Reality Time

Reality Time

This has been a big week for interconnected diabetes management (IDM) with two announcements that seem to indicate IDM was going mainstream. Today however comes word that while patients are using their devices to gather data, they are not analyzing or reviewing this data. According to an online survey of 155 patients with Type 1 diabetes only 31% downloaded data at least once in the past year. Or put another way almost 70% didn’t bother to download their data at all.

According to Jenise Wong, MD, PhD, of the University of California San Francisco, who reported the results at an oral session at the joint meeting of the Endocrine Society and the International Congress on Endocrinology; “We need to really equip patients with better tools and education on how to use their data.”

Now some would argue that this is why IDM is needed as it not only collects and transmits data but it provides for an easy interaction between the patient and their healthcare team. That it’s the healthcare team that’s doing all the data analytics. That all the patient needs to do is collect the data.

Yet as we noted yesterday in the real world all this data collection and analysis does not necessarily make managing diabetes any easier. That it actually adds to the demands of diabetes management. That this focus on data can actually make a patient tune out even when they are getting good advice. Here is a perfect example of what we are talking about.

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. We know this as we have used both systems and while its nice to have help too much help is annoying. What both systems lack is a sense of balance, some 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 keep their glucose levels in a tight range while for others its 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. Understanding that diabetes management is not one size fits all.

Although it was not covered in this survey we would bet that one reason patients don’t download or review this data regularly is 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. They 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. That it understands the demands of diabetes management, that it learns from the patient BEFORE offering advice. But most of all 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 so far as IDM programs being willing to not just listen to the patient but learn from them as well.