Monday, October 14, 2019

by David Kliff of the Diabetic Investor

Over the past few years there have been some tremendous technical advances for patients with diabetes. In particular, insulin using patients have some of the best tools at their disposal. Insulin pumps have gotten smarter and less of a hassle, the same goes for insulin pens which now offer connectivity. Continuous glucose monitoring systems (CGMs) are becoming the standard for glucose measurement. Perhaps the most important tool is not a device, but a software program more commonly known as an algorithm, which processes all the patient data and helps them more effectively dose their insulin.

These sophisticated algorithms not only have the ability to process information, they also are capable of learning and adjusting. Simply put the more data fed into the algorithm the better it gets.

What may come as somewhat of a surprise is that there are newer algorithms designed specifically for patients that only use long-acting insulin, either alone or in combination with oral medications. Even better these algorithms don’t require that a patient use a CGM and can be very effective using a conventional blood glucose monitor. And no they don’t require the patient consistently check their glucose levels and can be used with just one glucose test each day. The goal here is simple: help the patient more effectively dose their insulin.

To help sort through the complex maze of all the various programs available here is overview of some of the more popular programs:

Isage RX: This program supports all of the leading long acting insulin’s and requires just one glucose test per day.

Insulia®: Provides dosing recommendations and offers patient coaching.

Insulin Insights™: Allows for importing glucose data plus provides detailed reporting.

D-Nav®: Provides patient coaching along with dosing recommendations.

There are also a host of programs being offered and/or developed by all the leading insulin companies.

All of the programs offer similar features;

Smartphone apps

Physician and Patient portals

Reporting

Coaching

The key here of course is getting the patient to use the programs. Here are some tips on how to make this happen:

1. Proper positioning – as effective as these programs can be, they can and do add another step in the insulin dosing process. Therefore we’d recommend positioning these tools as an enhancement to insulin therapy helping the patient more effectively manage their diabetes.
2. Enhancing the doctor patient relationship – since all the programs share data with the physician it’s important the patient understand that these programs do not replace the physician rather helps the physician better advise the patient.
3. Baby steps – while it would be great if these tools were used each day, we would recommend phasing them in. Get the patient to try the program first but don’t make them mandatory. It’s ok if the patient doesn’t use the program every day.
4. Setting the proper expectations - data can sometimes be a doubled edge sword creating more questions than answers. This is to be expected as for the majority of patients this will be their first experience seeing this data. Some patients may be slightly overwhelmed which could cause them to stop using the program. We’d recommend explaining that just as insulin is a tool to help the patient more effectively manage their diabetes these programs are just one more tool to help in that regard.
5. Manage Expectations – while there is an extensive portfolio of clinical evidence that patients utilizing these programs achieve better outcomes these results do not happen overnight. It’s critical that the patient understand this and not expect immediate improvements in outcomes.

There is no question that advanced technology is changing the nature of the patient physician relationship. As noted previously, as effective as this technology can be it can at times seem overwhelming. Hence the reason we recommend taking a slow methodical approach when adopting new technology. Positioning the technology as an enhancement to diabetes management will help the patient feel more at ease.