Navigating technology for People with Diabetes

Susan Weiner, MS, RDN, CDE, FAADE

Jennifer C. Smith, RD, LD, CDE

Presenter Disclosure InformationIn compliance with the accrediting board policies, the American Diabetes Association requires the following disclosure to the participants:

Name of Presenter: Susan Weiner

Advisory Panel: Clinical Advisory Board Livongo

Diabetes in Real Life Columnist, Endocrine Today

Presenter Disclosure InformationIn compliance with the accrediting board policies, the American Diabetes Association requires the following disclosure to the participants:

Name of Presenter: Jennifer Smith RD, LD, CDE

Disclosed no conflict of interest

Objectives:At the end of this presentation participants will be able to:

Discuss how apps may assist a person with diabetes with daily self-management

List 4 categories of apps which may be useful for managing diabetes

Discuss why health literacy and numeracy must be considered in app use and development

A long time ago in a galaxy far, far away…

The feeling of being dragged down by the day‐to‐day demands of diabetes.

Richard R. Rubin, Ph.D., C.D.E.

Diabetes Overwhelmus

Technology with a Conscience

How do I count this?

All those carbs?

That means a LOT of insulin!

What Makes an app Useful?? Convenience

Ease of Use

Improved Diabetes Organization

Real time

Decision support

Cost effective

Reduce diabetes burnout

Improved communication with providers and caregivers

Potential improved clinical outcomes

Improved response time

Takes the remembering out of remembering

As Diabetes Devices Change, Apps Follow

https://beyondtype1.org/the-evolution-of-diabetes-technology/

How Things have Changed!

The Evolution of Diabetes and Lifestyle Apps

Self-monitoring

Smartphones

Guiding management strategies

Provider communication

Care-giver communication

Personal empowerment

Useful Apps May Make Life Easier

Less Inner Monologue to manage

Eliminate “parts”

Seamless data management/communication

Assistance with data analysis

Alerts - quick response

How Many People with Diabetes Use Apps Today?

There’s an App for Everything Food tracking/recipe

assistance

Exercise tracking

Accuracy in Carb Counting

Dosing assistance (for those on MDI)

Data analysis – data loading from devices

BG prediction

Insulin titration

Seamless Communication

App Selection Individualized need

Data tracking

Information for accuracy

Dosing assistance

Social connection

Combination/all-inclusive

Health literacy/numeracy

Connection from App to Care Team

Livongo

mySugr

OnDuo

Welldoc Blue Star

One Drop

Livongo

mySugr

mySugr

OnDuo for Diabetes Google’s healthcare arm (Verily) and drug

manufacturer Sanofi partnered to form a new diabetes company, Onduo

Program includes:

• Access to a dedicated Care Team • Devices to track glucose and diabetes supplies at no cost to you• Simple, targeted strategies for improving your health that fit your life

The Onduo app integrates with the Apple Health app to collect step data and retrospective continuous glucose data. This data is displayed on the dashboard and history views in the Onduo app

Welldoc BlueStar Insights – smarter with each

interaction

Wisdom – Accessible, in-app diabetes education (via AADE)

Coaching – 25,000+ automated, tailored messages

Engagement – Weekly challenges to engage/prompt

Connection – SMART visit reports to share in app

One DropBluetooth-enabled glucose meter • Strips & lancets delivered to your door – low cost• Certified diabetes coaches available 24/7 • Award-winning app to track glucose, food, meds, and activity

InPen

RapidCalcDiabetes manager

Insulia

InPen.

Designed for insulin-dependent individuals 12 and older on MDI.

Dosing in 0.5 to 30 units of insulin, dialed in half-unit increments.

Compatible with Lilly Humalog® and Novo Nordisk Novolog® U-100 3.0 mL insulin cartridges and single-use detachable and disposable needles (not included).

Lasts for one year – no recharging needed

The App

The InPen app is the other half of InPen’s smart diabetes management tool.

Helps calculate your doses/ keeps track of injection data.

Paired via Bluetooth® with the smartphone app, keeps tabs on units received at last injection, time taken

Allows share therapy data with your doctor or family, and much more.

** iOS only at present

RapidCalc DM ManagerINSULIN ON BOARD TRACKING

AUTOMATIC TARGET AND RATIO SELECTION

QUICK DATA ENTRY AND DOSE SUGGESTION

BASAL DOSE RECORDING WITH REMINDERS

"PUMPING WITHOUT A PUMP"

ACTIVITY BASED DOSE ADJUSTMENT

LOG BOOK, STATS AND CHARTING

Other FEATURES:

> Choice of mmol/L or mg/dL blood glucose units> Enter Carbs in grams or portions of 10, 12 or 15g> Choice of % or mmol/mol HbA1c units> Built-in help

A Digital Therapeutic for Patients and ProvidersPeople with Diabetes (PWD) Health Care Providers

A companion app (Android or iOS):

→ Insulia automates real-time basal insulin

dosing to help PWD get to the right dose.

Every day

→ Insulia supports PWD with educational

coaching messages based on blood glucose

values

A prescription-based web portal delivers:

→ Ability to configure personalized treatment

plans based on patient’s profile,

prescription and BG targets

→ Enhanced data management to support

effective diabetes management through

remote monitoring

Insulia® is a prescription-only, FDA cleared, digital basal insulin titration device for people with type 2 diabetes and their providers

Caregivers MatterSeamless communication from any location

Dexcom Share/FollowDexcom Follow –• Allows 5 people to remotely monitor glucose data and trends

on their smart phone • Allows alerts for high/low BG to caregivers

Medtronic Guardian ConnectApp – displays Sensor glucose data, trends and alerts ** Does not integrate with Medtronic pump

Works with Sugar.IQ assistant** Provides insight into trends and factors affecting them to help with informed decisions

Caregiver Data Share* Carelink Connect – access to glucose levels and automatic text message alerts

Abbott Libre

https://www.mobihealthnews.com/content/new-fda-clearance-abbott-freestyle-libre-users-can-ditch-handheld-readers-app

Freestyle LibreLink app• Current glucose• Trend arrow• Glucose history – 8 hrs• Notes –

food/insulin/exercise/health• Share reports

So much Data!

“Think Like a Pancreas” – Gary Scheiner

Data Collection Apps Data download and analysis:

Glooko (download all pumps and Dexcom CGM)

Accessible via App for Dexcomupload

Diasend (download all pumps and Dexcom)

Accessible via app

CGM Data at Your FingertipsDexcom Clarity App:

Time in range

Data insights for pattern analysis and adjustment

Email and on-phone screen notifications

Predicted A1C – comparison of current and past data

All Inclusive Apps for Logging Tidepool

Decisions, Decisions

Self-Care Choices Key Situations

To snack?

To check again soon?

To exercise?

To adjust insulin?

Driving

Sports

Tests/Stress

Bedtime

Food Apps FigWee

Carbs&Cals

CalorieKing

MyfitnessPal

Counting Carbs

Carbohydrate Counting

Exchanges

Visual Portions

Estimation of Portions

Food Labels

Figweehttps://figwee.com/

Non-Diabetes Specific Apps

Medical ID App (ICE)

Sleep

Stress Management

Organizing

When to take meds

Lifestyle Apps Stress

Coping skills

Decision making

Exercise

Individualize App recommendations

Health Literacy and Numeracy Assess health

literacy/numeracy

Evaluate individuals

desire to use an app

Provide options based on

need

Language MattersProblematic Preferred Rationale

Diabetic (adjective)Diabetic footDiabetic educationDiabetic person

“How long have you been diabetic?”

Compliance/compliance

Non-compliant/non-compliance

Foot ulcer, infection of the footDiabetes educationPerson with diabetes

“How long have you had diabetes?”

EngagementParticipationInvolvementMedication taking

“She takes insulin whenever she can afford it.”

• Focus on the physiology or pathophysiology

• Diabetic education is incorrect (education doesn’t have diabetes)

• Put the person first• Avoid using a disease to

describe a person

• Compliance and adherence imply doing what someone else wants, i.e., taking orders about personal care as if a child. In diabetes care and education, people make choices and perform self-care/self-management.

The Use of Language in Diabetes Care and Education, Jane K. Dickinson, RN, PhD, CDE et al October 17, 2017

Speaking the Language of Health:

Healthcare is a

Human Story

What Can an App DO for me??

Is There Too Much Noise in Healthcare?

Welcome to the Future

App Evaluation

Is it appropriate/credible?

Mission Statement

DANA is a resource to enable professionals working in partnership with persons with diabetes to have access to best in class information about diabetes technology.

Our goal is to empower collaborative decision making in the care and management of people with diabetes, leading to positive health outcomes.

DANA The Diabetes Advanced Network

Access Website

Take Aways: Respect a person’s individual needs

Do your homework – explore available Apps

Explore Devices– play with Apps

Interpret and use data analysis in the Apps

Use person centered language

Consider health literacy

“People don’t always remember what you say or even what you do, but they always remember how you made them feel.”

- Maya Angelou

Questions?

References www.companionmedical.com - InPen

www.myOmnipod.com

www.medtronicdiabetes.com

www.mySugr.com

www.dexcom.com

www.tandemdiabetes.com

ADA Standards of Care 2019 -https://www.professional.diabetes.org/content-page/practice-guidelines-resources

www.itunes.com

https://play.google.com/store

www.diatribe.com

Resources DANA – www.danatech.org

App Stores

iTunes, GooglePlay

ADA – www.diabetes.org

AADE- www.diabeteseducator.org

Contact

Susan Weiner Nutrition, PLLC Jennifer C. Smith, RD, LD, CDE

susan@susanweinernutrition.com Jennifer@integrateddiabetes.com