Barriers to Use of Technology in Diabetes Management

Elizabeth Holt, MD, FACE: Dr Miller, how important is technology to your patients who use blood glucose monitoring? What are some barriers to the use of technology, and how do you and your patients overcome them?

Eden Miller, DO: Thank you, Dr. Holt, for having me and discussing what’s so imperative when we talk about some of the opportunities for increased advancement in the field of diabetes. One thing technology does is level the playing field in terms of acquiring the data, analysis, and distribution. When we look at the barriers of technology, they’re vast but overcomable. A lot of it is just getting familiar. On the patient side, the first barrier is actual awareness. The awareness that there’s an integrated app with a glucose monitor. We’re already having patients monitor blood glucose. We’re already having them obtain those data. But it’s what they do with the data that helps empower them and equip health care prescribers to make changes with that data.

We always have a different level of understanding regarding technology. How do you download it? Where do you go? Do you know how to get into your app area? Do you know how to utilize the app? There are also some barriers or lack of knowledge on the prescriber side. I work with the American Diabetes Association [ADA] on overcoming therapeutic inertia. I’m on its committee. I’ve done a lot of these presentations on how to create a workflow in your clinic. How do you utilize technology so it’s a benefit, not a burden. You want something to be easier. You want something to empower the patient. That’s where our greatest advancements in diabetes are going to be—acquisition, distribution, and making meaning of the data of glucose levels.

Elizabeth Holt, MD, FACE: In your experience, has the use of blood glucose monitoring and digital systems led to improvements in your patient’s readings and range?

Eden Miller, DO: Absolutely. It’s more than just improvements. I had a patient say to me, “You can’t manage what you don’t monitor.” He said that was his foundational piece in engineering. I said, “You’re right. Not having that data makes it very hard.” At the same time, you and I remember from clinical practice when patients would bring in their glucose logbook. It was on a napkin, it had blood on it, or it was on receipts. We saw all sorts of variations. This consolidates the data and allows its transport to be done. The patient is already testing their glucose. When I get these data, it allows them to have that ownership.

I orient the patient to their data and equip them to engage with it. Make a note. Are there any things you did with your lifestyle? Were you taking your medication? Were you forgetting it? As a prescriber, you also have to prepare those patients. There’s improvement in knowing your data, but imagine the possibilities once you take it to the next level. Beyond glucose control, what about diabetes burden or distress? If we look at all the things we’re supposed to do—check your feet, drink your water, check your blood sugar, exercise—it takes hours. Anything that can lessen the burden of the things that are necessary to improve control, it is also a win for both the patient and the health care provider.

Elizabeth Holt, MD, FACE: What’s the importance of personalized guidance and support for patients with diabetes?

Eden Miller, DO: One thing that’s foundational when we work with the ADA to overcome inertia is understanding that as clinicians, we have our own inertia and need to be aware of it. But even more specific is knowing what those individual barriers are. One of the fatal flaws is that we assume we know what the troubles are for the patient. You have this assumption. We’re trying to create this plan that’s based on our opinion, not their opinion. One of the things that I do when a patient comes into the office—every time, even if I’ve known them for 20 years—I say, “Tell me one of the greatest challenges you’re facing regarding your diabetes. How can I help you overcome that or address it?” It’s 1 way we start personalization.

The other thing is that blood glucose monitoring is a personal journey. I often say it’s your little road map of all the places you visited: where you’re going, what happened, and the story surrounding it. I equip the patient to tell me that story. I’m learning their journey. Then I take those data, which are very individualized, and I make that intervention. It’s hard to make generalizations about diabetes control. We know the targets. We know those things. But it’s really that individual and all their different features: lifestyle, engagement, food choices. All those things are affected. By personalizing it, we get much better control because we’re dealing with the individual in front of us. We can bring in things that we know to be true of the disease as a whole. When you personalize it, the patient feels attended to, and their values, beliefs, and needs are addressed. That’s where we need to head so we can help equip them. Remember, this is a lifetime disease. It’s not a moment. It’s a marathon, not a sprint. Anytime we can customize it for them, they’re going to be able to go on the journey a lot easier.

Elizabeth Holt, MD, FACE: That’s a great point. Of course, the digital tools can also be personalized because they’re taking the patient’s data and presenting their own data to them. The tools can even digest the data and give them in summary so they can better understand what’s been going on.

Transcript edited for clarity