There exists a gap today between the technology we use and the practices we deploy to manage diabetes. This is because in addition to regular glucose tracking, diabetes management requires effective communication between patients and their healthcare professionals. While blood glucose meters, insulin pumps and continuous glucose monitors (CGMs) have evolved to allow people with the condition to live healthier lives than ever before, the enormous amounts of inaccessible data within these tools have led to a communication breakdown between patients and their physicians. How can this be?
Widespread adoption of glucose self-tracking and the technological tools that assist in this behavior is only one part of the greater diabetes management problem. The second, and more difficult issue, is how can people with diabetes communicate the data gathered by these technologies to physicians and diabetes educators, who use it to give feedback and refine treatment plans for their patients. For too many people, there is a gap between the data gathered from blood glucose meters and insulin pumps and the accessibility of that data. The lack of accessibility leads to a communication gap that keeps diabetes measurement from becoming diabetes management, and this is what needs innovation most of all.
Where We’ve Been: Poor Management by Poor Measurement
It wasn’t until the mid-80s that blood glucose meters gave people with diabetes the ability to live relatively normal lives. Prior to this crucial turning point, health care professionals typically recommended that patients with diabetes maintain a strict regimen of food intake, exercise and insulin dosage. Patients were advised to take the same amount of insulin, eat the same foods and do the same activities daily.
Treatment plans were static and there was no need for ongoing patient/physician communication. People with diabetes didn’t have regularly scheduled appointments and were only told to contact their doctors when they were feeling sick. What’s more, with such a regimented treatment plan as standard of care, people with diabetes were not encouraged to keep a daily log of their regimen. Ultimately, a lack of actionable glucose data prevented a dynamic treatment plan, and ongoing patient/physician communication suffered. We know now that effective treatment adjustments are key to meaningful management of diabetes. In the past, neither the measurement nor management tools supported this paradigm.
This static management approach was largely the product of the measurement technologies available at the time. Blood sugar was measured through the urine, but glucose levels are only detectable in urine if they’re already too high. There was no way for someone with diabetes to detect if their blood sugar was normal or too low, and because urine takes time to gather, there was no way of measuring blood glucose levels at any given moment. The only way to prevent individuals from injecting too much insulin and lowering blood sugar too far was to keep patients’ blood sugar just high and unhealthy enough to be detectable.
Doctors and patients needed a better way to monitor blood glucose levels—and finally the blood glucose meter was born. While the first blood glucose meters were expensive, cumbersome and required large samples of blood, they gave people with diabetes the ability to understand their health in the present, and act on it in real time.
With time, meters became smaller, more precise and more widely available. These combined with better insulin and more advanced endocrinology allowed for the static and strict regimens of old to be relaxed. For the first time, people with diabetes could be flexible in their diet and activity levels, and health care teams could respond more appropriately on a case-by-case basis.
Where We Are Now: Measurement and Management Diverge
With wider adoption of blood glucose monitors, diets became more flexible and the process of tracking treatment efforts became increasingly important. For the first time, doctors began to ask people to log their blood glucose readings, insulin, diet and activity levels so they could contextualize the numbers to refine treatment approaches and give personalized feedback to patients.
The most widely used method of logging this data remains in the form of the paper logbook. The advent of personal computing in the late-90s brought with it the first digital logbooks, meter specific diabetes management software. Each meter company had an incentive to keep people using their technology exclusively, so there were no investments in a communication platform that was interoperable across meter types.
While the digital logbooks allowed physicians the ability to access this richer set of data and to better guide patient’s treatment, the meter manufacturer software served as a limiting force for physicians because the cumbersome, time-consuming nature of multiple incompatible software packages and cables from meter manufacturers.
Where We’re Going: The Collapse of the Measurement/Management Divide
The two most widely used communication platforms – paper logbooks and meter programs – each have their own disadvantages. Due to the nuisance of maintaining a logbook, people often omit important information, write incorrect numbers, are inconsistent in logging, or forget to bring it to their checkups. People using digital logbooks often fail to supplement their blood glucose readings with information gathered while away from the computer—like diet, activity and mood. Underlying both approaches is the larger issue of sporadic communication with physicians and Diabetes Educators.
Simply put, diabetes measurement technology has outpaced the communication platforms that are used to facilitate patient/physician feedback. Diabetes management solutions of the future need to collapse these technologies into a unified solution. Data around blood glucose levels, exercise, diet and medication usage needs to be gathered and communicated in a constructive way to physicians, coaches, family members and others, who can then work toward the promise of a healthy, active diabetes management plan.
How do we get there?
Take advantage of the modern technologies that are literally at our fingertips: mobile devices. For the first time, technology companies outside the diabetes device manufacturing sector are building the interoperable communication platforms. As these interoperable communication platforms become widely adopted, clinics will be able to monitor entire populations in real time. Clinics can establish diabetes care parameters and monitor individuals that are at a high risk for health problems, giving extra attention and guidance as necessary.
While it may take time for the health care industry to adapt to this change in technological landscape, there are several mobile solutions for diabetes management that are already available to consumers. Companies like Telcare, iBGStar, and Glooko have offered the diabetes community a hint at what these larger treatment paradigms might look like.
I believe this is not just the future of diabetes management, but also the future of preventative medicine. Soon measurement and management will be indistinguishable, and checkups won’t end after you leave the doctor’s office.
Holly McGarraugh was the President and Chief Executive Officer of Apieron, Inc. 2008-2010. McGarraugh has over 20 years of experience in medical devices. She joined Apieron as Vice President of Marketing in January 2008. She previously served as Vice President of worldwide marketing for in vivo products at Abbott Diabetes Care where she lead commercialization efforts, including clinical acceptance and reimbursement, for continuous glucose monitoring; a new product category. Abbott Labs formed Abbott Diabetes Care by acquiring TheraSense, a start-up where McGarraugh served as Vice President of Marketing and Professional Relations. McGarraugh served as Director of Customer Service and Marketing and Vice President of Quality Assurance and Regulatory Affairs of Lifescan Inc. (a division of Johnson & Johnson). She was an early member of Lifescan Inc. McGarraugh holds an M.Ed. in Medical education from Vanderbilt University and a BS in Dietetics from David Lipscomb University. McGarraugh is currently consulting for Medical Device companies and is an advisor to Glooko.