Digital coaching for diabetes management

When you live with a chronic condition, you learn to expect the unexpected. Specific to diabetes management, I’ve recognized there are certain variables I can control like diet and exercise whereas others that I can’t as well like stress and mood. It’s a never ending rollercoaster.

As diabetes management is complex and influenced by factors both in and outside of my control that could benefit from real-time support, the advent of digital health coaching has been an exciting development I’m following closely for the last couple of years.

While there are several ‘coaching’ tools on the marketplace today that support patients/consumers with achieving individual diet, exercise, sleep and general health and wellness goals, I’ve been surprised and disappointed by the lack of coaching programs that support patients/consumers with disease management. And with the solutions on the market, there seems to be a lesser focus on dmanagement and more around prevention.

The diabetes management focused programs I have come across like Livongo and WellDoc’s BlueStar, while promising, both require a prescription to use.

And on the prevention side, Omada is arguably the best known for its online coaching program for diabetes prevention. With nearly 86 million pre-diabetic adults in the US alone, many of which may also be at risk of heart disease, stroke, as well as onset of full-on diabetes, they’re focused on early intervention to improve health outcomes and ultimately prevent the onset of costly and chronic conditions.

While I fully support Omada’s model and most definitely see value in intervening and engaging with at-risk/pre-diabetics to help change behavior and avoid onset of diabetes, I would argue that prevention is not enough as the estimated cost of diagnosed diabetes has drastically increased over the last five years.

According to the American Diabetes Association, an average $13,700 is spent each year on individual patients with diabetes in the US. This translates to a total cost of care for patients diagnosed/living with diabetes at over $250 billion a year. Wow.

Opportunity

In my exhaustive search on coaching programs for diabetes (both digital and in-person), I came across an ambitious study led by the NHS called the Diabetes Digital Coach Test Bed that has brought together a diverse group of health stakeholders to experiment and evaluate different ‘innovative’ approaches and technologies to see what has the greatest impact on diabetes management. The study, setup as a longitudinal research effort, makes health coaches and different mobile self-management tools and connected monitoring devices available to Type 1 and Type 2 patients so they can ‘do the right thing at the right time’ to manage their diabetes. This is great!

As a patient living with Type 1 with an interest in digital coaching programs, I’m really excited about the NHS study’s aims and end results. We definitely need more evidence/support on coaching’s effectiveness, and also more insight on patient needs and preferences around digital coaching products and services so we can design and develop better solutions that deliver better health outcomes, as well as engage and excite.

Diabetes and dating

Dating and Diabetes

As a single woman with T1D, my foray into dating has been an interesting experience and one I’m inspired to write about from a tech perspective related to gaps in decision support for diabetes management.

While there are many ways to meet and connect with prospective dates, the easiest way for me has been through online dating apps. Bumble, Tinder and yes Tinder on occasion are my main resources. Although hesitant at first, I took advantage of the profile sections of these apps to identify myself as T1D with health and fitness as a top priority. In so doing, I’ve been able (for the most part) to avoid dates with men who’ve never stepped foot in a gym, think ketchup is a vegetable, and don’t know about T1D.

As a smart, driven and attractive woman, I don’t have trouble getting dates but do struggle immensely with managing my blood sugar while on a date.

Drinking

Over the last couple of weeks, I went on four first dates that involved ordering a drink.

The first date was with a mechanical engineer who works in the diabetes space makes his own beer. The second date was a sommelier with a deep love and knowledge of Italian wine. The third was a general manager with an appreciation for wine, beer and a good old fashioned. And the fourth was with a semi-pro soccer player who enjoys light beer and mo-town.

Like most first dates, all four started with small talk and ordering a drink of choice. For me, this meant choosing a drink – wine, beer or cocktail – followed by determining the total carbs per drink and amount of insulin to take. My decision tree didn’t stop here, however, in that I then had to figure out when and where to take insulin without freaking out my date.

Guidelines

My experience of calculating insulin per drink in the dark really opened my eyes to the complexities of diabetes management and also made me curious why there aren’t resources that provide diabetics with the decision support they need in social contexts like dating.

While there are clinical guidelines for ‘safe drinking’ with diabetes, I do not have an interface for quick, real-time guidance when ordering a drink. In fact, most diabetes management resources omit alcohol/drinking guidelines and carb information all together. A taboo topic perhaps?

While the American Diabetes Association does provide some guidelines on ‘safe drinking’ with diabetes online, the guidelines are too general.

• If you have diabetes, practice caution when drinking. Do not drink on an empty stomach or when your blood glucose is low.
• Do not omit food from your regular meal plan and replace it with alcohol. (If you use carbohydrate counting to plan meals, do not count alcohol in your plan as a carbohydrate choice.)
• Wear an I.D. that notes you have diabetes.
• Sip your drink slowly to savor it and make it last.
• Have a zero calorie beverage by your side to keep yourself hydrated like water, diet soda or iced tea.
• Try a light beer or wine spritzer made with wine, ice cubes and club soda. Watch out for heavy craft beers, which can have twice the alcohol and calories as a light beer.
• For mixed drinks, choose calorie-free drink mixers like diet soda, club soda, diet tonic water or water.
• Do not drive or plan to drive for several hours after you drink alcohol.

While great to have these ‘general’ guidelines, there is nothing that tells me how many carbs are in a glass of cabernet versus a hefeweizen versus an old fashioned…why not?

Resources

While there are countless food apps, http://www.redbookmag.com/body/healthy-eating/advice/g614/lose-weight-apps-tools/?slide=9, that allow you to track your food intake and provide details on total daily carb, calorie and nutritional content, I’ve yet to find a food and or diabetes resource that allows you to add a drink to your daily ‘health’ story.

I’m certainly not promoting drinking as part of a healthy diet but I do think it’s important that food and or diabetes resources give consumers a way to be honest about their intake while also holding them accountable for meeting their individual health goals.

In doing some research to see if ANY tools were available for drinking with diabetes, I came across 1 obscure application that was poorly designed and felt clinically heavy from a content perspective, called Type 1 Diabetes Friend. Also, the app has only had 1,000 downloads since its launch in 2013.

I was pleased to find this app but was amazed this was the only available resource.

Food for thought

My questioning here is of course personal but as I’m not the only single person living with diabetes out there, I think there is an opportunity to develop a more user-friendly, intuitive and resourceful tool for helping people like me navigate social contexts like drinking for better diabetes management.

We can track our diet, fitness activity, who we’re with and where we’re at, but have far to go when it comes to designing honest resources that account for social contexts like dating, and provide people with the real-time support they need.

Understanding the impact of stress to get sexy back

Since my diagnosis with Type 1 twelve years ago, I’d never had an A1C above 7.0 until the end of last year when I went through a personal hell that resulted in my stress levels skyrocketing, and my blood sugar spiraling out of control.

 

As a former ballet dancer with a commitment to a healthy diet and exercise, you can imagine my shock when my doctor told me last December that my A1C was 7. 4.

The realization that a healthy diet and exercise couldn’t offset my stress and curb the spike in my blood sugar was overwhelming and incredibly humbling. I couldn’t fix this…

While there are general rules of things to avoid and adopt when it comes to diabetes management, every person’s needs are different, and have to be treated as such. One common thread, however, is the use of technology to assist patients and help reduce the burden of diabetes management. Pumps, CGMs, BGMs, health apps, health coaches, etc. are a few such tools.

For me, I needed to hack my current diabetes management routine, and explore the use of a pump or CGM to monitor my blood glucose levels, and how stress and other variables throughout the day were impacting me.

CGM

While there is an onboarding process for most when it comes to getting setup with an insulin pump and or CGM, I was fortunate to have had a friend in the medical device community who showed up with a bag of devices for me to test. No strings attached.

As I was told at my doctor’s appointment that I’d have to wait 3 months for CGM training and was about to head home for the holidays where stress levels and food consumption would be hard to control, I got lucky. And can’t even begin to imagine what other diabetics in similar situations do without available resources at critical moments in time.

While I didn’t have the proper training for onboarding, I watched YouTube videos at the airport before boarding my flight home on how to insert a CGM device into your stomach, and activate the sensor to get a real-time feed of your blood glucose readings. Imagine my dread on having to insert a foreign medical device into my body on my own for the first time…I felt sick to my stomach and didn’t trust the woman in my YouTube video.

I toughened up however and managed to inject, and get through the CGM setup process in roughly two hours time. I was amazed it took this long to get a real-time read of my blood sugar but was thankful nonetheless to have a continuous feed on my trends throughout the day.

Stress

Getting back to stress, I was away from the personal stress I’d been dealing with back in Boston so my numbers improved initially. The stress didn’t completely disappear however, so there was some up and down over the Christmas break.

I wore the sensor for 3 days until the sensor became dislodged after a long run…and while the duration of wearing the CGM was short, the data I now had on my patterns was super clear. It wasn’t the food I was eating that was impacting my blood glucose. It was the stress I’d been dealing with that was wrecking havoc on my health.

While this is a personal story, I think it’s important that we evaluate the impact of stress on our blood glucose and offer resources to patients, and empower providers, so diabetics can get through stressful events safely.

Moving forward, I will get setup with a Dexcom CGM in a few weeks (so excited!) and in the meantime, start researching diabetes technology solutions that measure the impact of stress but also intervene and provide personalized feedback to help patients cope.

Stress is anything but sexy…so there’s a lot of work to do here.

-Ashley

 

 

 

 

Sexy Tech and Diabetes

With CES underway showcasing the latest and greatest in consumer tech, it’s only appropriate to swoon and extend a thanks to companies like Apple, Amazon, Toyota, LG, Sony and even Lego for impressing us with their endlessly entertaining, innovative as well as sexy gadgets/technologies. For those of us living with diabetes and other chronic health conditions, CES is also a reminder that we haven’t achieved ‘sexy’ when it comes to diabetes and other condition management solutions from a usefulness, impact and excitement perspective, and still have a long ways to go.

Diagnosed 10 years ago with Type 1 diabetes in the deep south, I remember the shock that my life would never be the same and need for a single resource to help me manage the complexities of diabetes…Finding a good endocrinologist, counting carbs, checking my blood sugar before and after eating, taking insulin shots, avoiding sweets and making healthy food choices, navigating clunky medical devices, and talking with others (friends, coworkers, significant others, etc.) about my condition.

Today, I’m now living in Boston where I work at a design agency that’s focused on improving people’s health experiences through technology and design, and works with industry leading companies on innovative health solutions. Inspired by my personal and professional experiences with using technology, I’ve decided to start a blog to share my thoughts on the good and bad, and opportunities for improvement as it relates to diabetes solutions.

To kick things off, I’ve used a variety of different blood glucose monitors over the last ten years, but have yet to find one that is easy to use, engages me in my blood sugar readings, and integrates into my life to help me reach my health goals.

Livongo

Thanks to a friend who works at Livongo, a diabetes management company that combines the latest technology with coaching, I got setup as a ‘beta tester’ to experience their solution first hand and get some perspective on their technology and customer journey.

This opportunity came at a critical time in my life as I was dealing with a lot of personal stress that was impacting my diabetes management that resulted in my A1C going from 6.8 to 7.4. As a longtime health and fitness fanatic who grew up in a ballet company, lives for kale salads and now runs 10+miles in the snow, this was a wakeup call that kicked off an exploration of diabetes solutions to help me get back on track.

Onboarding

Just before Thanksgiving, I remember getting the Livongo welcome kit in the mail with the blood glucose monitor (BGM) and charger, test strips and instruction manual. Unlike a pump or CGM that requires in-person training for setup, the Livongo setup was seamless and required minimal information from me to get started.

It also came with a sleek black case that holds your BGM, test strips and lancets which I loved. In my experience, most diabetes cases are too big or too small with no sense of style.

After charging the BCM meter, I went through the BGM setup process using the Livongo portal to create my health profile. There were 24 questions (this was a bit much but helpful nonetheless) to capture my diabetes story, i.e. type of diabetes, date of diagnosis, general diabetes health management, target BG thresholds, and health goals. The process was pretty straightforward and simple, and immediately synced to my meter without delay.

I was also able to add friends and family to the meter so they could see how I was doing, and get notified when I had a high or low blood sugar.

Health Coaching

In addition to friends/family connections, Livongo also offers personalized health coaching. For me, this meant a text and or email from a certified nurse educator following a high or low blood glucose reading, and a real-time conversation on how to correct.

In the day and age of automated coaching/advisors, I have to say the real human connection/touchpoint was valuable and super attractive to me.

Like a therapist for your diabetes, you’re able to have an open and honest conversation with your health coach without judgement, and could fit it into my lifestyle on the go when I was out with friends, on a date, etc. This was fantastic.

Summary

Easy setup, a sleek case, and helpful feedback from live humans as opposed to robots certainly make Livongo a unique and attractive solution. I do see some opportunities for improvement however and if Livongo wanted to get to an Apple Health experience, I’d love to see an option in Livongo (and other diabetes company solutions) to pull in other data points like my fitness data (how far did I run today and how far do I have to go to achieve my health goals?), social activity (who am I with and what am I doing?), as well as mood (am I having a crappy or great day?) as these are all factors that attribute to my diabetes story and overall management.

I’m appreciative of the opportunity to try out Livongo and look forward to their evolution. I’m also curious to see what’s in store for diabetes tech at this year’s CES!

-Ashley