For Diabetes Educators, Technology at Every Turn

From the enthusiastic crowd at Sunday morning’s keynote, “Let’s Get Digital,” to an exhibit floor where device makers consumed more real estate than drug companies, there was no missing technology’s rise in diabetes management. And there’s more to come, along with policy questions, said speakers at this weekend’s annual meeting of the American Association of Diabetes Educators (AADE), held in Indianapolis, Indiana.

Digital health attracted $450 million in venture capital and continuous glucose monitoring (CGM) grabbed another $250 million in 2016, according to Christopher J. Bergstrom, MBA, an associate director at Boston Consulting Group, who offered Sunday’s keynote address. Technology’s role in both treating and preventing diabetes is crucial, notwithstanding CMS’ early decision to leave digital providers out of the 2018 launch of the Medicare Diabetes Prevention Program.

“There’s one thing I know,” he said. “Digital will be part of it. Why? There’s 84 million people with prediabetes!”

Bergstrom notes alliances have formed between startups and medical device mainstays, and between tech giants like Google’s Verily and pharmaceutical giant Sanofi. The marriage of healthcare and data will bear dividends that have yet to be fully understood.

“The new data sets are the patient-centered data sets,” he said. What can insurance companies learn about diabetes and depression from scanning 30,000 social media posts? Companies like Medtronic are asking, “How do we go beyond the pill?”

Role of Diabetes Educators

Diabetes educators are the foot soldiers who teach patients to use blood glucose meters, CGM systems, and digital tools that let patients track their personal data or share it with providers. The era of population health—and accountability for patients’ glycemic control—made for a standing-room-only crowd at Abbott’s presentation on the FreeStyle Libre Pro, which lets an educator or physician collect 2 weeks’ worth of data with no effort from the patient.

FreeStyle Libre Pro won FDA approval a month after last year’s AADE meeting, just one of many technology developments over the past year. Many educators wanted details on how to bill Medicare for Dexcom’s G5 CGM—and why CMS won’t let patients use their smartphone. And today, MannKind Corp, maker of the inhaled insulin Afrezza, announced it would be part of a clinical trial with the digital device platform One Drop evaluating its effectiveness in combination with the management tool.

Not every digital health tool can serve every purpose, but various ones on the market can:

• Track patient data, which clinicians can use to make medication adjustments
• Offer reminders to take medication
• WellDoc’s BlueStar system offers AADE’s curriculum through a smartphone
• Provide real-time feedback for patients managing their disease

Digital Health and the Triple Aim

On Sunday afternoon, Kevin Clauson, PharmD, associate professor of Lipscomb University, addressed how diabetes educators can harness the potential of digital health. As digital tools become smaller, less expensive, and better connected to health systems, they have the potential to improve self-care, deliver a better patient experience, and lower costs.

The catch, he said, is that patient data will become a commodity, and Clauson said educators must be mindful of this when their patients have opportunities to use free or low-cost options.

He reviewed more up-and-coming technological tools, many of which could improve medication adherence. Proteus Digital Health, which received attention all weekend, can include a digestible sensor in a pill, which offers the first fool-proof way of measuring adherence. Type 2 diabetes and hypertension are high on its list of target conditions.

Apple, he said, is working on another step: “middleware,” which will let health systems connect all the information from thousands of apps and wearables into usable information that can be integrated into an electronic health record. However, the questions here are not just technical. Health systems are concerned about being overwhelmed with patient data, and being held liable if they fail to act on something that lands in patient record.

As Bergstrom said in his morning talk, the ethical and policy questions will come faster than anyone realizes. The next generation of tools is at the doorstep. “There’s going to be a tipping point, right before we know it,” he said.