers

Digital Diabetes Tools: Risks & Concerns

The Future of Digital Diabetes Tools

 

Introduction

Over the past decade, we’ve seen a steep rise in the use of supplemental digital health devices and services for a wide range of conditions. The causes are manifold: health data collection is becoming more accurate and secure, technologies are improving, and patients and healthcare providers alike increasingly favor the convenience these devices offer.

The World Health Organization (WHO) defines mobile or digital health as “medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants (PDAs), and other wireless devices.” Devices and services like these can make routine healthcare processes much more efficient for everyone involved, especially if the patient has a chronic illness that requires regular observation or intervention or has limited access to a physical medical office.

The diabetes care space has seen a significant increase in digital connectivity in recent years plus increasing use of new technologies such as predictive analytics and artificial intelligence. Some digital diabetes health tools give clinicians the ability to receive patient data in milliseconds and to administer care remotely. As with all digital tools, however, there are important factors to consider, especially when health is on the line.

Why Make Diabetes Digital?

According to the 2020 report Diabetes Digital App Technology, published by the American Diabetes Association (ADA), digital diabetes tools support people with diabetes who need to adopt either lifestyle interventions or medication adjustments in response to glucose-monitoring data. These tools can include medical devices like continuous blood glucose monitors, automated insulin pumps, and “smart” injector pens or virtual tools like mobile apps, online patient portals, and community support and education hubs.

For people with diabetes, most of their disease management takes place outside the medical office. Any type of diabetes may require regular blood tests and insulin injections (often multiple times per day), plus recommended practices like weight tracking, diet adjustments, exercise, and potentially treating other conditions that could be the result of uncontrolled disease. Since clinicians often do not have the resources or capacity to monitor a patient’s management, the patient is entrusted with their own care until their next clinic appointment — which is not always the most reliable solution, especially for a complex disease like diabetes.

Fortunately, this is where digital tools can fill the gap left between the patient and their medical team. Tools range from physical to virtual:

  • Automatic insulin pumps are programmed to administer doses on a schedule or in response to changing blood glucose levels. These tools can be particularly helpful for individuals with type 1 diabetes who are dependent upon injected insulin (since their bodies no longer have the capacity to make their own insulin).
  • Wearable continuous glucose monitors collect real-time blood glucose data without the need for needles, test strips, or the time it takes to administer a test.
  • Tracking apps can connect to these devices and upload patient data to a dedicated health coach, or a user can log their own data or health activities.
  • In some cases, devices can upload data to an AI-powered hub that can make algorithmic decisions about medical intervention or medication adjustments. It is important to point out, however, that factors like diet, exercise, and stress can have major and difficult-to-predict effects on blood glucose levels and insulin needs.

There has been an influx of AI-driven diabetes care solutions in recent years because diabetes indicators are often specific, measurable, and have agreed-upon implications. However, there is huge risk of underperformance and inaccuracy with such tools, especially if the data is not reviewed by a clinical expert who knows each patient’s situation. Too often overlooked is the fact that even the most comprehensive digital care solutions are no substitute for medical expertise when it comes to a complicated and unpredictable disease like diabetes.

If used correctly and overseen by a clinician, digital diabetes tools enable patient autonomy and better disease self-management between medical appointments.

Digital Diabetes Tools

Current digital diabetes tools can be grouped into four categories, from least to most medical intervention:

  • Online resources and education hubs without tracking capabilities or treatment recommendations. Examples include:
  • Interactive wellness trackers that provide motivation and recommendations, but do not treat or diagnose (often smartphone apps)
  • Standalone medical devices that relay information or administer medication (these may also come with a dedicated smartphone app)
    • Examples include: portable glucose meters, needle-free wearable sensors/monitors, automatic insulin pumps
  • Platforms that display, download, and/or use data from medical devices and expert review to help diagnose, prevent, monitor, or treat a condition

Related resource: Diabetes Patient Education: Management Resources & Materials

How Digital Diabetes Tools Can Help Patients

With the help of digital tools, people with diabetes can gain more power over their disease self-management. Care can also become less intimidating with automated and easy-to-use tools, which can take the guesswork out of test results or medication dosage. Patients can grow to better understand their diabetes and develop short- and long-term health goals.

When a digital monitoring tool is connected to an online portal or app, all the relevant patient data is collected and accessed in one convenient place. This information can then be shared with clinicians, guardians, or other approved healthcare proxies. Apps and platforms can also provide nutrition, exercise, and general health guidance in between doctor’s appointments, which can be especially effective if this guidance is administered or verified by a clinical expert.

While these virtual tools are accessible to anyone with a computer or a smartphone, not everyone has access to this kind of technology or feels comfortable using it. Patients can still receive remote guidance if they have access to a landline, where they can have conversations with a dedicated health coach. Integrated diabetes care services — those that incorporate digital devices, apps, and expert review — will adapt their communication modes to suit a patient’s needs.

No matter how patients access them, digital diabetes care tools can empower self-care and help improve a patient’s overall health and quality of life.

How Digital Diabetes Tools Help Providers

Digital diabetes care tools can help meet routine patient needs between doctor’s appointments, especially by tracking blood glucose data, administering insulin using properly set rules, and offering wellness guidance. When patients are supported by digital tools and use them correctly, clinicians find that patient adherence increases, which results in better treatment outcomes and fewer emergency interventions.

Related resource: Diabetes Non-compliance: Improving Patient Outcomes

If a patient’s digital tool is connected to a clinic’s electronic medical records (EMR), the clinician can easily access patient information to recommend a medication adjustment or prepare for their next appointment. However, if data is not automatically transmitted, the success of these devices is dependent on the patient’s ability to enter their data into the correct platform.

Automatic tools like insulin pumps and continuous glucose monitors can decrease the frequency or risk of hospital or emergency room visits and may even decrease the need for in-person appointments (depending on how dedicated the patient is to at-home care). This can free up a clinician’s time to see higher-risk patients who require in-person appointments.

Digital Diabetes Tools: Risks & Concerns

No matter how advanced, digital diabetes tools cannot take the place of a certified clinician. As much as these tools may support and enhance their disease self-management, patients should exercise great caution and not assume that digital tools can stand in for their diabetes care provider.

According to the previously mentioned ADA report, regulations and guidelines governing digital health tools have not kept pace with developments in technology, so there are no comprehensive standards for these tools. This is especially concerning for digital-only devices and services, such as those that are not expert-driven, those that don’t partner with a patient’s clinician, and those powered by AI. Mobile apps intended to manage health are largely unregulated unless they meet the definition of medical devices for therapeutic and/or diagnostic purposes, and data on their efficacy remains limited. Patient data security is also a major concern.

However, for integrated platforms and services built on clinical practice guidelines and powered by experts, there is very low risk for non-compliance; recommendations are peer-reviewed, and all patient guidance is verified by a certified specialist. In essence, the Stability Health solution acts as an extension of a clinician’s care and does not seek to replace a patient’s doctor. Though these digital services are not practicing medicine, the experts behind the scenes are always collaborating with a patient’s provider. This helps to fill any of the gaps in care left by a standalone, unregulated mobile app.

The Future of Digital Diabetes Tools

The COVID-19 pandemic forced many providers and patients to quickly adapt to telehealth and other digital health services — often with positive results — and it’s unlikely the trend will subside as the world opens back up. This is good news for diabetes patients with limited access to in-person appointments, and for general practitioners with limited time or opportunity for comprehensive patient and self-education.

Because recent growth in the digital healthcare space has been so rapid, many of these tools are still restricted by regulations concerning ethics and efficacy. And while digital-only solutions cannot meet the full spectrum of need (especially for complex diseases), they can provide remote or underserved populations with access to critical health guidance.

Over the next decade, we’ll likely see more growth in the telehealth space, with routine appointments increasingly taking place over phone, text, or video call. Chronic disease management will see an increasing shift to the virtual or digital space, so that patients can handle testing and monitoring from home while sending data to their clinician for review. Tools dedicated to digital diabetes care can also be adapted to other conditions or chronic illnesses, such as asthma, wound care, Crohn’s disease, or HIV. Artificial intelligence has some potential to take on more complex health management tasks, but we’re still a long way off from digital-only, algorithmic healthcare — if it’s even possible or desired.

Tools aside, we’ll continue to see faster, more efficient means of managing chronic diseases, and increasingly easier ways for clinicians and patients to access expert guidance. For example, Stability Health — an integrated digital health service — will continue to invest in their technology while ensuring they comply with clinical practice guidelines to deliver the most effective results. Soon, more patients than ever will gain access to comprehensive, truly personalized digital care tools that act as an extension of their clinicians’ care, resulting in improved outcomes and healthier patient populations.

Alicia Warnock, MD, Chief Operating Officer Stability Health
Alicia received her medical training at the Uniformed Services University of the Health Sciences and spent 12 years as a physician and officer in the U.S. Navy. While practicing as an internist, she led the design and implementation of one of the Navy’s first Patient Center Medical Homes to receive NCQA accreditation. She spent the final seven years of her active-duty service practicing endocrinology at the Walter Reed National Military Medical Center (WRNMMC) in Bethesda, Maryland, where she was the Director of Diabetes Institute from 2015 to 2019.