Accelerating Transformation to a Digital-First Diabetes Care Model

We have learned that the diabetes community is capable of deploying new care models. We have rapidly adjusted to using video visits and remotely collected diabetes device data from continuous glucose monitors, meters, and insulin pumps.

In the future, digital-first diabetes care will be the norm. While a video visit changes only the location of a synchronous doctor-patient interaction, new virtual care models will capitalize on automation and asynchronous technologies, enabling efficiencies freer from the boundaries of time, provider capacity, and geography.

We have learned that delivering compassionate, efficient, and effective diabetes care requires an entire care team—the registered dieticians, certified diabetes educators, medical assistants, healthcare navigators, pharmacists, and mental health providers. Video visit driven care with a predominant physician-only care model strips diabetes care of the richness and diversity of interactions and teamwork required.

In the future, digital-first care models must enable the full multitude of roles and skillsets of the diabetes multidisciplinary care team, facilitating handoffs from team member to team member that allow communications and coordination to flow around a patient’s needs. Patients will engage with in a hybrid model of in-person and virtual visits at a personalized frequency.

We have learned that crises exacerbate inequity. Those who lack a computer or an internet connection, or the skills to connect, may be left behind. We have learned that the current care models rely on patients to schedule appointments and come in. Those who cannot connect using a patient portal, or video visits, may end up in a perpetual cycle of being rescheduled. They may be getting delayed care or worse care.

In the future, using robust population health platforms, we will more effectively focus our attention on caring for patients at higher risk, including those on the other side of the digital divide, those not connected to closed loop technologies, or with comorbid illness and diabetes complications. Diabetes technology will be easier to understand, more affordable, and more accessible to a broad group of primary care providers, with virtual support by diabetes specialists.

We have learned that managing a clinical visit with the electronic health record, diabetes software, and a video visit interaction is disjointed and complex, and distracts from the personal interaction. In the future, these platforms will be integrated so that documentation of the care conversation is increasingly automated. We will have a streamlined process of coaching our patients to optimally use their diabetes technology, and their user experience will be enjoyable.

We have learned that the transition to virtual care unmasked weak points in our infrastructure, workflows, and traditional care delivery model. We previously overcame these shortcomings on a daily basis through manual efforts that we considered routine, but were actually taxing and even heroic. We dig through cabinets to find a cord or dongle to download a meter. We download digital data, print it out onto paper, and then scan it back into a different computer record. We manage prior auth after prior auth through fax and filling out paper forms. We send prescription after prescription, trying to figure out which insulin is covered this year at the lowest cost.

In the future, all diabetes devices will allow data to be streamed wirelessly, continuously, via a standard application programming interface (API) to any software application. All diabetes software will do the same, allowing data to go where it needs to go, with no software serving as the “final resting place” locking up a person’s diabetes data. Each person with diabetes will have a comprehensive, longitudinal diabetes care record that pulls together all of an individual’s relevant data from the electronic health record, home device data, and more. Data sharing with family members and clinics will be foolproof, and clinical access to this information will be a breeze. Prior authorizations will be electronic and automated. Decision support tools will let patients and prescribers know the cost of a prescription before it is chosen.

We have learned to remind ourselves that we must treat the person with the disease, not the disease. Amidst a global pandemic, every person with diabetes is facing not just the challenges borne by having diabetes, but the challenges faced by each individual—economic challenges, supply chain uncertainties, and social and home challenges. Those with food and financial insecurity suffer even more.

In the future, we must continue to remember that having diabetes can potentially add layers to the fears, concerns, and uncertainties that permeate all of our lives. We must continue to prioritize the humanism of treating diabetes.