Hope Warshaw, MMSc, RD, CDE, BC-ADM, though not a person with diabetes, has worked in diabetes care and education since the late 1970’s. “To say I’ve witnessed a lot of change in technology and care is an understatement,” says Warshaw. She says she vividly remembers the first glucose monitors. Portable? Not! Time consuming? Yes! We’ve come a long, long way, but when it comes to technology we always want smaller, sleeker, and speedier.
Fast-forward 35 years, Warshaw spends the bulk of her professional time consulting with diabetes and nutrition-related companies and writing books and articles for people with diabetes and their caregivers. Warshaw is the author of several best-selling books published by the American Diabetes Association including Diabetes Meal Planning Made Easy and Guide to Healthy Restaurant Eating. Learn more about Warshaw at her website. Warshaw recently joined our Scientific Advisory Board to help ensure we achieve our mission of helping people with diabetes thrive.
There are a lot people building software to help people with diabetes. Where do you feel like we are coming up short? What do we need to be focusing on that’s not getting enough attention?
Hope: Four words capture my thoughts – connectedness, stickiness, simplicity and management-enhancing. To an extent, these concepts overlap. Let me explain. Keep in mind, though I don’t use these devices several times a day, I’ve observed the marketing blitz and glitz for many devices over the years.
Connectedness: People with diabetes and caregivers who do a lot of daily monitoring are clamoring to not have to re-enter their results, whether glucose results or grams of carbohydrate, either into a device or to record on paper. That’s downright annoying! As a RD, CDE, a frustration I’ve had over the years has been the disassociation between the quantity of carbohydrate (and other nutrients) consumed and glucose results. I think back to the early (and still used) glucose monitoring booklets. They only allowed space for glucose results and medications. This essentially disassociates the impact of carbohydrate (and food in general) on resulting glucose results, particularly post eating.
Stickiness: People are often enamored with a new device, app, or technology and will use it a lot when they first get their hands, or fingertips, on it and start to use it. But what about six months, a year later? Are they still using the device…has use of it stuck and become an appendage, of sorts? What matters most in diabetes care is consistently using a device to help you manage diabetes day in, day out.
Simplicity: To achieve stickiness, noted above, a device needs to be simple to use, quick to do a test and easy to carry.
Management-enhancing: Here’s where I believe the rubber meets the road when it comes to monitoring and thus tight control. Research shows us there’s no benefit in diabetes management to test, test, test and generate lots of results if you don’t know how to or just don’t translate these results into improving care and/or you don’t have a provider who uses them. It appears that monitors (and other diabetes devices, like pumps integrated with CGM, are moving towards helping people take actions based on results to improve care. Think about the first baby steps towards an artificial pancreas with threshold suspend on a pump or the meters which give advice about insulin dosing. We have work to do in this area! I’m often disheartened that even very smart and diligent people I work with who generate lots of glucose data have never really been taught pattern management – how to see glucose patterns and use the numbers (whether from a meter or CGM) – to change medication dosing (particularly insulin). Don’t get me wrong, I well realize people with diabetes are trying to live life to the fullest and are just trying to squeeze diabetes management into their busy life.
What role does connecting people living with diabetes to each other play in improving outcomes?
Hope: From my observations (and engagement) over the last few years, as the Diabetes Online Community (DOC), has grown exponentially – A LOT. But that’s simply from listening and observing. Because social networking, and specifically social networking among people with diabetes, is still in its relative infancy, there’s not been a lot of objective research to study how this engagement can impact and improve outcomes.
There are a few bits and pieces of research, conducted in people with diabetes specifically and in people with other chronic diseases, which is starting to show that for those who regularly engage (get and give support), social networking can be advantageous. Keep in mind this is always going to be hard to measure objectively and advantageous is not just the impact on clinical measures. Quality of life matters, too!
In that case and on a purely observational level, I’m overwhelmed and heartened by the valued relationships that have been formed thru the DOC and how these connections have grown into jobs, organizations, relationships, and advocacy initiatives to improve diabetes care and technology. How can that not all be great stuff for people dealing with this really tough 24/7 disease?
How do you see technology changing the way educators support people with diabetes in the decade to come?
Hope: Ah, the crystal ball question! If there is one thing we know from research study after research study, which in my world is diabetes research with an overlap of weight control research, it’s that people need constant and continuous SUPPORT. With the notion that support is essential to positive outcomes, health care systems will be developed to dovetail our technological capabilities with systems to deliver the needed care and support.
From the vantage point of “diabetes education” or “self-management training” as it’s called today, we’ll need to break down barriers and create new successful models, many which should be virtual, of delivering the education, management support and psychological support that we know is crucial for successful outcomes. Yes, we’ll need new reimbursement models and will need to figure out payment models to deliver telehealth. I’m confident we’ll get there and I believe this will all be good for people with diabetes.