Nutrition411: The Podcast, Ep. 25

Emerging Technology in the Management of Patients With Diabetes

Lisa Jones, MA, RDN, LDN, FAND

This podcast series aims to highlight the science, psychology, and strategies behind the practice of dietetics. Moderator, Lisa Jones, MA, RDN, LDN, FAND, interviews prominent dietitians and health professionals to help our community think differently about food and nutrition.

In this episode, Lisa Jones interviews Jennifer Smith, RD, LD, CDCES, and Susan Weiner, MS, RDN, CDN, CDCES, FADCES, about emerging technological advances shaping the management of patients with diabetes, educating clients or patients, and meeting their diabetes care needs using technology. This is episode 2 of a 4-part series.

Additional Resources:

Listen to part 1 of this 4-part podcast here. 

Listen to part 3 of this 4-part podcast here.

 

TRANSCRIPTION:

Narrator:

Hello and welcome to Nutrition 411 The Podcast, a special podcast series led by registered dietician and nutritionist Lisa Jung. The views of the speakers are their own and do not reflect the views of their respective institutions or Consultant360.

Lisa Jones:

Hello and welcome to Nutrition 411, the podcast where we communicate the information that you need to know now about the science, psychology, and strategies behind the practice of dietetics. Today's podcast is part of a series of short episodes on diabetes technology featuring a Q&A with Jennifer Smith and Susan Weiner.

I want to introduce Jennifer first. Jennifer holds a bachelor's degree in Human Nutrition and Biology from the University of Wisconsin Green Bay. She is a registered and licensed dietician, certified diabetes educator, and certified trainer on most makes and models of insulin pumps and continuous glucose monitoring systems. She's an active member of the American Diabetes Association, and American Association of Diabetes Educators, and was an active member and educator for Team Wild, which means we inspire life with diabetes. She is a contributing author for the Diabetes Sisters website.

For the past 10 years, Jennifer has been the Director of Lifestyle and Nutrition with Integrated Diabetes Services. Jennifer has also lived with type 1 diabetes since she was a child, so she has firsthand knowledge of the day-to-day events that affect diabetes management. Welcome, Jennifer.

Jennifer Smith:

Thank you. It's wonderful to be here.

Lisa Jones:

Yeah. Thank you for being here.

Jennifer Smith:

Of course.

Lisa Jones:

And now I want to introduce Susan. Susan is an award-winning nutrition, health, and diabetes expert and the owner of Susan Weiner Nutrition. Susan served as the 2015 ADCES Diabetes Educator of the Year and is an ADCES fellow. Susan is the Diabetes in Real Life columnist for Endocrine Today and is the on-air host for video interviews and content for helio.com. She is the co-author of The Complete Diabetes Organizer: Your Guide To Less Stressful and More Manageable Diabetes Life, and Diabetes: 365 Tips for Living Well. She has extensive TV, radio, podcast, and video experience and is well-versed in media communications. Welcome, Susan.

Susan Weiner:

Thank you so much, Lisa. It's great to be here.

Lisa Jones:

Welcome to episode two where we will be talking about a deep dive into emerging technological advances. Jennifer, if you had to sum up the conversation that we just had in one or two sentences in our last episode, what do you think the key takeaways would be for that episode, where we talked all about apps?

Jennifer Smith:

Yeah. I think honestly individualize per the person's need and in the ability to personalize, you have to actually get to know the person that you're working with. And I understand that that can be difficult with timeframes that you have to fall within a 20-minute or a 30-minute or a 45-minute visit, there's only so much that you can get to, but once you really get to know the person that you're working with, you'll get a sense of the person's internal feelings about how to navigate life with diabetes, what they're really thinking about on a day-to-day basis. And that may help you then individualize the app to recommend for their benefit.

Lisa Jones:

Yeah, it's all about individualization.

Jennifer Smith:

Yes.

Lisa Jones:

That is great. Susan, how about you? What are your thoughts?

Susan Weiner:

Going back to the person-centered approach to care and the person with the lived experience is best to say what is really best for them at this point on their diabetes journey. And diabetes apps bring with them a number of benefits as Jenny and I discussed, such as reducing friction for gathering health data and providing decision support, remembering how much time and how many hours are spent in diabetes, and how little time is spent with clinicians and the healthcare team. So the apps can drive personal engagement and enhanced care with more collaboration between the person with diabetes and the diabetes care and education specialist as well as the registered dietician. But if there is a point that health literacy, numeracy or just being generally overwhelmed, changes for the person along their journey with diabetes, app and technology recommendations, in general, should change as well.

And I wanted to add one more thing and we could expand on it in a further discussion. There were two sites that I wanted to recommend to everyone today to check out. One is called Danatech, and that is now free through the ADCES, the Association of Diabetes Care and Education Specialist website, everything you need or want to know about all aspects of technology, don't do it yourself. It's all there. And the second one is called Diabetes Wise, which comes out of Stanford and also has a portal for providers, free to use, on new diabetes applications as well as devices and for people who are living with diabetes. So Diabetes Wise and Danatech are great way to keep up with everything. Lisa, as you pointed out, there's a lot to keep up with.

Lisa Jones:

Yes, you are not kidding. I feel like it could be like a full-time job trying to learn all these things. And I like the key takeaway of the apps drive engagement and collaboration. That is so true. So thank you for that. And then I look forward to our discussion because now we're going to be talking about how our emerging technological advances shape the management and treatment of diabetes. So what are your thoughts on that, Susan?

Jennifer Smith:

So I think that technology is moving at a very quick pace and people who are adopters of technology are going with that. More people with type one diabetes and I should say people with type two diabetes, especially those who are on insulin or are on multiple medications. And we're seeing advances in terms of new approvals of insulin pumps, automated insulin delivery systems, and helping with calculations in ways with technology that used to be done with pen and paper. So managing that from a personal standpoint of the person with the lived experience, again, can be very overwhelming. And as a dietician and as a diabetes care and education specialist, I always take a step back and ask the person with diabetes, to tell me about their diabetes. No one asks them that. Tell me about your journey with diabetes. That open-ended question will help us understand where they are on adopting the technology.

And there is a very big factor of diabetes, distress, and diabetes burnout separate from anxiety and depression that people can have in regular life. But in addition to that diabetes distress and burnout that people often feel, not only from the diagnosis itself of diabetes and any complications, physical and mental complications that can come along with that but having to always be on, as Jenny said before. It does not take a holiday. It does not take time off.

So I think I always look at where a person is now and take the time to find out, hey, I'm assuming that this person, because they've had diabetes for seven years, knows how to carb count, or they can do a correction bolus or they understand how to read a food label. That may or may not be the case, or somebody may have shut down in their care to the point that they're not ready right now to take on new technologies.

Lisa Jones:

I love that question that you said, Susan, tell me about your diabetes. I can't even count on my hand the last time I was at a practitioner when they asked me about the reason why I was there, they just start asking my symptoms or something, but they don't say, tell me about it. That's fantastic. That's great.

Susan Weiner:

Yeah, Lisa, we are programmed as dieticians and as clinicians to be fixers. We want to fix a problem and that causes us sometimes [inaudible 00:09:12] we are trying to do good things, provide too much education and too much information at once without listening. So that's an issue that we all have to work on is reflective listening and that very active listening.

Lisa Jones:

Active listening, yes, that's the way to go. And that question couldn't be better. So yes, I want to hear from Jennifer. What are your thoughts on this?

Jennifer Smith:

Absolutely. There are, as you said before, Susan, so many apps, and with emerging technology, it is moving at a very rapid pace. I have had type one for over 35 years and the speed of development has really picked up in the past five years. There was not very much development outside of maybe a smaller meter and a better way to stick your finger when I had my first 25 years with diabetes. But in the past five to 10 years, the development of technology to be better and to be more helpful and to dose more accurate, it's there. But again, going back to much of what Susan said we have to know when the technology is going to fit the person's needs. They may be at a baseline that says, okay, we could start with technology like a smart insulin pen. Maybe they're not ready yet for where we want them to be.

Again, that's our perception of what they could need and could benefit from. That's not necessarily meeting where they are right now. So we may need to, again, start at the bottom level or the bottom rung, and we may need to step up slowly with somebody. And to do that, again, we really need to identify where are they. Now, if somebody comes to you with really great questions, hey, I've looked into this or I've seen this advertised, do you think this could help me more? That's the point of education that then, as long as we know enough, we can bring up this is what this could do, this is what this would mean. This is the education path that we would need to go down in order to get you able to use this type of product.

Because again, we've got a lot of smart technology from data collection systems to insulin delivery systems to, again, glucose monitoring with continuous glucose monitors and insulin pumps that are now "smart pumps." They work with an algorithm that actually adjusts insulin delivery up and down based on a CGM value. But if the person doesn't have a basic of knowing how to count carbs as precisely as possible, then the best technology may not serve them.

Lisa Jones:

Yeah, so that makes total sense too. And it also makes me think of you managing and the treatment of diabetes, but you're also probably managing disinformation as well. If you want to speak to how much that comes up, is it every time, or how frequently do you see that, that you're having to correct misinformation?

Jennifer Smith:

I think it is, on a percent, maybe 40 or 50% of the time. So a fair enough amount honestly, where somebody's heard something from somebody from somebody else, and we have to address this system isn't as smart as you think it is. I think everybody with diabetes has also had my personal I've had somebody come up and oh, it's so great that you have that insulin pump now. That must mean that you don't have to do very much. These are common comments, and this is the general public who is not very well-informed about diabetes nor the difference in types of diabetes, or what true technology can and can't do today. So then somebody with diabetes may come in having heard from their neighbor, why don't you get that newest, such and such device? It looks like you don't have to do very much anymore.

And so these are some of the things that we have to reeducate on. I think the other type of reeducation that ends up happening is with somebody who has started to search for more information and we have to clear up what they learned 10, 15, 20, or 30 years ago, that might be still what they're relying on in terms of information. And because we've had such a shift in how to manage diabetes now because of new products, new medications, and new technology, they may still be using old information that has to be shifted in a way. It's not necessarily it's completely wrong, but we know so much more now that we can do things better.

Lisa Jones:

Yes, and as an educator, that kind of goes back to what we were talking about in the earlier segment is you have to constantly keep up with all this information.

Jennifer Smith:

Correct.

Lisa Jones:

So that's compounding it. And then I'm curious what your thoughts are on this, Susan.

Susan Weiner:

Correcting misinformation I'm very careful with because it's like someone coming in and you say, you shouldn't feel that way. That's how they feel about something or that's the way they're perceiving something. So it goes back to me really listening to where it comes from or where it came from. Sometimes it could be from a health professional, sometimes it can be from an annoying coworker who just wants to give information. So I like to provide information that I think can help with decision-making and make sure that when we come up with a way to get past that, that it's collaborative in nature so that the person feels great in making a different decision. And I'm sure that many people that Jenny has worked with in her practice may have gone from multiple daily injections, as an example, to an insulin pump. And that's a very big change.

Or someone who is burning out on an insulin pump, which everyone is telling them is fantastic. They may take a pump break and go back to multiple daily injections. And I think that this is where we, as dieticians, again, have to really learn what all of this terminology means and be able to read reports and interpret them. And even when a person with diabetes is doing everything "as they should be doing it", life happens. There could be sick days, physical and emotional stress that affects blood sugar levels, sunburn, caffeine, lack of sleep, and many things that can affect blood glucose levels that are not just around food, physical activity, and when you take your insulin. So I'm really careful and do everything in a collaborative nature to make sure that I'm not missing anything. And I'm looking at everything from my perspective with complete and total respect for the person with the lived condition of diabetes.

Lisa Jones:

Yes. And that sounds like the perfect plan because that also goes back to what we were discussing earlier and that is to meet them where they're at. And it sounds like that's what you're doing. And then how can we improve where you currently are and move forward, making the changes necessary for success? So thank you for sharing. Any other comments about advances?

Jennifer Smith:

I guess I'd like to say, especially for those who are working with more people who are intensively managed with insulin, really do your homework on learning and understanding what our new insulin delivery devices can and cannot do. Because as you talk about clearing up misinformation, I see that there is a lot of potential social misinformation about the new devices and what they can and cannot do, and what you could expect from using them.

So from an educator's perspective, really do your homework about these new devices. And a new one was just approved, the islet, not too long ago. So from the perspective of being able to provide the best information to someone, you yourself should really know the ins and outs of these devices to be able to instruct someone from a personal level of, I believe based on what you're telling me, this product may be more the route to go versus this route. Don't get kind of just shoved into one product because that's all that your organization knows about. Really, really expand and take a look at all of them and how they work.

Lisa Jones:

Yes, that's great advice too. And then it makes me think of, I'd rather have somebody I ask them to recommend something and they tell me they don't know versus somebody that's just like, yeah, and they don't have any experience with it, but they're still like, yeah, it sounds good.

Jennifer Smith:

Right. Yes.

Lisa Jones:

You know what I mean?

Jennifer Smith:

Yes.

Lisa Jones:

Such a great point. Susan, anything else that you'd like to add on this subject?

Susan Weiner:

Yeah, in addition to echoing how Jenny just put that so eloquently, I would say don't recommend something that someone's either not eligible for or not insured for. So we can recommend a piece of great advice, but maybe it's not recommended for a specific person because they have a comorbid medical condition, comorbidity, or they're not of a certain age. Also, if their insurance won't cover it for whatever reason, and you get their hopes up and then they can't use a certain device, that does not reflect very well on your recommendation either. So be careful with that. And the other recommendation for apps is language. Most apps are written in English. Several are now in English and Spanish and some other languages, but if you are considering an app for somebody who is speaking a specific language, please make sure that that is available for them with their skillset in that language as well.

Lisa Jones:

Yes, thank you for the additional language. We haven't discussed that yet, so that's a good point to keep in mind as well with all these other wonderful discussions that we've had. So thank you both.

Jennifer Smith:

Of course.

Susan Weiner:

It was my pleasure.

Narrator:

For more diabetes technology content, visit consultant360.com.