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Importance of Amount of Time Monitoring Diabetes


Experts discuss how the amount of time a patient spends engaging with the BGM and diabetes apps will contribute to managing their diabetes.


Elizabeth Holt, MD, FACE: How about the actual amounts of time that the patients spend on the app to show the improvements in your blood glucose metrics? Is that a reasonable amount of time to ask people to spend on their diabetes self-management?

Eden Miller, DO: It’s funny you bring that up because I look at those numbers and I’m like—that’s it? How much time do we spend on our phone? How many minutes per day? You know the little notification you get on your phone—“you spent 12% less on your phone screen time,” all these things. I thought they totally can do that. I’m just really sacrificing 1 Candy Crush episode per week for them to do. I don’t even think it’s a sacrifice…It’s minimal engagement. I’m not saying that what we want is minimal engagement, but I do not see this as a time burden. If anything, if you were to compare the amount of time it would take to log your glucose as a patient, because there are some primary care physicians out there [who are] not even downloading downloadable non-Bluetooth meters. So, imagine if you were to compare the time it takes to write on a piece of paper, to remember that piece of paper, to not lose that piece of paper, and to bring it to your appointment, versus engaging in an application at your convenience, at your level. Then on the flip side, with a prescriber, for you to be able to acquire that data in a meaningful way, that if the patient doesn’t engage, I’m not engaged. That to me is you’re in the time positive. The time savings—if you were to really compare what the conventional way of doing it is, versus the Bluetooth-connected way.

Elizabeth Holt, MD, FACE: Do you think we can use this data to understand patient engagement and empowerment? For example, the patients who were more engaged versus the patients who were less engaged.

Eden Miller, DO: That’s a very large dataset. That was the other thing. We’re used to datasets with drug trials, a couple thousand people…You’re looking at thousands of glucose metrics. One of the things I like about, both with the Bluetooth-connected SMBGs [self-monitoring of blood glucose] as well as even the streaming CGMs [continuous glucose monitors], is we’re able to peer into glycemia at a level that we weren’t aware of. A lot of hype has been around CGM. By no means, I think it’s an amazing new way of doing it, but we don’t want to abandon SMBG, as well. We just want to bring better meaning to it. This is what this application does. I’m curious to see, both for the individual and the population, what are the effects. I think you can tease out some of the data in the type 1 realm, because really, we’re like what? Self-monitoring blood glucose for type 1? How are they doing it? This data is confirmatory for those who are still in that option and that arena. Then also, the type 2 realm. Goodness gracious, we have patients who are doing minimal testing and not having much of the impact. For me, I’m curious to see some of the secondary analyses of what these could be. To my original comment, there is a modicum of engagement that I think is ideal. Each person is different and so imagine if I were to show them, “I notice that you engaged in the app a little bit more, maybe 1 time per week, and look at the improvement.” That’s always something that’s imperative, because when a patient puts out an effort or they do something, they’re hoping to get that little nugget of return that you did something. I’ve been working on my fruits and vegetables. You’re healthier. Your weight changed. One of the areas of greatest need of improvement is SMBG, because the studies show the patient, if they bring it to the office and they hand it to the prescriber, what does the prescriber do? Thanks. That took me a long time. That was a lot of effort. So, both the patient and physician need to honor those numbers and what they mean. This app helps that. Now that we’ve done the patient side, let’s look at the other side. Let’s look at the prescriber. Let’s look at those different levels in primary care to say, does this help you? Does this help you engage more with the patient? Does this help you overcome the barriers? I’ll be honest with you, patients are driving blind in the management of their disease. Prescribers are driving blind in the management of their disease. If we could open their eyes with any amount of that, they’re going to have a better journey and they’re going to have a better outcome.

Elizabeth Holt, MD, FACE: You make some really good points there, and clinical glucose monitoring is accessible and affordable to most people with diabetes. In fact, about 95% of people with diabetes who monitor their glucoses, use blood glucose monitoring to do that. So, having these tools in order to make it easier to share the data is very important. Real-world evidence like this to look at that can help us see the importance of that.

Eden Miller, DO: It’s already there. You know what I mean? It’s as if I don’t have to do anything different. That data and that ability are already there. I just need to take that next step in data viewing and inquiring. I think it’s not a hard next step to take.

Elizabeth Holt, MD, FACE: The investigators also looked at engagement in minutes per week and in people with type 2 diabetes. In the people with type 2 diabetes, even in those engaging in 10 or fewer minutes per week, they saw improvements in their blood glucose levels with hyperglycemic readings reducing by 11.1 percentage points, even with 10 or fewer minutes per week. Is that impactful?

Eden Miller, DO: Yes. I would phrase it to a patient as, “You can spend 10 minutes on your disease every week and this is the data improvement that you can have.” Oftentimes, we spend so many minutes worrying about diabetes rather than engaging in it, and this is an opportunity to even reframe that for the person to say, “Listen, I don’t want you to worry about your diabetes. I want you to engage in it. Let’s look at this application. You tell me what you’ve learned about yourself when I see you the next time.”

Elizabeth Holt, MD, FACE: I love that point. Don’t worry about it. Engage with it. Really good point to make for your patients.

Transcript edited for clarity.

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