Could Shared Decision Making Regarding Technology Choices Help Address Therapeutic Inertia?
One Size Does Not Fit All
The American Diabetes Association (ADA) Standards of Medical Care in Diabetes, opens it chapter, Diabetes Technology, stating, “there is no “one-size-fits-all approach to technology use in people with diabetes”1. The ADA defines diabetes technology as the hardware, devices, and software that people with diabetes use to manage their condition, from lifestyle to blood glucose levels, and acknowledges that “the complexity and rapid change of the diabetes technology landscape can also be a barrier to patient and provider implementation”.
When coupled with education and follow up support, technology has the potential to improve the lives and health of people with diabetes and help overcome therapeutic inertia, collaborative use of the data leading to persistent, incremental adjustments in the diabetes care plan, and identifying and addressing barriers to following the care plan is critical to timely therapy optimization2.
ADA Standards Recommendation 7.1 Use of technology should be individualized based on a patient’s needs, desires, skill level, and availability of devices.
Diabetes Technology Decisions
In 2020, the Association of Diabetes Care and Education Specialists (ADCES) and Sanofi conducted a survey of 700 people on insulin therapy3,4 . The results underscore the challenges of taking insulin and the desire for more user-friendly technology choices to support insulin management.
- 62% report being too busy or forgetting to log insulin doses during the day.
- 80% would appreciate a streamlined way to assemble and display all their diabetes data.
- The majority believe having a connected device would provide several valuable benefits in diabetes care and quality of life.
The ADA standards state that there is no consensus to guide choosing which form of insulin administration is best for a given patient, and research to guide this decision-making is needed. Adoption of pump therapy in the U.S. shows geographical variations, potentially related to socioeconomic status, provider preference or center characteristics. Pump therapy is more common in individuals of higher socioeconomic status as reflected by race/ ethnicity, private health insurance, family income, and education. Individuals in disadvantaged groups often face additional barriers to optimal diabetes care and addressing the differences in access to insulin pumps and other diabetes technology may contribute to fewer health disparities1.
DiabetesWise.org is an initiative from Stanford University School of Medicine and people living with diabetes. Supported by the Leona M. and Harry B. Helmsley Charitable Trust, DiabetesWise.org has the goal of helping individuals find the right diabetes devices for their lifestyle. Individuals visiting the website are encouraged to answer a few questions to help guide them in the right direction. They can also benefit from the wisdom of patients like them who share their experiences with various technology tools. As seen in Table 1, there are multiple sides to these considerations. For example, what is convenient to one patient may not be convenient to another. It is important to uncover these details when working with patients to determine the best treatment options.
Table 1: Shared Decision Making Technology and Self-Management Matrix
The following graphics are examples with actor portrayal
A Framework for Technology-Enabled Diabetes Care and Education
The Identify-Configure-Collaborate (ICC) model has recently been adopted by ADCES as the framework for integrating any technology tool into diabetes clinical care5. ADCES is exploring if application of this framework by the diabetes care and education specialist may be useful in developing informed technology choice and optimal education and support for technology tools as a standard of care for every patient with diabetes.
Identify:
Help every patient make informed decisions regarding technology choices; recognize choices will evolve over time as the diabetes journey continues.
Configure:
Help patients get off to a strong start with their chosen technology tools by configuring tools to match their care plan; set clear expectations regarding integrating the tools into their daily diabetes self-management.
Collaborate:
Use the data on an ongoing basis in partnership with the patient to assess and incrementally optimize the care plan.
Medtronic is working to make diabetes technology available to all patients. By offering a full suite of insulin delivery and glucose monitoring technologies, Medtronic is committed to meeting patients where they are in their diabetes care and helping patients learn about their technology options as their life with diabetes evolves.
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Smart insulin pens connect to a mobile app to provide dosing calculations, reminders and CGM system integration.
1
American Diabetes Association Diabetes Technology: Standards of Medical Care in Diabetes – 2020. Diabetes Care, 2019;43(S1):S77-S88.
2
Harbison R, Hecht M, MacLeod J. Building a Data-Driven Multiple Daily Insulin Therapy Model Using Smart Insulin Pens. J Dm Science & Technol, 2020, https://doi.org/10.1777/193229682095.
3
ADCES, Sanofi: https://www.diabeteseducator.org/news-and-publications/press-releases/press-releases/2020/10/19/national-survey-reveals-people-living-with-diabetes-feel-they-are-doing-everything-they-can-to-manage-their-condition-yet-believe-more-can-be-done. Accessed 10/20/2020. (Press release).
4
ADCES, Sanofi: https://www.diabeteseducator.org/docs/default-source/practice/educator-tools/sanofi-survey-2020/adces-national-diabetes-survey-results_infographic.pdf?sfvrsn=2. Accessed 10/20/2020. (Infographic).
5
Greenwood DA, Howell F, Scher L, et a. A framework for optimizing technology-enabled diabetes and cardiometabolic care and education: the role of the diabetes care and education specialist. Diabetes Educator, 2020;46(4):323-334.